A nurse is caring for a 5-year-old child who is postoperative following a tonsillectomy.
Which of the following pain scales should the nurse use to determine the child's pain level?

Choice A rationale

Positioning the infant supine increases pressure on the surgical site, potentially disrupting healing or increasing the risk of cerebrospinal fluid leakage. Supine positioning is contraindicated immediately after myelomeningocele repair as it can compromise the integrity of the repair.

Choice B rationale

Monitoring head circumference detects signs of hydrocephalus, a common complication after myelomeningocele repair due to cerebrospinal fluid dynamics. Enlarging head circumference can indicate increased intracranial pressure and require immediate intervention to prevent further neurological damage.

Choice C rationale

Intake and output monitoring provides essential hydration and renal function data post-surgery. While important, it is not the priority intervention immediately following surgery, as it does not directly address complications such as hydrocephalus or infection risk.

Choice D rationale

Maintaining skin integrity prevents infection and promotes healing but does not address potential neurological complications. While this intervention remains vital for recovery, it is secondary to detecting hydrocephalus or fluid imbalances post-surgery.

B. Slight yellow vaginal discharge is correct.This is a classic symptom of gonorrhea in females. Gonorrhea often causes mucopurulent cervicitis, leading to a mild yellow vaginal discharge. It’s one of the most common signs, especially in sexually active adolescents.

Incorrect options:

• A. Low-grade fever for three days:
  Not a typical early symptom of gonorrhea. Fever may occur in severe or disseminated gonococcal infections, but it's uncommon as an initial presentation.

• C. Frothy, white vaginal discharge:
  This is more characteristic of trichomoniasis, another STI, caused by Trichomonas vaginalis. The discharge is typically frothy, greenish-yellow, and accompanied by a foul odor.

• D. Decrease in urinary frequency:
  Not associated with gonorrhea. Gonorrhea can cause increased urinary frequency and urgency if the urethra is involved, but a decrease is not typical.