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1.5 CE Test Hours

Original Research

Pain in Nonverbal Children with Medical Complexity

A Two-Year Retrospective Study

Contrada, Emily

AJN The American Journal of Nursing: August 2018 - Volume 118 - Issue 8 - p 38,51
doi: 10.1097/
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Pain in Nonverbal Children with Medical Complexity: A Two-Year Retrospective Study


To present the details of a study done to describe the signs and symptoms that parents of nonverbal children with medical complexity found worrisome, to describe sources of pain in these children, and to identify nursing pain assessment practices for this population.

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After completing this continuing education activity, you should be able to

  • outline findings from the authors’ review of the literature.
  • recognize nursing pain assessment practices in this population.
  • discuss the findings of this study and any implications for practice.
  1. For their study, the authors defined children with medical complexity as those meeting 5 criteria, one of which is having
    1. only 1 chronic illness.
    2. mild to moderate developmental delays.
    3. limited or no verbal abilities.
  2. Although children with medical complexity account for between 5% and 10% of all hospitalizations, they account for what percentage of hospital deaths?
    1. nearly 25%
    2. about 32%
    3. up to 43%
  3. In a study by Mackie and colleagues, 15% of children with congenital heart disease were readmitted within how many days of discharge?
    1. 31
    2. 43
    3. 52
  4. Some children with medical complexity display behaviors not usually associated with pain, such as noises and expressions consistent with
    1. withdrawal.
    2. laughter.
    3. anger.
  5. Exclusion criteria for children in the authors’ study included
    1. having more than very limited verbal ability.
    2. being unable to communicate in English.
    3. being unable to identify pain sites.
  6. At the study site, which of the following pain scales is identified for use with preverbal and neurotypical children younger than age 7?
    1. the Numeric Rating Scale
    2. the Wong–Baker FACES Pain Rating Scale
    3. the revised Face, Legs, Activity, Cry, Consolability (r-FLACC) scale
  7. At the study site, which of the following pain scales is identified for use with children who can verbally convey pain?
    1. the Individualized Numeric Rating Scale (INRS)
    2. the Wong–Baker FACES Pain Rating Scale
    3. the r-FLACC scale
  8. A limitation of the Pediatric Pain Profile tool is that it
    1. is difficult to populate.
    2. requires further testing.
    3. has lower reliability in patients with literacy challenges.
  9. Of the 46 subjects in the authors’ study, how many were able to self-report pain?
    1. 0
    2. 5
    3. 10
  10. Among the study subjects, the most common chronic condition was
    1. cerebral palsy.
    2. weakness or paralysis.
    3. seizure disorders.
  11. The most frequently identified cause of medical complexity was
    1. hypoxic ischemic encephalopathy.
    2. chromosomal abnormalities.
    3. neonatal infections.
  12. The most commonly reported symptom prompting parents to seek medical evaluation for a child was
    1. irritability.
    2. parental recognition of pain.
    3. abdominal distention.
  13. The most common discharge diagnosis was
    1. infection.
    2. constipation.
    3. seizure activity.
  14. The most commonly consulted specialty service was
    1. gastroenterology.
    2. pediatrics.
    3. neurology.
  15. The most common nurse-documented observation related to pain was
    1. “no evidence of pain.”
    2. “crying/cannot comfort.”
    3. “expresses pain.”
  16. The method of pain assessment used most often in this study was
    1. the INRS.
    2. the Wong–Baker FACES Pain Rating Scale.
    3. the r-FLACC scale.
  17. For pain scores > 4 with a documented intervention, 82% of pain reassessments showed a documented reduction in pain intensity of ≥ 30% within how many hours?
    1. 1
    2. 2
    3. 3
  18. Regarding future research, the authors recommend all of the following except
    1. using larger sample sizes to allow for greater generalizability of findings.
    2. omitting data collection of common sources of pain, such as infection.
    3. including children with complex chronic conditions who have some verbal abilities and can self-report.
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