A nurse is planning care for a 2-month-old infant following a surgical procedure. Which of the following pain rating scales should the nurse plan to use to determine the infant's level of pain?
PANAD scale
OUCHER scale
FLACC scale
FACE Scale
The Correct Answer is C
The appropriate pain rating scale to use for a 2-month-old infant is the FLACC (Face, Legs, Activity, Cry, Consolability) scale. The FLACC scale is commonly used for infants and young children who are unable to self-report their pain. It assesses facial expression, leg movement, activity level, cry, and ability to be consoled. Each category is scored on a scale of 0 to 2, and the total score provides an indication of the infant's pain level.
The PANAD scale and OUCHER scale are more commonly used for older children, while the FACE scale is specific to assessing pain in individuals with cognitive impairments.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
These behaviors suggest that the child is experiencing distress or discomfort in response to the separation from the mother and the hospital environment.
Anxiety reactions are common in toddlers who are hospitalized or experience separation from their primary caregivers. It is a normal response to unfamiliar and potentially stressful situations. Toddlers at this age are still developing a sense of security and trust in their environment, and being in the hospital can disrupt their routine and comfort.
It is important for the nurse to provide a calm and supportive environment for the toddler, offering reassurance and comfort. The nurse can engage in activities that promote a sense of security and provide opportunities for the toddler to express their emotions and fears, such as through play or comforting rituals.
Correct Answer is D
Explanation
Scoliosis is a condition characterized by an abnormal sideways curvature of the spine, resulting in an S or C shape when viewed from the back. It commonly develops during adolescence and can vary in severity. The lateral curvature of the spine observed during the physical examination is a key sign of scoliosis.
Lordosis refers to an excessive inward curvature of the spine in the lower back, while kyphosis refers to an excessive outward curvature of the spine in the upper back, often referred to as a "hunchback."
Torticollis, on the other hand, is a condition characterized by an abnormal position or tilt of the head due to muscle tightness or weakness.

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