A nurse is providing care to an infant who is unable to communicate verbally.
Which pain assessment tool would be most suitable for this infant?

FLACC Scale.

Wong-Baker FACES Pain Rating Scale.

Numeric Rating Scale (NRS)

Visual Analog Scale (VAS)

Answer and Explanation

The Correct Answer is A

Choice A rationale:

The FLACC Scale (Face, Legs, Activity, Cry, Consolability) is the most suitable pain assessment tool for infants who are unable to communicate verbally.

It takes into account facial expressions, leg movement, activity, cry, and consolability, which are important indicators of pain in non-verbal infants.

Choice B rationale:

The Wong-Baker FACES Pain Rating Scale is designed for children aged 3 years and older who can use facial expressions to indicate their pain level.

It is not the best choice for infants, as they may not yet have the ability to convey pain using these facial expressions effectively.

Choice C rationale:

The Numeric Rating Scale (NRS) requires assigning a numerical value to pain, which is not appropriate for infants who cannot understand or use numbers for pain assessment.

Choice D rationale:

The Visual Analog Scale (VAS) is also not suitable for infants as it requires marking pain on a line, which is beyond the capability of non-verbal infants.

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Correct Answer is C

Explanation

Choice A rationale:

The normal range for both the FLACC Scale and the Wong-Baker FACES Pain Rating Scale is not 0-10.

The FLACC Scale typically ranges from 0 to 2, and the Wong-Baker FACES Pain Rating Scale ranges from 0 to 10.

Therefore, choice A is not accurate.

Choice B rationale:

Similarly, the normal range for both scales is not 0-2.

While the FLACC Scale has a range of 0 to 2, the Wong-Baker FACES Pain Rating Scale covers a range from 0 to 10.

Choice B is not the correct answer.

Choice C rationale:

The FLACC Scale is designed to assess pain in infants and young children and ranges from 0 to 2.

The Wong-Baker FACES Pain Rating Scale is used for older children and adults, ranging from 0 to 10.

Therefore, choice C is the correct answer as it accurately represents the normal ranges for these pain assessment scales.

Choice D rationale:

Choice D provides incorrect information about the normal ranges for both pain assessment scales.

It states that the FLACC Scale has a range of 0-10, which is not accurate, and the Wong-Baker FACES Pain Rating Scale has a range of 0-2, which is also incorrect.

A. "The child is probably just tired. They'll be fine in a little while.”.. B. "We need to give the child some pain medication right away.”.. C. "The child is in a lot of pain. We need to do everything we can to help them feel better.”.. D. "The child is probably just scared. There's no need to worry.”..

Correct Answer is B

Explanation

Choice A rationale:

Assuming the child is tired and will be fine in a little while is not appropriate when the child has a high pain score.

It's important to address the child's pain promptly.

Choice B rationale:

This is the correct choice.

When a non-verbal child with difficulty breathing scores high on the FLACC Scale, it indicates significant pain.

Administering pain medication promptly is necessary.

Choice C rationale:

Acknowledging the child's pain and expressing a commitment to help them feel better is a good approach, but it doesn't address the urgency of the situation.

The child's high pain score requires immediate action.

Choice D rationale:

Assuming the child is scared and there's no need to worry is not appropriate when the child has a high pain score.

Pain needs to be managed effectively.

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A nurse is providing care to an infant who is unable to communicate verbally.Which pain assessment tool would be most suitable for this infant?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client asks a nurse about the normal range for the FLACC Scale and Wong-Baker FACES Pain Rating Scale when assessing their infant’s and older child’s pain respectively. How should the nurse respond?

Correct Answer is C

Explanation

A 3-year-old child is admitted to the hospital with a diagnosis of pneumonia. The child is non-verbal and has difficulty breathing. The nurse uses the FLACC Scale to assess the child's pain. The child scores a 9/10 on the FLACC Scale. Which of the following statements by the patient is appropriate?

Correct Answer is B

Explanation

A nurse is providing care to an infant who is unable to communicate verbally.Which pain assessment tool would be most suitable for this infant?

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A nurse is providing care to an infant who is unable to communicate verbally.
Which pain assessment tool would be most suitable for this infant?