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.
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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 A
Explanation
The nurse should include information that growth spurts in height occur toward the end of mid puberty. Gynecomastia is not a common change in boys during puberty, but it might occur in some cases. Changes in the voice and pubic hair growth signal the beginning of puberty. If scrotal changes have not occurred by the age of 14 years, puberty might be considered delayed.
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