A nurse is evaluating an 8-month-old infant's pain level following the administration of hydrocodone. Which of the following pain scales would the nurse use?
Oucher scale
Visual Analog
FLACC scale
FACES pain scale
The Correct Answer is C
A) Oucher scale: The Oucher scale is a pain assessment tool that is appropriate for children ages 3 to 12 years. It uses a series of photos depicting facial expressions that range from no pain to extreme pain. While useful for older children, it is not the most appropriate choice for an 8-month-old infant.
B) Visual Analog scale: The Visual Analog scale is typically used for children and adults who are able to understand and use numerical ratings or visual representations of pain. Since an 8-month-old infant is unable to verbally communicate or use this scale, it would not be suitable for evaluating their pain.
C) FLACC scale: The FLACC scale (Face, Legs, Activity, Cry, Consolability) is designed for infants and young children who are unable to verbally communicate their pain. It is ideal for assessing the pain levels of infants, as it evaluates observable behaviors like facial expressions, leg movement, and crying, which are indicators of pain in nonverbal children.
D) FACES pain scale: The FACES pain scale is typically used for children as young as 3 years old, but it requires the child to be able to identify and select facial expressions that correspond to their pain. An 8-month-old infant would not be able to engage with this scale, as it requires some cognitive development and understanding of emotional expressions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) You should avoid exercising for the next 6 weeks:
This statement is not accurate. The client is encouraged to gradually increase activity and participate in physical therapy as prescribed to improve mobility and strength following a total hip arthroplasty. While some rest and limited activity may be necessary immediately after surgery, complete avoidance of exercise for six weeks is generally not advised unless there are complications. Physical therapy exercises are often a key component in the recovery process after hip replacement surgery.
B) You should avoid lying on your right side:
This recommendation is incorrect unless specifically contraindicated due to complications. After a right total hip arthroplasty, the client can typically lie on either side once they are comfortable, unless instructed otherwise by the healthcare provider. It is important to follow the surgical instructions regarding positioning, especially avoiding positions that might place stress on the new joint
C) You should avoid putting a pillow between your legs when in bed:
This statement is incorrect. After a total hip arthroplasty, placing a pillow between the legs when lying on either side is recommended to maintain proper alignment of the hip joint and prevent dislocation. The pillow helps keep the legs slightly apart, preventing the hip from rotating inward, which can put the new joint at risk for dislocation.
D) You should avoid crossing your legs formonths:
This is correct. Following a total hip arthroplasty, it is essential to avoid crossing the legs, especially for the first several months. Crossing the legs can lead to hip dislocation or improper alignment of the joint. The nurse should reinforce the importance of avoiding crossing the legs both while sitting and lying down to ensure proper healing and to avoid complications such as dislocation of the new hip joint.
Correct Answer is C
Explanation
A. Facial erythema is not a primary diagnostic feature of this specific respiratory bacterial infection. While intense coughing fits may cause temporary facial flushing or venous congestion, it is not a hallmark finding. Conditions like fifth disease or slapped-cheek syndrome are more likely to present with persistent malar rashes. This sign lacks the specificity required for a pertussis diagnosis.
B. Peeling of the skin on the extremities, known as desquamation, is classically associated with Kawasaki disease or scarlet fever. Bordetella pertussis does not typically produce the exotoxin profile necessary to cause significant integumentary shedding or widespread dermatological involvement. The pathology of pertussis is primarily localized to the ciliated epithelium of the respiratory tract. It is not an exfoliative disease.
C. In the catarrhal phase of the infection, a low-grade temperature is a standard clinical finding as the immune system responds to the initial bacterial colonization. The presence of systemic inflammation results in mild pyrexia alongside coryza. This manifestation is most prominent before the onset of the characteristic paroxysmal cough. Fever helps differentiate early pertussis from non-inflammatory conditions.
D. A beefy, red tongue, often described as a strawberry tongue, is a classic sign of scarlet fever or toxic shock syndrome. This manifestation occurs due to capillary permeability and inflammation of the lingual papillae caused by Streptococcus pyogenes. Pertussis involves the respiratory mucosa rather than the oral structures or the tongue. This symptom indicates a different bacterial or inflammatory etiology.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.