Chapter 28: Pediatric Pain and Fever Management Garzon Maaks: Burns' Pediatric Primary Care, 7th Edition

Chapter 28: Pediatric Pain and Fever Management
Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition
MULTIPLE CHOICE
1. A 3-year-old child is recovering from injuries sustained in a motor vehicle accident. How will
the primary care pediatric nurse practitioner evaluate this child’s pain?
a. Ask the child to rate pain intensity on a 4- to 5-item pain discrimination scale.
b. Have the child describe any pain as “no pain, a little pain, or a lot of pain.”
c. Question the child about the intensity and specific location of any pain.
d. Rely on nonverbal responses such as facial expressions and limb movements.
ANS: B
Three-year-olds can describe “no pain, a little pain, or a lot of pain” but cannot use a numeric
pain rating scale or describe intensity or location of pain. Reliance on nonverbal responses is
useful for infants and toddlers who cannot describe pain.
2. A 4-year-old child has just been released from the hospital after orthopedic surgery on one leg
following a bicycle accident. The child is sitting quietly on the exam table. When asked to rate
pain, the child points to the “1” on a faces rating pain scale. What will the primary care
pediatric nurse practitioner do next?
a. Assess the child’s vital signs and ability to walk without pain.
b. Refill the prescription for a narcotic analgesic medication.
c. Suggest that the parents give acetaminophen for mild pain.
d. Teach the parent to give analgesics based on the child’s report of pain.
ANS: A
Many children underreport pain because of fears of injections or of rehospitalization and other
concerns, and reliance on self-report alone is insufficient. The PNP should evaluate other
indications of pain as well before making a clinical decision. Parents should also be taught to
assess a variety of factors when deciding when to give analgesics.
3. The primary care pediatric nurse practitioner is preparing to perform a painful procedure on a
4-month-old infant. Besides providing local anesthesia, what other pain control method
provides analgesic effects?
a. Providing toys
b. Singing or music
c. Sucrose solution
d. Swaddling or cuddling
ANS: C
A 12% sucrose solution given 2 minutes prior to a procedure will have analgesic effects for 5
to 10 minutes and is useful for infants. The other methods are distraction techniques, which
are not analgesic but help small children cope with or reduce the fear response to pain. These
are generally more useful in older children and not infants.
4. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat

phantom limb pain and reports that the medications are no longer effective. What will the
primary care pediatric nurse practitioner do?
a. Change the TCA to a selective serotonin reuptake inhibitor.
b. Evaluate the adolescent for drug-seeking behavior.
c. Increase the TCA dose and reevaluate in 2 to 3 weeks.
d. Refer the adolescent to a pain management specialist.
ANS: D
Chronic pain management can include pharmacologic and non-pharmacologic measures.
When medications are used, it is suggested that pain management specialists be consulted. An
SSRI may be prescribed, but this drug has a black box warning and shouldn’t be used unless
necessary. An adolescent with a phantom limb pain condition is not likely to be engaging in
drug-seeking behavior. TCA dosing is generally not managed in the primary setting.
5. The parent of a school-age child with a chronic pain condition tells the primary care pediatric
nurse practitioner that the child has requested to stay home from school more often in the past
few months. The child’s exam does not reveal any significant change in pathology, and a
review of the child’s medications indicates appropriate dosing of analgesic medications. What
will the nurse practitioner recommend?
a. Assessing the child’s pain every day to determine changes
b. Ensuring the child stays quiet in bed with videos when having pain
c. Having the child do homework when staying home from school
d. Requiring the child to go to school even during pain episodes
ANS: C
To promote optimal coping with chronic pain in children, parents should not give excessive
attention or special privileges when the child complains of pain and, if allowing the child to
stay home, should require quiet, low-key activities and not video games or television, which
may reinforce the child not wanting to go to school. Parents who focus on the child’s pain
only reinforce the child’s behaviors. Parents should encourage normal activities but not
necessarily require them.

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Chapter 28: Pediatric Pain and Fever Management

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

4. An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat

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