Medical-Surgical Nursing Exam Sample QuestionsThese sample questions apply to all exams taken on or after October 25, 2014. Show
The following sample questions are similar to those on the Medical-Surgical Nursing Examination but do not represent the full range of content or levels of difficulty. The answers to the sample questions are provided after the last question. Please note: Taking these or any sample question(s) is not a requirement to sit for an actual certification examination. Completion of these or any other sample question(s) does not imply eligibility for certification or successful performance on any certification examination. To respond to the sample questions, first enter your first and last names in the boxes below (this information will not be recorded; it is strictly for purposes of identifying your results). Then click the button corresponding to the best answer for each question. When you are finished, click the "Evaluate" button at the bottom of the page. A new browser window will open, displaying your results, which you may print, if you wish. This practice exam is not timed, and you may take it as many times as you wish. Good luck! For acute medical and surgical pain in children Introduction Aim Definition of Terms Assessment Pain Assessment Tools Physiological Indicators Key Considerations Special Considerations Companion Documents Links Education Evidence Table IntroductionPain assessment is crucial if pain management is to be effective. Nurses are in a unique position to assess pain as they have the most contact with the child and their family in hospital. Pain is the most common
symptom children experience in hospital. Acute pain (noiciception) is associated with tissue damage and an inflammatory response, it is self limiting of short duration and does not involve neural tissue. AimThe guideline specifically seeks to provide nurses with information regarding
Definition of TermsPain:
Pain assessment: is a multidimensional observational assessment of a patients’ experience of pain. Pain measurement tools: are instruments designed to measure pain. AssessmentPain assessment is a broad concept involving clinical judgment based on observation of the type, significance and context of the individual’s pain experience. Pain assessment in infants and children is also challenging due to the subjectivity and multidimensional nature of pain. The dependence on others to assess pain, limited language, comprehension and perception of pain expressed contextually. In some children it can be difficult to distinguish between pain, anxiety and distress. Assessment and documenting pain is needed in order to improve management of pain. When assessing a child’s level of pain careful consideration needs to be given to their:
Pain measurement quantifies pain intensity and enables the nurse to determine the efficacy of interventions aimed at reducing pain. A pain assessment should be conducted during a patient’s admission. (link to Nursing Assessment nursing clinical guideline) Points to consider:
When to assess pain?
Pain Assessment ToolsTools used for pain assessment at RCH have been selected on their validity, reliability and usability and are recognized by pain specialists to be clinically effective in assessing acute pain. All share a common numeric and recorded as values 0-10 and documented on the clinical observation chart as the 5th vital sign. Three ways of measuring pain:
Pain Assessment Tools used at RCHThere are three main tools used for the neonate, infant and child 3-18 years these tools reflect a combination of self-report and behavioural
assessment. 1. FLACC - The acronym FLACC stands for Face,Legs, Activity, Cry and Consolability. Behavioural
How to use FLACCEach category (Face, Legs etc) is scored on a 0-2 scale, which results in a total pain score between 0 and 10. The person assessing the child should observe them briefly and then score each category according to the description supplied.
 2. Wong-Baker faces pain scale 3-18yo How to use?
3. Visual Analogue scale 8-years and older Self report How to use? Ask the child using numbers from 0 = no pain through to 10 being the worst pain
Physiological indicators
Physiological indicators in isolation cannot be used as a measurement for pain. A tool that incorporates physical, behavioural and self report is preferred when possible. Key considerations
Special ConsiderationsMulti language Wong Baker and Numeric tools are available if needed https://www.briggshealthcare.com/Wong-Baker-Faces-Pain-Rating-Scale-8-Languages Modified PAT Tool is used in the Neonatal Intensive Care Unit http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_Pain_Assessment/ Comfort B is used for Ventilated paediatric patients assessing both pain and sedation
http://www.rch.org.au/picu_intranet/guidelines/Nursing_management_of_the_patient_with_invasive_mechanical_ventilation_in_PICU/ Companion Documents
Further information on pain management principles and assessing pain in children can be found here:
Links
Education
Evidence TableThe evidence table for this guideline can be viewed by clicking here. Please remember to
read the disclaimer. The development of this nursing guideline was coordinated by Sueann Penrose, CNC, Children's Pain Management Service, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2022. What cues support the nurse's assessment regarding the client's fluid status?What cues support the nurse's assessment regarding the client's fluid status? Dry mucus membranes (Dry or cracked mucus membranes can be the result of inadequate hydration, which, like inelastic skin turgor, validates the initial finding of fluid volume deficit).
What client cues would indicate the presence of anaphylactic reaction?A reaction is usually classed as anaphylaxis if there are changes in a person's breathing, heart rate or blood pressure. Most healthcare professionals consider an allergic reaction to be anaphylaxis when it involves difficulty breathing or affects the heart rhythm or blood pressure.
What is important for the nurse to assess when inspecting the skin of a patient?There are five key areas to note during a focused integumentary assessment: color, skin temperature, moisture level, skin turgor, and any lesions or skin breakdown.
What additional finding validates the nurse's initial assessment regarding the client's fluid status?What additional finding validates the nurse's initial assessment regarding the client's fluid status? Because Mandi shows early signs of fluid volume deficit, the nurse provides her with a sports drink. While Mandi drinks the fluid, the nurse continues the assessment.
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The nurse questions the client about her symptoms what should the nurse ask about first
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