A nurse is giving an intramuscular injection to a newborn who was delivered at 38 weeks of gestation. Which of the following pain scales should the nurse use to assess the newborn's pain?
Natal Infant Pa Scale PS
FACES pain rating scale
Premature infant Pain Profile (PIPP)
visual analog scale (VAS)
The Correct Answer is A
Choice A reason:
A. Natal Infant Pain Scale (NIPS): The NIPS is a behavioral assessment tool designed for both preterm and full-term neonates. It evaluates six behavioral indicators in response to painful procedures. These indicators include changes in facial expression (such as grimacing, brow bulge, and eye squeeze), body movements (such as fisting, tremulousness, and limb withdrawal), and other signs of distressChoice B reason:
FACES pain rating scale The FACES pain rating scale should not be used because it is a visual scale that uses facial expressions to assess pain in children who can communicate using pictures of faces displaying different emotions. It is generally used for older children and not appropriate for newborns.
Choice C reason
Premature Infant Pain Profile (PIPP): The PIPP is another pain assessment tool specifically developed for preterm infants. It considers physiological and behavioral parameters, including facial expressions, heart rate, oxygen saturation, and gestational age. While useful for preterm infants, it may not be the best choice for full-term newborns.Since the newborn in this scenario was delivered at 38 weeks of gestation, the PIPP would be an appropriate pain assessment tool to use. It considers specific physiological and behavioural indicators of pain in newborns and helps healthcare providers evaluate and manage pain in this vulnerable population.
Choice D reason:
Visual analog scale (VAS) should not be used because the visual analog scale is a pain assessment tool typically used for older children, adolescents, and adults who can understand and provide a subjective rating of their pain intensity along a linear scale. It involves marking a point on the line corresponding to the level of pain experienced. Since newborns cannot communicate in this way, the VAS is not suitable for their pain assessment.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason:
Discourage physical activity during the day is incorrect. Encouraging physical activity is generally beneficial for individuals with dementia. Regular exercise can improve mood, reduce agitation, and enhance overall health. However, the level and type of physical activity should be tailored to the individual's abilities and preferences.
Choice B reason
Use clothing with buttons and zippers is incorrect. Clothing with buttons and zippers can be challenging for individuals with dementia due to fine motor skill impairments and difficulty with dressing. It is often recommended to use clothing with simple closures, such as Velcro or elastic bands, to make dressing easier and more manageable for the individual.
Choice C reason:
Individuals with dementia may experience difficulties with communication, memory, and problem-solving, which can affect their ability to recognize and express the need to use the restroom. As a result, they may be at risk of urinary or bowel incontinence. To address this concern and promote the client's comfort and dignity, establishing a toileting schedule is essential. A consistent routine for bathroom breaks can help prevent accidents and improve the client's overall well-being.
Choice D reason:
Engage the client in activities that increase sensory stimulation is incorrect. While sensory stimulation activities can be enjoyable and engaging for individuals with dementia, it is essential to select activities that are appropriate and not overwhelming. Some individuals with dementia may become overstimulated, which can lead to agitation or distress. Activities should be tailored to the individual's preferences and abilities.
Correct Answer is ["18"]
Explanation
The client weighs 198 lb, which is equivalent to (198 ÷ 2.2 = 90kg.
Therefore, the amount of mannitol for the test dose is 0.2 g/kg x 90 kg = 18 g.
The nurse should administer 18 g of mannitol IV bolus over 5 min as a test dose to the client who has severe oliguria.
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