Pediatric Nursing Exam: Pain Assessment, Pain Management, Opioid and
Nonopioid Analgesics, Biobehavioral Interventions, Nonnutritive Sucking,
Kangaroo Care, Sedation, Conscious and General Anesthesia, FLACC and Wong-
Baker FACES Scales, Cognitive Impairment, Down Syndrome, Fragile X
Syndrome, Autism Spectrum Disorders, Developmental Milestones, Stuttering,
Cochlear Implants, Visual and Hearing Impairments, Retinoblastoma,
Hospitalization Stressors, Separation Anxiety, Loss of Control, Therapeutic Play,
Mainstreaming, Palliative and End-of-Life Care, Ethical Considerations,
DNR/DNAR, Double Effect Principle, Family Support, Parental Education, Sibling
Coping, Adaptive Behaviors, Self-Care Promotion Exam Questions Verified and
Provided with Complete A+ Graded Rationales Latest Updated 2026
What is pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue
damage, or described in terms of such damage.
What does pain do besides hurt?
In the pediatric population, pain is frequently under-recognized and inadequately treated.
Untreated pain can affect a child's healing/recovery process.
What is the "Wind-Up Phenomenon"?
Prolonged exposure to pain - multiple levels of the spinal cord experience an altered excitability - may
cause normal nonpainful stimuli to be perceived as noxious stimuli.
What is pain in children influenced by?
Influenced by age and developmental level, the cause of the pain, the nature of the pain and the child's
ability to express the pain in a meaningful way.
,How can we perform an observational pain assessment?
Requires a trained observer that are associated with painful stimuli.
Facial expression is the most consistent and specific indicator of pain in infants.
Most reliable when used to measure short sharp procedural pain, such as pain due to heel lance or
injections.
(0-3 years old)
How are cognitively impaired children affected by pain differently?
May not be able to express pain through behaviors or self-report.
Parents report behaviors such as: crying; being less active; seeking comfort; moaning; not cooperating;
being irritable; being stiff, spastic, tense, or rigid; sleeping less; being difficult to satisfy or pacify;
flinching or moving body part away; being agitated or fidgety.
Parent's are going to be important in the care.
Wong-Baker FACES Pain Rating Scale
At what age can a numerical pain scale be used?
Children as young as 8.
What are some biobehavioral therapies for pain management?
Distraction
Relaxation
Guided Imagery
Massage
,Heat/Cold
TENS
(NOT a substitute for analgesics!)
Nonnutritive Sucking (Pacifier)
Reduces behavioral, physiologic, and hormonal responses to pain from procedures, such as heel
punctures, venipuncture, and immunization injections.
The administration of concentrated sucrose with or without nonnutritive sucking has calming and pain-
relieving effects for invasive procedures in neonates.
Kangaroo Care
Skin-to-skin holding of infants dressed only in diapers against their mother's or father's chest; significant
differences were found in pain responses during heel lancing between infants who were kangaroo held
and those who were not.
Nonopioid Pain Management
Acetaminophen and NSAID’s are suitable for mild to moderate pain.
They work primarily at the peripheral nervous system.
Opioid Pain Management
Morphine Sulfate is standard agent. Needed for moderate to severe pain.
They work primarily at the central nervous system.
, What is the difference between opioids and nonopioids?
Nonopioids have a ceiling effect.
(Ceiling effect = doses higher than the recommended dose will not produce greater pain relief.)
For nonopioids, the peak effect occurs about 2 hours after oral administration.
Opioids do not have a ceiling effect, therefore...
larger dosages can be safely given for increasing severity of pain.
For opioids, the peak effect is approximately a half hour for the IV route.
What are some considerations for route of pain medication administration?
Several routes of administration can be used.
Oral route preferred because of convenience, cost, and relatively steady blood levels.
Children should not have to endure pain, such as IM injections, to achieve pain relief.
Why is timing important for pain management in children?
Timing for administration depends on type of pain. Continuous pain control should have a preventative
schedule of medication, or around-the-clock meds.
Breakthrough pain is possible, and can be treated with PRN pain meds.
What are some opioid side effects? How are they managed?
Respiratory depression, treated with Naloxone (Narcan) available if needed.
Constipation, treated with stool softeners and laxatives.
Nonopioid Analgesics, Biobehavioral Interventions, Nonnutritive Sucking,
Kangaroo Care, Sedation, Conscious and General Anesthesia, FLACC and Wong-
Baker FACES Scales, Cognitive Impairment, Down Syndrome, Fragile X
Syndrome, Autism Spectrum Disorders, Developmental Milestones, Stuttering,
Cochlear Implants, Visual and Hearing Impairments, Retinoblastoma,
Hospitalization Stressors, Separation Anxiety, Loss of Control, Therapeutic Play,
Mainstreaming, Palliative and End-of-Life Care, Ethical Considerations,
DNR/DNAR, Double Effect Principle, Family Support, Parental Education, Sibling
Coping, Adaptive Behaviors, Self-Care Promotion Exam Questions Verified and
Provided with Complete A+ Graded Rationales Latest Updated 2026
What is pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue
damage, or described in terms of such damage.
What does pain do besides hurt?
In the pediatric population, pain is frequently under-recognized and inadequately treated.
Untreated pain can affect a child's healing/recovery process.
What is the "Wind-Up Phenomenon"?
Prolonged exposure to pain - multiple levels of the spinal cord experience an altered excitability - may
cause normal nonpainful stimuli to be perceived as noxious stimuli.
What is pain in children influenced by?
Influenced by age and developmental level, the cause of the pain, the nature of the pain and the child's
ability to express the pain in a meaningful way.
,How can we perform an observational pain assessment?
Requires a trained observer that are associated with painful stimuli.
Facial expression is the most consistent and specific indicator of pain in infants.
Most reliable when used to measure short sharp procedural pain, such as pain due to heel lance or
injections.
(0-3 years old)
How are cognitively impaired children affected by pain differently?
May not be able to express pain through behaviors or self-report.
Parents report behaviors such as: crying; being less active; seeking comfort; moaning; not cooperating;
being irritable; being stiff, spastic, tense, or rigid; sleeping less; being difficult to satisfy or pacify;
flinching or moving body part away; being agitated or fidgety.
Parent's are going to be important in the care.
Wong-Baker FACES Pain Rating Scale
At what age can a numerical pain scale be used?
Children as young as 8.
What are some biobehavioral therapies for pain management?
Distraction
Relaxation
Guided Imagery
Massage
,Heat/Cold
TENS
(NOT a substitute for analgesics!)
Nonnutritive Sucking (Pacifier)
Reduces behavioral, physiologic, and hormonal responses to pain from procedures, such as heel
punctures, venipuncture, and immunization injections.
The administration of concentrated sucrose with or without nonnutritive sucking has calming and pain-
relieving effects for invasive procedures in neonates.
Kangaroo Care
Skin-to-skin holding of infants dressed only in diapers against their mother's or father's chest; significant
differences were found in pain responses during heel lancing between infants who were kangaroo held
and those who were not.
Nonopioid Pain Management
Acetaminophen and NSAID’s are suitable for mild to moderate pain.
They work primarily at the peripheral nervous system.
Opioid Pain Management
Morphine Sulfate is standard agent. Needed for moderate to severe pain.
They work primarily at the central nervous system.
, What is the difference between opioids and nonopioids?
Nonopioids have a ceiling effect.
(Ceiling effect = doses higher than the recommended dose will not produce greater pain relief.)
For nonopioids, the peak effect occurs about 2 hours after oral administration.
Opioids do not have a ceiling effect, therefore...
larger dosages can be safely given for increasing severity of pain.
For opioids, the peak effect is approximately a half hour for the IV route.
What are some considerations for route of pain medication administration?
Several routes of administration can be used.
Oral route preferred because of convenience, cost, and relatively steady blood levels.
Children should not have to endure pain, such as IM injections, to achieve pain relief.
Why is timing important for pain management in children?
Timing for administration depends on type of pain. Continuous pain control should have a preventative
schedule of medication, or around-the-clock meds.
Breakthrough pain is possible, and can be treated with PRN pain meds.
What are some opioid side effects? How are they managed?
Respiratory depression, treated with Naloxone (Narcan) available if needed.
Constipation, treated with stool softeners and laxatives.
