An 8-year-old child, who is post-op appendectomy, is playing with a set of building blocks. The child’s pulse and blood pressure are slightly elevated above their presurgery levels. When asked what level the child would rate the postoperative pain on a numeric pain scale, the child states that the pain is “8 on a scale of 1 to 10.” The child’s primary health-care provider has ordered Tylenol (acetaminophen) and morphine sulfate for pain. Which of the following actions should the nurse perform at this time?

Report the child’s pain level to the child’s primary health-care provider.

Administer acetaminophen to the child based on the child’s behavior.

Administer morphine to the child based on the child’s rating of the pain.

Query the child about how the child is able to play with such severe pain.

Answer and Explanation

The Correct Answer is C

Pain control post-surgery refers to the strategies and treatments used to manage discomfort and promote healing after a surgical procedure. It’s a critical part of recovery that affects mobility, emotional well-being, and risk of complications.

Rationale for correct answer:

C. Administering morphine to the child based on the child’s rating of the pain is correct. The gold standard for pain assessment is the child’s self-report, as long as the child is developmentally capable of using a numeric pain scale (which an 8-year-old is). Even though the child appears to be playing, this does not negate the reported pain score. Children can sometimes distract themselves with play but still experience significant pain.

Rationale for incorrect answers:

A. Reporting the child’s pain level to the child’s primary health-care provider is not necessary at this point. The provider has already prescribed pain medications, and the nurse has the autonomy to administer them according to the child’s needs.

B. Administering acetaminophen to the child based on the child’s behavior undermines the child’s self-report. Behavior (playing) is not always a reliable indicator of pain severity. Acetaminophen alone would likely be insufficient for reported severe pain.

D. Querying the child about how the child is able to play with such severe pain could make the child feel disbelieved or dismissed. Nurses should validate, not question, the child’s reported pain level.

Take home points

Self-report is the most reliable indicator of pain in children who can use numeric or other validated pain scales.
Children may still engage in play despite experiencing significant pain.
Nurses should trust the child’s pain rating and treat accordingly.
Opioids like morphine are indicated for severe postoperative pain, while acetaminophen may be used for mild pain or as part of multimodal therapy.

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Correct Answer is C

Explanation

A tympanostomy tube placement is a minor outpatient procedure typically done in children with recurrent otitis media. Freestanding outpatient surgery centers, also known as ambulatory surgical centers (ASCs), are independent medical facilities designed specifically for same-day surgical procedures that don’t require an overnight hospital stay.

Rationale for correct answer:

C. Freestanding centers do not have the capacity for inpatient admissions. This is the major disadvantage compared to hospital-based surgery centers, as unplanned transfers delay continuity of care and increase risks in case of complications.

Rationale for incorrect answers:

A. Outpatient centers actually have lower infection risks compared to hospitals due to shorter stays and reduced exposure to hospital-acquired infections.

B. Care at outpatient centers is usually less expensive, making this an advantage rather than a disadvantage.

D. Outpatient centers allow same-day discharge, which reduces family disruption, making this incorrect.

Take-Home Points

Main disadvantage of freestanding surgery centers: inability to provide overnight care, requiring transfer if complications arise.
Outpatient centers are generally safe, cost-effective, and less disruptive for families.
Nurses should educate parents about possible transfer needs and what to expect in the rare event of complications.
Preoperative and postoperative planning should always consider the setting’s limitations.

A. Delay the dressing change until the child is finished playing in the playroom. B. Perform the dressing change in the playroom while the child finishes drawing the picture. C. Escort the child to the treatment room for the dressing change and back to the playroom once it is done. D. Ask the child whether the dressing change should be performed at that time or after the child has finished the drawing.

Correct Answer is C

Explanation

Pain is a complex sensory and emotional experience that signals actual or potential harm to the body. Pain can exist without visible injury. It’s influenced by past experiences, emotions, and environment. It is subjective hence only the person experiencing it can truly describe its intensity and impact.

Rationale for correct answer:

C. Painful or stressful procedures should not be performed in the child’s playroom or hospital bed. The playroom should remain a safe, positive environment for coping and distraction. Performing the procedure in a designated treatment room preserves the child’s sense of security and allows the playroom to remain associated with fun and comfort. Escorting the child back afterward helps re-establish normalcy and security.

Rationale for incorrect answers:

A. Delaying procedures unnecessarily can interfere with treatment schedules and may prolong anxiety.

B. Performing the dressing change in the playroom while the child finishes drawing the picture is inappropriate. The playroom must remain a safe space for positive experiences; painful procedures should never be done there.

D. Offering choices is good in pediatric care, but in this case the timing of the dressing change is a medical necessity. Giving the child this option may create false expectations or resistance.

Take home points

Never perform painful procedures in a child’s playroom or hospital bed, these spaces should be safe, comforting zones.
Use a treatment room for procedures to help children cope better with hospitalization.
Escorting the child back to play afterward helps restore a sense of normalcy and reduces trauma.
Offer choices only when appropriate (e.g., which arm for a blood pressure cuff), but not when the procedure’s timing is medically necessary.

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Naxlex Comprehensive Predictor Exams

A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location?

Correct Answer is C

Explanation

An 8-year-old child is in the playroom drawing a picture. The child’s painful dressing change is due to be performed. Which of the following actions by the nurse is appropriate?

Correct Answer is C

Explanation

You are working with a new nurse to give an intramuscular injection. Which principles do you want to include when doing this teaching? Select all that apply

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A nurse has been assigned to care for a 12-year-old child who will likely die from his illness. The child asks the nurse, “Do you think I am going to die?” Which of the following responses would be appropriate for the nurse to make?

An 18-month-old child has just returned from the operating room with intravenous solution running into a vein in the right hand, a nasogastric tube in place, and a dressing covering the abdomen. Which of the following actions by the nurse would be appropriate? Select all that apply

The nurse is caring for a 14-year-old adolescent after a serious injury. A twice-daily dressing change has been ordered by the child’s primary health-care provider. When planning care with the patient, which of the following statements would be best for the nurse to make?

The nurse is assessing whether or not an 8-year-old child has given assent for a scheduled painful procedure. Which of the following statements by the child would reflect that the child has given assent?