A nurse is caring for a 6-month-old infant who is postoperative. Which of the following pain assessment scales should the nurse use to determine the infant's pain level?

FACES

FLACC

Visual Analog Scale

Oucher

Answer and Explanation

The Correct Answer is B

A. FACES. The Wong-Baker FACES scale is used for children aged 3 years and older who can understand and select a face representing their pain level.

B. FLACC. The FLACC scale (Face, Legs, Activity, Cry, Consolability) is used for infants and nonverbal children to assess pain through observation of behaviors.

C. Visual Analog Scale. The Visual Analog Scale (VAS) requires the client to point on a numeric pain scale, which is inappropriate for infants who cannot communicate pain verbally.

D. Oucher. The Oucher scale is similar to FACES and is used in children aged 3–12 years. It relies on self-report, which is not feasible for a 6-month-old infant.

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Correct Answer is C

Explanation

A. Denial of pruritus. Pruritus (itching) is a hallmark symptom of contact dermatitis, so its denial would be unusual.

B. Reports of joint discomfort. Joint pain is not a characteristic feature of contact dermatitis; it is more common in systemic inflammatory conditions such as arthritis.

C. Reports of exposure to a skin irritant. Contact dermatitis is caused by direct contact with an irritant or allergen, so a history of exposure is a key finding.

D. Elevated temperature. Fever is not typical of contact dermatitis unless an infection is present.

A. When the client states they have the urge to defecate. B. Immediately before meals. C. Every 2 hr day and night. D. After every drink or meal.

Correct Answer is A

Explanation

helps train the body to respond to natural urges.

B. Immediately before meals. Although eating stimulates peristalsis, this is not the most effective approach because the client may not be ready to defecate at that time.

C. Every 2 hr day and night. A rigid 2-hour schedule is unnecessary and may cause distress or inconvenience for the client.

D. After every drink or meal. While eating may trigger the gastrocolic reflex, forcing bathroom visits after every meal or drink is not always appropriate.

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A nurse is caring for a 6-month-old infant who is postoperative. Which of the following pain assessment scales should the nurse use to determine the infant's pain level?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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