1. Priority Question
The nurse is caring for four children. Which child should the nurse assess
first?
A. A 4-year-old who rates postoperative pain using a FACES scale
B. A 7-year-old receiving morphine who is difficult to arouse and has
shallow respirations
C. A 10-year-old requesting another ice pack for an ankle injury
D. A 15-year-old keeping a diary of chronic headaches
Correct answer: B
Rationale: Difficult arousal and shallow respirations suggest opioid-
induced respiratory depression, the most dangerous opioid adverse effect.
The nurse should immediately assess respiratory rate, depth, oxygenation,
and sedation level and prepare to intervene.
2. Correct Understanding
Which nursing student statement about pediatric pain demonstrates correct
understanding?
A. “Children who are sleeping are not experiencing pain.”
B. “A child’s self-report is the preferred indicator when the child can
communicate.”
C. “Vital signs provide the most reliable measurement of pain intensity.”
D. “Children with chronic pain usually display dramatic pain behaviors.”
Correct answer: B
Rationale: When developmentally able, the child’s report is the most
reliable indicator of pain. Sleep, quiet behavior, or normal vital signs do not
rule out pain. Children with chronic pain may display few observable
behaviors.
3. Select All That Apply
Which components should the nurse include in a comprehensive pediatric
pain assessment? Select all that apply.
A. Pain intensity
B. Pain quality
,C. Factors that relieve or aggravate pain
D. Effect on sleep, activity, and function
E. Previous pain experiences
F. Whether the nurse believes the child’s behavior matches the reported
pain
Correct answers: A, B, C, D, E
Rationale: Pain assessment includes intensity, quality, location, timing,
previous experiences, relieving or aggravating factors, associated
symptoms, and functional interference. Treatment should not be based on
whether the nurse believes the child appears to be in pain.
4. Need for Further Teaching
Which statement by a parent indicates a need for further teaching?
A. “My child may express pain differently from another child.”
B. “I should report changes in my child’s usual behavior.”
C. “If my child is not crying, the pain cannot be severe.”
D. “The nurse may use both my observations and a pain scale.”
Correct answer: C
Rationale: Children may become quiet, withdrawn, rigid, or less active
during pain. Adolescents may have minimal crying or resistance. Absence of
crying does not mean absence of significant pain.
5. Priority Question
A nonverbal 2-year-old is recovering from abdominal surgery. Which pain
assessment tool is most appropriate?
A. Numeric Rating Scale
B. FLACC scale
C. Visual Analog Scale
D. Adolescent Pediatric Pain Tool
Correct answer: B
Rationale: The FLACC scale is appropriate for infants and young children
or children unable to provide a self-report. It evaluates face, legs, activity,
cry, and consolability.
, 6. Correct Understanding
The nurse calculates a FLACC score by assessing which behaviors?
A. Facial expression, limb movement, alertness, crying, and circulation
B. Face, legs, activity, cry, and consolability
C. Fear, language, agitation, cooperation, and comfort
D. Facial tension, lung sounds, activity, crying, and consciousness
Correct answer: B
Rationale: FLACC stands for Face, Legs, Activity, Cry, and Consolability.
Each category is scored from 0 to 2 for a total score from 0 to 10.
7. Select All That Apply
Which findings may indicate pain in an infant? Select all that apply.
A. Brow lowering
B. Tightly closed eyes
C. Open, square-shaped mouth
D. Generalized rigidity
E. Reflex withdrawal
F. Consistent verbal description of pain quality
Correct answers: A, B, C, D, E
Rationale: Infants communicate pain through crying, facial expressions,
body rigidity, thrashing, and withdrawal. They cannot provide a verbal
description of pain quality.
8. Need for Further Teaching
Which nurse action when using the FLACC scale indicates a need for
further teaching?
A. Observe the child’s facial expression.
B. Determine whether the child can be consoled.
C. Ask the parent about the child’s usual behaviors.
D. Replace the child’s self-report with the FLACC score when the child can
communicate clearly.
The nurse is caring for four children. Which child should the nurse assess
first?
A. A 4-year-old who rates postoperative pain using a FACES scale
B. A 7-year-old receiving morphine who is difficult to arouse and has
shallow respirations
C. A 10-year-old requesting another ice pack for an ankle injury
D. A 15-year-old keeping a diary of chronic headaches
Correct answer: B
Rationale: Difficult arousal and shallow respirations suggest opioid-
induced respiratory depression, the most dangerous opioid adverse effect.
The nurse should immediately assess respiratory rate, depth, oxygenation,
and sedation level and prepare to intervene.
2. Correct Understanding
Which nursing student statement about pediatric pain demonstrates correct
understanding?
A. “Children who are sleeping are not experiencing pain.”
B. “A child’s self-report is the preferred indicator when the child can
communicate.”
C. “Vital signs provide the most reliable measurement of pain intensity.”
D. “Children with chronic pain usually display dramatic pain behaviors.”
Correct answer: B
Rationale: When developmentally able, the child’s report is the most
reliable indicator of pain. Sleep, quiet behavior, or normal vital signs do not
rule out pain. Children with chronic pain may display few observable
behaviors.
3. Select All That Apply
Which components should the nurse include in a comprehensive pediatric
pain assessment? Select all that apply.
A. Pain intensity
B. Pain quality
,C. Factors that relieve or aggravate pain
D. Effect on sleep, activity, and function
E. Previous pain experiences
F. Whether the nurse believes the child’s behavior matches the reported
pain
Correct answers: A, B, C, D, E
Rationale: Pain assessment includes intensity, quality, location, timing,
previous experiences, relieving or aggravating factors, associated
symptoms, and functional interference. Treatment should not be based on
whether the nurse believes the child appears to be in pain.
4. Need for Further Teaching
Which statement by a parent indicates a need for further teaching?
A. “My child may express pain differently from another child.”
B. “I should report changes in my child’s usual behavior.”
C. “If my child is not crying, the pain cannot be severe.”
D. “The nurse may use both my observations and a pain scale.”
Correct answer: C
Rationale: Children may become quiet, withdrawn, rigid, or less active
during pain. Adolescents may have minimal crying or resistance. Absence of
crying does not mean absence of significant pain.
5. Priority Question
A nonverbal 2-year-old is recovering from abdominal surgery. Which pain
assessment tool is most appropriate?
A. Numeric Rating Scale
B. FLACC scale
C. Visual Analog Scale
D. Adolescent Pediatric Pain Tool
Correct answer: B
Rationale: The FLACC scale is appropriate for infants and young children
or children unable to provide a self-report. It evaluates face, legs, activity,
cry, and consolability.
, 6. Correct Understanding
The nurse calculates a FLACC score by assessing which behaviors?
A. Facial expression, limb movement, alertness, crying, and circulation
B. Face, legs, activity, cry, and consolability
C. Fear, language, agitation, cooperation, and comfort
D. Facial tension, lung sounds, activity, crying, and consciousness
Correct answer: B
Rationale: FLACC stands for Face, Legs, Activity, Cry, and Consolability.
Each category is scored from 0 to 2 for a total score from 0 to 10.
7. Select All That Apply
Which findings may indicate pain in an infant? Select all that apply.
A. Brow lowering
B. Tightly closed eyes
C. Open, square-shaped mouth
D. Generalized rigidity
E. Reflex withdrawal
F. Consistent verbal description of pain quality
Correct answers: A, B, C, D, E
Rationale: Infants communicate pain through crying, facial expressions,
body rigidity, thrashing, and withdrawal. They cannot provide a verbal
description of pain quality.
8. Need for Further Teaching
Which nurse action when using the FLACC scale indicates a need for
further teaching?
A. Observe the child’s facial expression.
B. Determine whether the child can be consoled.
C. Ask the parent about the child’s usual behaviors.
D. Replace the child’s self-report with the FLACC score when the child can
communicate clearly.
