A nurse is caring for an 18-month-old infant who is 12 hr postoperative following a myringotomy. Which of the following pain rating scales should the nurse use?
Poker Chip Tool
Color tool
Numeric scale
FLACC scale
The Correct Answer is D
A. The Poker Chip Tool is used to assess pain in children who can understand the concept of "a few" to "lots" of pain, typically in older children. It is not appropriate for infants or toddlers.
B. The Color tool is used for children who can associate color with pain intensity, but it is generally for older children who can understand this system, not for infants.
C. The Numeric scale is designed for children who are old enough to understand and use numbers (typically older than 8 years). An 18-month-old would not be able to understand this scale.
D. The FLACC (Face, Legs, Activity, Cry, Consolability) scale is specifically designed to assess pain in infants and nonverbal children. It uses behavioral indicators to rate pain intensity and is appropriate for an 18-month-old toddler.
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Related Questions
Correct Answer is B
Explanation
A. Wiping from the outer corner of the eye to the inner canthus is incorrect because this can introduce bacteria from the outer part of the eye into the inner part, which could exacerbate the infection. The proper technique is to wipe from the inner canthus to the outer canthus to prevent contamination.
B. Cleaning the eye with a moist cloth is appropriate for conjunctivitis as it helps remove secretions and crusts that accumulate. Using a clean, moist cloth minimizes irritation to the eye.
C. Keeping the eye covered with a compress is not recommended unless directed by a provider. Compresses could increase irritation or harbor bacteria if not kept clean.
D. Applying eye ointment in the morning is not optimal because ointment should generally be applied at night to prevent blurred vision during the day. The nurse should advise applying it as prescribed by the healthcare provider.
Correct Answer is B
Explanation
A. Applying calamine lotion is helpful for symptom relief but does not remove the poison ivy oil from the skin.
B. Flushing the affected area with cold, running water immediately after exposure helps to remove the poison ivy oil (urushiol) from the skin, which is crucial in preventing or reducing the severity of the rash.
C. While an oatmeal bath can help soothe itching, it is not the priority action in the acute stage of exposure.
D. Administering an oral corticosteroid may be necessary if the rash is severe, but flushing the area with water should be the first step in preventing further reaction.
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