Review Practice Exercise 2

Pain assessment and management in children > Child Health

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Practice Exercise 2

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Total Questions : 4

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Question 1:

A nurse is preparing to administer an intramuscular injection to a 1-year-old. Which biobehavioral intervention would be most appropriate to reduce the pain?

A. Explaining the procedure in detail B. Offering a candy C. Offering a sucrose solution D. Using a guided imagery technique

Answer and Explanation

Choice A:

A 1-year-old lacks the cognitive ability to understand a detailed explanation; verbal preparation is more effective in older children.

Choice B:

Candy does not have the same analgesic effect as sucrose solution, and choking hazards make it inappropriate for a 1-year-old.

Choice C:

Sucrose given orally a few minutes before an injection has been shown to reduce pain behaviors in infants and young toddlers. It stimulates sweet taste receptors, triggering endogenous opioid release, which has a calming and analgesic effect. It is simple, quick, and safe when used appropriately.

Choice D:

Guided imagery requires cognitive and imaginative skills that a 1-year-old has not yet developed.

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Question 2:

The gold standard for pain assessment in a child who can communicate is:

A. The FLACC scale B. The child's self-report C. The parent's report D. The nurse's observation

Answer and Explanation

Choice A:

The FLACC (Face, Legs, Activity, Cry, Consolability) scale is a behavioral scale is used for children unable to self-report, such as infants or non-verbal children.

Choice B:

The child’s self-report is considered the gold standard for pain assessment if the child is developmentally able to communicate. Pain is a subjective experience, only the person feeling it can truly describe its intensity, location, and nature. Validated self-report tools for children include the Faces Pain Scale – Revised (FPS-R), the Oucher scale, and numeric rating scales (for older children).Rationale for incorrect answers:

Choice C:

The parent's report is helpful for gaining insight, especially in non-verbal children, but it’s secondary to the child’s own report when possible.

Choice D:

The nurse's observation is useful as part of a comprehensive assessment, but it’s not as accurate as self-report for children who can communicate.

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Question 3:

A 9-year-old child is receiving morphine for postoperative pain via a PCA pump. The most critical side effect to monitor for is:

A. Nausea and vomiting B. Constipation C. Itching D. Respiratory depression

Answer and Explanation

Choice A:

Nausea and vomiting are common opioid side effects but not immediately life-threatening; managed with antiemetics.

Choice B:

Constipation is a predictable long-term effect of opioids, preventable with stool softeners and laxatives; not an acute emergency.

Choice C:

Itching usually occurs due to histamine release from opioids; uncomfortable but not critical.

Choice D:

Respiratory depression is the most critical and potentially life-threatening side effect of opioid use, including morphine administered via PCA (patient-controlled analgesia). Opioids depress the brain’s respiratory center, which can reduce respiratory rate and tidal volume, leading to hypoxia.

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Question 4:

Which of the following is an example of a coanalgesic drug?

A. Ibuprofen B. Morphine C. An antidepressant D. Acetaminophen

Answer and Explanation

Choice A:

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), classified as a non-opioid analgesic, not a coanalgesic.

Choice B:

Morphine is an opioid analgesic, directly used for pain relief, not an adjuvant.

Choice C:

Coanalgesic drugs (also called adjuvant analgesics) are medications not primarily designed for pain relief but have pain-modifying properties, especially for neuropathic pain. Certain antidepressants, such as tricyclic antidepressants (e.g., amitriptyline) and SNRIs (e.g., duloxetine), can modulate pain pathways by enhancing serotonin and norepinephrine activity in the CNS.

Choice D:

Acetaminophen is a non-opioid analgesic/antipyretic; not considered a coanalgesic.

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Practice Exercise 2

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