ATI PEDIATRIC EXAM TEST BANK (EVERYTHING YOU NEED ON ATI PEDIATRIC)- COMPLETE
QUESTIONS AND DETAILED SOLUTIONS LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: 102 Transdermal fentanyl (Duragesic) is being used for
an adolescent with cancer who is in hospice care. The adolescent
has been comfortable for several hours but now complains of
severe pain. The most appropriate nursing action is to:
A. Administer meperidine (Demerol) intramuscularly (IM).
B. Administer morphine sulfate immediate release (MSIR)
intravenously (IV).
C. Use a nonpharmacologic strategy.
D. Place another fentanyl patch on the adolescent.
Answer:
Administer morphine sulfate immediate release (MSIR) intravenously
(IV)
Rationale: 103 The nurse is caring postoperatively for an 8-year-old child
with multiple fractures and other trauma resulting from a motor vehicle
injury. The child is experiencing severe pain. An important consideration
in managing the child's pain is to: A. Give only an opioid analgesic at this
time. B. Increase the dosage of analgesic until the child is adequately
sedated. C. Plan a preventive schedule of pain medication around the
clock.
Question 2: D. Give the child a clock and explain when he or she
can have pain medications.
Answer:
Plan a preventive schedule of pain medication around the clock
Question 3: 104 Kyle, age 6 months, is brought to the clinic. His
parent says, "I think he hurts. He cries and rolls his head from side
to side a lot." This most likely suggests which feature of pain?
, A. a. Type
B. b. Severity
C. c. Duration
D. d. Location
Answer:
Location
Rationale: The child is displaying a local sign of pain. Rolling the head
from side to side and pulling at ears indicate pain in the ear. The child's
behavior indicates the location of the pain. The behavior does not
provide information about the type, severity, or duration. 105 Physiologic
measurements in children's pain assessment are: a. The best indicator
of pain in children of all ages. b. Essential to determine whether a child is
telling the truth about pain. c. Of most value when children also report
having pain.
Question 4: d. Of limited value as sole indicator of pain.
Answer:
Of limited value as sole indicator of pain
Rationale: Physiologic manifestations of pain may vary considerably, not
providing a consistent measure of pain. Heart rate may increase or
decrease. The same signs that may suggest fear, anxiety, or anger also
indicate pain. In chronic pain the body adapts, and these signs decrease
or stabilize. These are of limited value and must be viewed in the context
of a pain-rating scale, behavioral assessment, and parental report.
When the child states that pain exists, it does. That is the truth. 106
Nonpharmacologic strategies for pain management: a. May reduce pain
perception. b. Make pharmacologic strategies unnecessary. c. Usually
take too long to implement.
Question 5: d. Trick children into believing they do not have pain.
,Answer:
May reduce pain perception
Rationale: Nonpharmacologic techniques provide coping strategies that
may help reduce pain perception, make the pain more tolerable,
decrease anxiety, and enhance the effectiveness of analgesics.
Nonpharmacologic techniques should be learned before the pain occurs.
With severe pain it is best to use both pharmacologic and
nonpharmacologic measures for pain control. The nonpharmacologic
strategy should be matched with the child's pain severity and taught to
the child before the onset of the painful experience. Some of the
techniques may facilitate the child's experience with mild pain, but the
child will still know that discomfort is present.
Question 6: 107 Which drug is usually the best choice for
patient-controlled analgesia (PCA) for a child in the immediate
postoperative period?
A. a. Codeine
B. b. Morphine
C. c. Methadone
D. d. Meperidine
Answer:
Morphine
Rationale: The most commonly prescribed medications for PCA are
morphine, hydromorphone, and fentanyl. Parenteral use of codeine is
not recommended. Methadone is not available in parenteral form in the
United States. Meperidine is not used for continuous and extended pain
relief. 108 A lumbar puncture is needed on a school-age child. The most
appropriate action to provide analgesia during this procedure is to apply:
a. Tetracaine-adrenaline-cocaine (TAC) 15 minutes before procedure. b.
Transdermal fentanyl (Duragesic) patch immediately before procedure.
, c. Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure.
Question 7: d. EMLA 30 minutes before procedure.
Answer:
Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure
Rationale: EMLA is an effective analgesic agent when applied to the skin
60 minutes before a procedure. It eliminates or reduces the pain from
most procedures involving skin puncture. TAC provides skin anesthesia
about 15 minutes after application to nonintact skin. The gel can be
placed on the wound for suturing. Transdermal fentanyl patches are
useful for continuous pain control, not rapid pain control. For maximal
effectiveness EMLA must be applied approximately 60 minutes in
advance. 109 The nurse is caring for a child receiving intravenous (IV)
morphine for severe postoperative pain. The nurse observes a slower
respiratory rate, and the child cannot be aroused. The most appropriate
management of this child is for the nurse to: a. Administer naloxone
(Narcan). b. Discontinue IV infusion. c. Discontinue morphine until child
is fully awake.
Question 8: d. Stimulate child by calling name, shaking gently, and
asking to breathe deeply.
Answer:
Administer naloxone (Narcan)
Rationale: The management of opioid-induced respiratory depression
includes lowering the rate of infusion and stimulating the child. If the
respiratory rate is depressed and the child cannot be aroused, IV
naloxone should be administered. The child will be in pain because of
the reversal of the morphine. The morphine should be discontinued, but
naloxone is indicated if the child is unresponsive.
QUESTIONS AND DETAILED SOLUTIONS LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: 102 Transdermal fentanyl (Duragesic) is being used for
an adolescent with cancer who is in hospice care. The adolescent
has been comfortable for several hours but now complains of
severe pain. The most appropriate nursing action is to:
A. Administer meperidine (Demerol) intramuscularly (IM).
B. Administer morphine sulfate immediate release (MSIR)
intravenously (IV).
C. Use a nonpharmacologic strategy.
D. Place another fentanyl patch on the adolescent.
Answer:
Administer morphine sulfate immediate release (MSIR) intravenously
(IV)
Rationale: 103 The nurse is caring postoperatively for an 8-year-old child
with multiple fractures and other trauma resulting from a motor vehicle
injury. The child is experiencing severe pain. An important consideration
in managing the child's pain is to: A. Give only an opioid analgesic at this
time. B. Increase the dosage of analgesic until the child is adequately
sedated. C. Plan a preventive schedule of pain medication around the
clock.
Question 2: D. Give the child a clock and explain when he or she
can have pain medications.
Answer:
Plan a preventive schedule of pain medication around the clock
Question 3: 104 Kyle, age 6 months, is brought to the clinic. His
parent says, "I think he hurts. He cries and rolls his head from side
to side a lot." This most likely suggests which feature of pain?
, A. a. Type
B. b. Severity
C. c. Duration
D. d. Location
Answer:
Location
Rationale: The child is displaying a local sign of pain. Rolling the head
from side to side and pulling at ears indicate pain in the ear. The child's
behavior indicates the location of the pain. The behavior does not
provide information about the type, severity, or duration. 105 Physiologic
measurements in children's pain assessment are: a. The best indicator
of pain in children of all ages. b. Essential to determine whether a child is
telling the truth about pain. c. Of most value when children also report
having pain.
Question 4: d. Of limited value as sole indicator of pain.
Answer:
Of limited value as sole indicator of pain
Rationale: Physiologic manifestations of pain may vary considerably, not
providing a consistent measure of pain. Heart rate may increase or
decrease. The same signs that may suggest fear, anxiety, or anger also
indicate pain. In chronic pain the body adapts, and these signs decrease
or stabilize. These are of limited value and must be viewed in the context
of a pain-rating scale, behavioral assessment, and parental report.
When the child states that pain exists, it does. That is the truth. 106
Nonpharmacologic strategies for pain management: a. May reduce pain
perception. b. Make pharmacologic strategies unnecessary. c. Usually
take too long to implement.
Question 5: d. Trick children into believing they do not have pain.
,Answer:
May reduce pain perception
Rationale: Nonpharmacologic techniques provide coping strategies that
may help reduce pain perception, make the pain more tolerable,
decrease anxiety, and enhance the effectiveness of analgesics.
Nonpharmacologic techniques should be learned before the pain occurs.
With severe pain it is best to use both pharmacologic and
nonpharmacologic measures for pain control. The nonpharmacologic
strategy should be matched with the child's pain severity and taught to
the child before the onset of the painful experience. Some of the
techniques may facilitate the child's experience with mild pain, but the
child will still know that discomfort is present.
Question 6: 107 Which drug is usually the best choice for
patient-controlled analgesia (PCA) for a child in the immediate
postoperative period?
A. a. Codeine
B. b. Morphine
C. c. Methadone
D. d. Meperidine
Answer:
Morphine
Rationale: The most commonly prescribed medications for PCA are
morphine, hydromorphone, and fentanyl. Parenteral use of codeine is
not recommended. Methadone is not available in parenteral form in the
United States. Meperidine is not used for continuous and extended pain
relief. 108 A lumbar puncture is needed on a school-age child. The most
appropriate action to provide analgesia during this procedure is to apply:
a. Tetracaine-adrenaline-cocaine (TAC) 15 minutes before procedure. b.
Transdermal fentanyl (Duragesic) patch immediately before procedure.
, c. Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure.
Question 7: d. EMLA 30 minutes before procedure.
Answer:
Eutectic mixture of local anesthetics (EMLA) 1 hour before procedure
Rationale: EMLA is an effective analgesic agent when applied to the skin
60 minutes before a procedure. It eliminates or reduces the pain from
most procedures involving skin puncture. TAC provides skin anesthesia
about 15 minutes after application to nonintact skin. The gel can be
placed on the wound for suturing. Transdermal fentanyl patches are
useful for continuous pain control, not rapid pain control. For maximal
effectiveness EMLA must be applied approximately 60 minutes in
advance. 109 The nurse is caring for a child receiving intravenous (IV)
morphine for severe postoperative pain. The nurse observes a slower
respiratory rate, and the child cannot be aroused. The most appropriate
management of this child is for the nurse to: a. Administer naloxone
(Narcan). b. Discontinue IV infusion. c. Discontinue morphine until child
is fully awake.
Question 8: d. Stimulate child by calling name, shaking gently, and
asking to breathe deeply.
Answer:
Administer naloxone (Narcan)
Rationale: The management of opioid-induced respiratory depression
includes lowering the rate of infusion and stimulating the child. If the
respiratory rate is depressed and the child cannot be aroused, IV
naloxone should be administered. The child will be in pain because of
the reversal of the morphine. The morphine should be discontinued, but
naloxone is indicated if the child is unresponsive.
