PNCB AC Part 2 Exam with Questions and Answers

PNCB AC Part 2 Exam with Questions and Answers A 14-year-old with sickle cell disease presents with acute chest syndrome. The child continues to complain of pain after administration of intravenous (IV) morphine 5mg, IV fluids, and oxygen. What would be the most appropriate medication to administer next? a. Morphine 10 mg IV b. Methylprednisolone 30mg IV c. Ketorolac 15mg IV d. Midazolam 2 mg IV ANSWER C - Ketorolac is a parenteral, nonsteroidal analgesic that does not have the same risks or side effects as narcotics, and is often given in conjunction with a narcotic for acute pain crisis. Additional morphine places this child at risk for respiratory depression. Methylprednisolone does not have a role in acute pain management. Midazolam is a short acting benzodiazepine with sedative and amnestic properties, though, no role in acute pain management A 50 kg, 12-year-old is admitted following posterior spinal fusion to the pediatric intensive care unit (PICU) for hemodynamic monitoring. Which of the following intravenous therapies is the best choice for pain management? a. Continuous infusion of fentanyl at 25 mcg per hour b. PCA with morphine, 5 mg basal, 2 mg PCA dose, with 10 minute lockout c. PCA with morphine, 1 mg basal, 0.8mg PCA dose with 8 minute lockout d. Fentanyl 100 mcg every 2-4 hours PRN ANSWER C- Children who have spinal surgery experience significant pain following the procedure. The best method of pain control includes the use of patient controlled analgesia with a very small basal rate and total hourly dosing based on the recommended, calculated dose based on weight, which in this case is a total per hour of 0.14mg/kg.