NURS 4331 COMPREHENSIVE EXAM UPDATED QUESTIONS
AND SOLUTIONS RATED A+
✔✔infants pain must be assessed - ✔✔by behavioral and physiological indicators (BIG
DIFFERENCE)
✔✔pain assessment QUESTT - ✔✔Q=uestion the child
U=se pain rating scale
E=valuate behavior and physiologic changes
S=ecure parental involvement
T=ake cause of pain into account
T=ake action
✔✔physiologic measures of pain - ✔✔NUMBERS =
vital signs - increased -increased BP pulse RR
✔✔behavioral pain assessment - ✔✔facial expression, body movements, crying=
grimace. crying uncontrollably, flailing of arms/ legs
✔✔be consistent with - ✔✔PAIN SCALE
use the same scale to evaluate pain bcs using different scales can change pain
evaluation
✔✔behavioral/observation of pain - ✔✔Facial Expressions• Movement/Actions: Pulling
ear, clenching teeth, body stiffening, guarding
• Positioning: Abdominal pain - lie on one side & draw knees to chest
• Walking: Limp or refuse to use extremity Irritability & restlessness
• General change in behavior - quiet & withdrawn, sleep to make pain go away
✔✔FLACC pain tool - ✔✔used to assess newborns, face, legs, activity, cry,
consolability
✔✔Nonpharmacologic Pain Management - ✔✔relaxation = music
distraction = therapy dogs
sucking sucrose=SWEETEASE IN A PACIFIER
Heat/cold
✔✔pharmacologic pain interventions - ✔✔opioids/non opioids
PCA
local/topical analgesia= EMLA CREAM + TEGADERM
epidural
✔✔when giving meds must - ✔✔FOLLOW UP monitoring and assessment = check the
effectiveness of intervention
, ✔✔if med is no longer effective - ✔✔or NOT effective -> contact the HCP for a different
med or stronger dose= if safe dose
✔✔chronic pain can cause - ✔✔significant emotional and social consequence due to
pain and disability
✔✔lidocaine/prilocaine - ✔✔Emla - Dermatological - Topical Local Anesthetics and
Combinations
used in school age kids
leave on 45mins-1hr
✔✔neurological system develops - ✔✔soon after conception and closes around the 4th
week after conception = NEURAL TUBE= take folic acid
✔✔nerves are - ✔✔fully developed at birth BUT IMMATURE
✔✔shunt - ✔✔catheter placed in ventricle and allows passage of CSF to PERITONEAL
CAVITY
✔✔ventilation txt - ✔✔hyperventilation = decreased CO2 = vasoconstriction and
decreases ICP
(CO2 is a vasodilator in the head)
✔✔ketogenic diet - ✔✔**helps prevents/control/reduce seizures;**
high fat, low carb, mimics effects of fasting and puts body in constant state of ketosis
✔✔txt for hydrocephalus - ✔✔ventriculoperitoneal shunt placement
✔✔s/s of hydrocephalus - ✔✔dilated scalp veins, bulging fontanel, apnea, headaches,
vomiting/lethargy
✔✔cushings triad - ✔✔IICP
change in respirations/ irregular and deep/ cheyne stokes
widening pulse pressure (large gap between diastolic and systolic BP)
bradycardia
✔✔infection of VP shunt - ✔✔increased VS
poor feeding
AND SOLUTIONS RATED A+
✔✔infants pain must be assessed - ✔✔by behavioral and physiological indicators (BIG
DIFFERENCE)
✔✔pain assessment QUESTT - ✔✔Q=uestion the child
U=se pain rating scale
E=valuate behavior and physiologic changes
S=ecure parental involvement
T=ake cause of pain into account
T=ake action
✔✔physiologic measures of pain - ✔✔NUMBERS =
vital signs - increased -increased BP pulse RR
✔✔behavioral pain assessment - ✔✔facial expression, body movements, crying=
grimace. crying uncontrollably, flailing of arms/ legs
✔✔be consistent with - ✔✔PAIN SCALE
use the same scale to evaluate pain bcs using different scales can change pain
evaluation
✔✔behavioral/observation of pain - ✔✔Facial Expressions• Movement/Actions: Pulling
ear, clenching teeth, body stiffening, guarding
• Positioning: Abdominal pain - lie on one side & draw knees to chest
• Walking: Limp or refuse to use extremity Irritability & restlessness
• General change in behavior - quiet & withdrawn, sleep to make pain go away
✔✔FLACC pain tool - ✔✔used to assess newborns, face, legs, activity, cry,
consolability
✔✔Nonpharmacologic Pain Management - ✔✔relaxation = music
distraction = therapy dogs
sucking sucrose=SWEETEASE IN A PACIFIER
Heat/cold
✔✔pharmacologic pain interventions - ✔✔opioids/non opioids
PCA
local/topical analgesia= EMLA CREAM + TEGADERM
epidural
✔✔when giving meds must - ✔✔FOLLOW UP monitoring and assessment = check the
effectiveness of intervention
, ✔✔if med is no longer effective - ✔✔or NOT effective -> contact the HCP for a different
med or stronger dose= if safe dose
✔✔chronic pain can cause - ✔✔significant emotional and social consequence due to
pain and disability
✔✔lidocaine/prilocaine - ✔✔Emla - Dermatological - Topical Local Anesthetics and
Combinations
used in school age kids
leave on 45mins-1hr
✔✔neurological system develops - ✔✔soon after conception and closes around the 4th
week after conception = NEURAL TUBE= take folic acid
✔✔nerves are - ✔✔fully developed at birth BUT IMMATURE
✔✔shunt - ✔✔catheter placed in ventricle and allows passage of CSF to PERITONEAL
CAVITY
✔✔ventilation txt - ✔✔hyperventilation = decreased CO2 = vasoconstriction and
decreases ICP
(CO2 is a vasodilator in the head)
✔✔ketogenic diet - ✔✔**helps prevents/control/reduce seizures;**
high fat, low carb, mimics effects of fasting and puts body in constant state of ketosis
✔✔txt for hydrocephalus - ✔✔ventriculoperitoneal shunt placement
✔✔s/s of hydrocephalus - ✔✔dilated scalp veins, bulging fontanel, apnea, headaches,
vomiting/lethargy
✔✔cushings triad - ✔✔IICP
change in respirations/ irregular and deep/ cheyne stokes
widening pulse pressure (large gap between diastolic and systolic BP)
bradycardia
✔✔infection of VP shunt - ✔✔increased VS
poor feeding
