NUR 411 Practical Exam #1 Questions With Complete
Solutions
· How would you assess that an NG is safe to use in a pediatric
patient? Correct Answers Measure or confirm the length of the
NG and assess how it is secured with every feeding. This is
documented in the hospital chart every shift. Initial steps after
placement including recording length, pH testing, auscultation
and Abdominal x-ray. Most NG tube have centimeter markings
so the number recorded in the chart is the number where the NG
exits the nare. If measuring with a paper tape measure, confirm
whether the previous measurement was performed by measuring
the length of the tube to the hub or including the hub. Below is
an example of an NG with centimeter markings.
• Describe how you would assess pain in an infant, child, and
adolescent. Correct Answers Infant: 2 months and older you
could use FLACC. There are also infant and neonatal pain scales
(Neonatal Infant Pain Scale and Riley Infant Pain Scale in Ricci
text)
Child: 3-4 years and up can use FACES
Older school age children and adolescents: can use visual analog
(this is a horizontal line representing pain spectrum and child
points to where their pain is from no pain to pain as bad as it
could be) or numeric scale (0-10 scale used in adults)
• Describe nursing considerations for administering
supplemental oxygen to infants and preschool/school-age
children. Correct Answers Oxygen is considered a drug and
requires a provider's order except when following emergency
protocols. Children require high flow rates may be restricted to
,their room because the wall-mounted oxygen delivery system
must be used. Children on low flow rates may be able to use a
portable oxygen tank to travel to therapies/play room etc.
Oxygen is highly flammable so signs need to be posted that say
"oxygen in use." Educate family about avoiding matches,
lighters, flammable materials, or sparks around child. If a mask
is used, select the appropriate size that best fits the child's face
and makes a tight seal to prevent oxygen leakage. Provide
humidification with oxygen delivery to prevent drying of nasal
mucous and to help loosen secretions. Evaluate effectiveness of
02 delivery by monitor response to treatment (vital signs include
pulse oximetry, appearance including color/distress, respiratory
effort)
• Differentiate between the FLACC scale and FACES scale.
How and when would you use each? Correct Answers FLACC
is a behavioral scale (you assess pain based on your observations
of the child's behavior, not their self-reporting of pain). Reliable
for use from 2 months-7 years of age. Five parameters are
scored from 0-2 (facial expression, legs, activity, cry, and
consolability) highest score is 10. The higher the score the
greater the pain. The rFLACC is a revised version of the scale
with additional behavioral indicators of pain specifically for
children with cognitive impairment.
FACES: self-report pain tool used in children 3-4 years of age
and up. Six faces are shown with varying expressions and
correlating numbers from 0 (no hurt) to 5 (hurts worst). The
child selects which facial expression correlates with the current
pain. Children need to be developmentally able to understand
the instructions and interpret the scale.
, • How does the child's developmental level impact the
experience and of pain? Correct Answers Developmental level
affects children's understanding of pain. Younger children who
don't understand the cause of pain or don't know what to expect
from painful procedures may exhibit more fear. Children in pain
may regress developmentally so a simpler pain scale and simpler
communication may be needed even for an older child
Infant: infants feel pain, preterm infants may feel pain more
intensely than older infants due to lack of inhibitory mechanisms
that develop later. The greatest indicator of pain in infants is
often change in facial expression.
Toddlers: may react intensely to painful and non-painful
procedures. Limited vocabulary makes it difficult for toddlers to
express pain. It can be helpful to use the vocabulary they are
familiar with (owie, boo-boo). Involve caregivers in assessment
of pain as they know their children best and can identify changes
in normal behavior.
Preschoolers: May hide from painful stimuli/procedures.
Magical thinking characteristic of preschool years may lead
them to believe they are being punished when experiencing pain.
Preschoolers may exhibit adults to know they are in pain and
may not verbalize. They may struggle to describe the type of
pain but can point to location.
School-age: Better able to describe pain. May attempt to appear
brave (not verbalizing pain, not asking for medication). May
appear withdrawn when in pain.
Adolescents: Fear loss of control, may refuse medications.
Similar to school-age children may attempt to appear stoic
(adult-like) and not report pain.
Solutions
· How would you assess that an NG is safe to use in a pediatric
patient? Correct Answers Measure or confirm the length of the
NG and assess how it is secured with every feeding. This is
documented in the hospital chart every shift. Initial steps after
placement including recording length, pH testing, auscultation
and Abdominal x-ray. Most NG tube have centimeter markings
so the number recorded in the chart is the number where the NG
exits the nare. If measuring with a paper tape measure, confirm
whether the previous measurement was performed by measuring
the length of the tube to the hub or including the hub. Below is
an example of an NG with centimeter markings.
• Describe how you would assess pain in an infant, child, and
adolescent. Correct Answers Infant: 2 months and older you
could use FLACC. There are also infant and neonatal pain scales
(Neonatal Infant Pain Scale and Riley Infant Pain Scale in Ricci
text)
Child: 3-4 years and up can use FACES
Older school age children and adolescents: can use visual analog
(this is a horizontal line representing pain spectrum and child
points to where their pain is from no pain to pain as bad as it
could be) or numeric scale (0-10 scale used in adults)
• Describe nursing considerations for administering
supplemental oxygen to infants and preschool/school-age
children. Correct Answers Oxygen is considered a drug and
requires a provider's order except when following emergency
protocols. Children require high flow rates may be restricted to
,their room because the wall-mounted oxygen delivery system
must be used. Children on low flow rates may be able to use a
portable oxygen tank to travel to therapies/play room etc.
Oxygen is highly flammable so signs need to be posted that say
"oxygen in use." Educate family about avoiding matches,
lighters, flammable materials, or sparks around child. If a mask
is used, select the appropriate size that best fits the child's face
and makes a tight seal to prevent oxygen leakage. Provide
humidification with oxygen delivery to prevent drying of nasal
mucous and to help loosen secretions. Evaluate effectiveness of
02 delivery by monitor response to treatment (vital signs include
pulse oximetry, appearance including color/distress, respiratory
effort)
• Differentiate between the FLACC scale and FACES scale.
How and when would you use each? Correct Answers FLACC
is a behavioral scale (you assess pain based on your observations
of the child's behavior, not their self-reporting of pain). Reliable
for use from 2 months-7 years of age. Five parameters are
scored from 0-2 (facial expression, legs, activity, cry, and
consolability) highest score is 10. The higher the score the
greater the pain. The rFLACC is a revised version of the scale
with additional behavioral indicators of pain specifically for
children with cognitive impairment.
FACES: self-report pain tool used in children 3-4 years of age
and up. Six faces are shown with varying expressions and
correlating numbers from 0 (no hurt) to 5 (hurts worst). The
child selects which facial expression correlates with the current
pain. Children need to be developmentally able to understand
the instructions and interpret the scale.
, • How does the child's developmental level impact the
experience and of pain? Correct Answers Developmental level
affects children's understanding of pain. Younger children who
don't understand the cause of pain or don't know what to expect
from painful procedures may exhibit more fear. Children in pain
may regress developmentally so a simpler pain scale and simpler
communication may be needed even for an older child
Infant: infants feel pain, preterm infants may feel pain more
intensely than older infants due to lack of inhibitory mechanisms
that develop later. The greatest indicator of pain in infants is
often change in facial expression.
Toddlers: may react intensely to painful and non-painful
procedures. Limited vocabulary makes it difficult for toddlers to
express pain. It can be helpful to use the vocabulary they are
familiar with (owie, boo-boo). Involve caregivers in assessment
of pain as they know their children best and can identify changes
in normal behavior.
Preschoolers: May hide from painful stimuli/procedures.
Magical thinking characteristic of preschool years may lead
them to believe they are being punished when experiencing pain.
Preschoolers may exhibit adults to know they are in pain and
may not verbalize. They may struggle to describe the type of
pain but can point to location.
School-age: Better able to describe pain. May attempt to appear
brave (not verbalizing pain, not asking for medication). May
appear withdrawn when in pain.
Adolescents: Fear loss of control, may refuse medications.
Similar to school-age children may attempt to appear stoic
(adult-like) and not report pain.
