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A nurse is collecting data from an 18-month-old toddler who is postoperative. Which of the following rating scales should the nurse use to identify the toddler's pain level?

Color tool

FACES

Visual analog

FLACC

Answer and Explanation

The Correct Answer is D

Choice A reason:

The color tool is not a pain assessment tool; it is used to assess oxygen saturation levels.

Choice B reason:

The FACES scale is commonly used for children who are 3 years of age and older, but it may not be suitable for an 18-month-old toddler who may have limited ability to express pain through facial expressions.

Choice C reason:

The visual analog scale is typically used for older children and adults. It may not be effective for assessing pain in an 18-month-old toddler.

Choice D reason:

The FLACC scale (Face, Legs, Activity, Cry, Consolability) is a validated pain assessment tool for young children, including toddlers. It evaluates specific behaviors related to pain, making it suitable for this age group.

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Correct Answer is B

Explanation

Choice A reason:

Increased urinary output is not typically associated with heart failure. In fact, heart failure often leads to decreased urine output due to decreased cardiac output.

Choice B reason:

Tachycardia (rapid heart rate) is a common manifestation of heart failure in infants. The heart compensates for decreased cardiac output by beating faster.

Choice C reason:

Bounding peripheral pulses are not typically associated with heart failure. In fact, weak peripheral pulses may be a sign of decreased cardiac output.

Choice D reason:

Increased blood pressure is not typically associated with heart failure in infants. Instead, infants with heart failure may have low or normal blood pressure.

A. Give the child a pacifier that has been dipped in an oral sucrose solution during the procedure. B. Apply a eutectic mixture of local anesthetics cream to the intended puncture site 1 hr before the procedure. C. Instruct the parent how to perform kangaroo care during the procedure. D. Administer aspirin to the child 1 hr before the procedure.

Correct Answer is A

Explanation

Choice A reason:

Using a pacifier dipped in an oral sucrose solution can help provide comfort and alleviate pain during the procedure, making it a suitable option for blood specimen collection in preschoolers.

Choice B reason:

Applying a eutectic mixture of local anesthetics cream may not be the most appropriate option for blood specimen collection in preschoolers, as it may not provide sufficient pain relief for the procedure.

Choice C reason:

Kangaroo care involves skin-to-skin contact between an infant and a parent, which is beneficial for bonding and comfort but may not be directly applicable to a blood specimen collection procedure.

Choice D reason:

Placing the infant in a prone position for sleeping is not related to blood specimen collection and may not be appropriate immediately postoperatively.

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A nurse is collecting data from an 18-month-old toddler who is postoperative. Which of the following rating scales should the nurse use to identify the toddler's pain level?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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