NURS 331
Guidelines for Testing
Final Exam
Chapters Question Allotment
(Content Breakdown)
Information from Respiratory Distress video Respiratory information
from itube and Mrs. Roberts 6- 8 questions
Information from medication administration Medication administration
video from itube and Mrs. Quatrini 6-8 questions
Wong Chapter 20 and Mrs. Quatrini Pediatric Variations in Nursing Interventions
Pg. 575-632 7-9 questions
IV Therapy (Propacket) and Dr. Rupert Principles of IV Therapy
6-8 questions
Preparing for Procedures/Informed 5-7 questions
consent/Immunizations Mrs Quatrini
Skin Powerpoint on D2L/Moodle 5-6 questions
Safety/Growth & Development 5-7 questions
Nursing Process 2 questions
Math calculations- Pickar 5 questions
Instructions to ensure a correct answer for math calculations
Round all answers to medication problems as appropriate. To nearest hundredths when
less than 1 mL, and to the nearest tenth when greater than 1 mL. Kilogram weights
should be rounded immediately to the nearest tenth, before proceeding with the problem.
Otherwise, do not round until you get to the final answer. Answers that are not correctly
rounded to the nearest tenth are graded as incorrect. For example, 3.25 is rounded to 3.3
IV flow problems are rounded to the nearest whole drop. For example 33.3 is rounded to
33 drops.
If the answer is less than 1, with no whole number before the decimal point. ALWAYS
place a zero in front of the decimal…this is a safety issue. An answer on the test not
preceded by a zero as appropriate will be graded as incorrect. For example .8 must be
written as 0.8 in ordered to be considered correct.
ALWAYS omit terminal zeros. Answers containing terminal zeros violate patient safety
standards and will be graded incorrect. For example 12.50 must be written as 12.5 in
order to be considered correct.
The answer must be labeled in correct terms. Incorrectly labeled answers will be marked
incorrect. For example: 7 mg is not the same as 7 mL.
, Pediatrics Final
Oxygenation (6-8 questions):
Video:
Pediatric patients have an increased risk for respiratory distress due to …
(1) size and length of trachea smaller diameter
(2) fewer alveoli gas exchange differs
(3) Lungs Breathing controlled by their diaphragm which is higher and not able to contract as
much
Breath sounds:
- Stridor:
o harsh, inspiratory, high pitched crowing sound
- Wheezing
o prolonged, whistling or sighing sound through a narrowed airway on expiration
Asthma
- Grunting:
o deep guttural sound resulting from premature closing of glottis during expiration
(animal sound)
- Retractions:
o Sinking of the soft tissues around the rib cage
Retractions: TEST QUESTION!
1. Subcostal: base of rib cage
2. Intercostal: majority, bulk of ribs
3. Substernal: base of sternum, xiphoid process
4. Sternal: sternum
5. Clavicular: clavicles
Adventitious lung sounds:
- Crepitus:
o crackling or crinkling sound felt in subQ tissue that indicates free air has escaped
in the tissue
- Crackles:
o short, sharp, rough sounds
- Pleural rubs:
o loud, low pitched sound from inflamed pleura rubbing against each other, leather
rubbing sound
When evaluating respiratory status:
1. General appearance (position, facial expression, skin color)
2. LOC (restlessness, irritability, drowsiness)
, 3. Rate rhythm effort of breathing at rest (abnormal patterns - ataxia, look for retractions,
nasal flaring)
4. Chest shape and motion (asymmetry means atelectasis)
5. Palpation (fremitus, vibrations, breath sounds should be symmetrical)
6. Percussion (is the lung fluid filled w/ air or fluid)
Monitoring:
Pulse Oximetry noninvasive and can be intermittent or continuous
- Perform baseline assessment:
o Adequate circulation (pulse/color)
o Site must be clean and dry
o Minimal movement
o Site:
Can be on finger, toe, hand, foot, earlobe, bridge of nose, forehead
- Factors that interfere with readings
o Movement, sunlight and bright lights, nail polish
- Assessment
o Inspect every 4hr for condition of skin
o Can cause pressure necrosis, burn if wiring not compatible
o Move site every 24hr
Normal Readings:
- 95-100 (ideal)
- 91-100 (acceptable)
- 85-89 (acceptable for preemies in NICU) need interventions
- <86 (medical emergency)
Action if pulse ox <90% (hypoxemia): confirm probe is properly placed, make sure oxygen is
at right level, place child in semi fowlers (mom and dad can hold, carseat), encourage deep
breathing, stay with child**, remain calm, report findings
Invasive oxygen saturation monitoring:
- Blood gasses:
o via arterial puncture (radial, brachial, femoral)
o via arterial catheters
- Collected in heparinized tubes, deliver to lab stat, immediately on ice to reduce blood cell
metabolism, apply pressure for 3-5 min to site with dry gauze or until bleeding stops
Hypoxemia: low concentration of oxygen in the blood
Hypoxia: deficiency in oxygen reaching tissue
Signs and Symptoms of respiratory distress:
- Early signs: nasal flaring, sternal retractions, tachypnea (60 or > notify Dr./hold feedings)
tachycardia, accessory muscles, adventitious lung sounds (wheezes, crackles, ronchi,
stridor), restlessness, agitated, anxious, *diminished breath sounds in infants always
require evaluation*
Guidelines for Testing
Final Exam
Chapters Question Allotment
(Content Breakdown)
Information from Respiratory Distress video Respiratory information
from itube and Mrs. Roberts 6- 8 questions
Information from medication administration Medication administration
video from itube and Mrs. Quatrini 6-8 questions
Wong Chapter 20 and Mrs. Quatrini Pediatric Variations in Nursing Interventions
Pg. 575-632 7-9 questions
IV Therapy (Propacket) and Dr. Rupert Principles of IV Therapy
6-8 questions
Preparing for Procedures/Informed 5-7 questions
consent/Immunizations Mrs Quatrini
Skin Powerpoint on D2L/Moodle 5-6 questions
Safety/Growth & Development 5-7 questions
Nursing Process 2 questions
Math calculations- Pickar 5 questions
Instructions to ensure a correct answer for math calculations
Round all answers to medication problems as appropriate. To nearest hundredths when
less than 1 mL, and to the nearest tenth when greater than 1 mL. Kilogram weights
should be rounded immediately to the nearest tenth, before proceeding with the problem.
Otherwise, do not round until you get to the final answer. Answers that are not correctly
rounded to the nearest tenth are graded as incorrect. For example, 3.25 is rounded to 3.3
IV flow problems are rounded to the nearest whole drop. For example 33.3 is rounded to
33 drops.
If the answer is less than 1, with no whole number before the decimal point. ALWAYS
place a zero in front of the decimal…this is a safety issue. An answer on the test not
preceded by a zero as appropriate will be graded as incorrect. For example .8 must be
written as 0.8 in ordered to be considered correct.
ALWAYS omit terminal zeros. Answers containing terminal zeros violate patient safety
standards and will be graded incorrect. For example 12.50 must be written as 12.5 in
order to be considered correct.
The answer must be labeled in correct terms. Incorrectly labeled answers will be marked
incorrect. For example: 7 mg is not the same as 7 mL.
, Pediatrics Final
Oxygenation (6-8 questions):
Video:
Pediatric patients have an increased risk for respiratory distress due to …
(1) size and length of trachea smaller diameter
(2) fewer alveoli gas exchange differs
(3) Lungs Breathing controlled by their diaphragm which is higher and not able to contract as
much
Breath sounds:
- Stridor:
o harsh, inspiratory, high pitched crowing sound
- Wheezing
o prolonged, whistling or sighing sound through a narrowed airway on expiration
Asthma
- Grunting:
o deep guttural sound resulting from premature closing of glottis during expiration
(animal sound)
- Retractions:
o Sinking of the soft tissues around the rib cage
Retractions: TEST QUESTION!
1. Subcostal: base of rib cage
2. Intercostal: majority, bulk of ribs
3. Substernal: base of sternum, xiphoid process
4. Sternal: sternum
5. Clavicular: clavicles
Adventitious lung sounds:
- Crepitus:
o crackling or crinkling sound felt in subQ tissue that indicates free air has escaped
in the tissue
- Crackles:
o short, sharp, rough sounds
- Pleural rubs:
o loud, low pitched sound from inflamed pleura rubbing against each other, leather
rubbing sound
When evaluating respiratory status:
1. General appearance (position, facial expression, skin color)
2. LOC (restlessness, irritability, drowsiness)
, 3. Rate rhythm effort of breathing at rest (abnormal patterns - ataxia, look for retractions,
nasal flaring)
4. Chest shape and motion (asymmetry means atelectasis)
5. Palpation (fremitus, vibrations, breath sounds should be symmetrical)
6. Percussion (is the lung fluid filled w/ air or fluid)
Monitoring:
Pulse Oximetry noninvasive and can be intermittent or continuous
- Perform baseline assessment:
o Adequate circulation (pulse/color)
o Site must be clean and dry
o Minimal movement
o Site:
Can be on finger, toe, hand, foot, earlobe, bridge of nose, forehead
- Factors that interfere with readings
o Movement, sunlight and bright lights, nail polish
- Assessment
o Inspect every 4hr for condition of skin
o Can cause pressure necrosis, burn if wiring not compatible
o Move site every 24hr
Normal Readings:
- 95-100 (ideal)
- 91-100 (acceptable)
- 85-89 (acceptable for preemies in NICU) need interventions
- <86 (medical emergency)
Action if pulse ox <90% (hypoxemia): confirm probe is properly placed, make sure oxygen is
at right level, place child in semi fowlers (mom and dad can hold, carseat), encourage deep
breathing, stay with child**, remain calm, report findings
Invasive oxygen saturation monitoring:
- Blood gasses:
o via arterial puncture (radial, brachial, femoral)
o via arterial catheters
- Collected in heparinized tubes, deliver to lab stat, immediately on ice to reduce blood cell
metabolism, apply pressure for 3-5 min to site with dry gauze or until bleeding stops
Hypoxemia: low concentration of oxygen in the blood
Hypoxia: deficiency in oxygen reaching tissue
Signs and Symptoms of respiratory distress:
- Early signs: nasal flaring, sternal retractions, tachypnea (60 or > notify Dr./hold feedings)
tachycardia, accessory muscles, adventitious lung sounds (wheezes, crackles, ronchi,
stridor), restlessness, agitated, anxious, *diminished breath sounds in infants always
require evaluation*
