A nurse is collecting data from a 5-month-old infant who is postoperative following umbilical hernia repair. Which of the following measures should the nurse use to evaluate the infant's pain level?
FLACC pain rating scale
COMFORT pain rating scale
FACES pain rating scale
CRIES pain rating scale
The Correct Answer is A
A. The FLACC pain rating scale is appropriate for infants and young children, assessing pain based on Face, Legs, Activity, Cry, and Consolability, making it suitable for a 5-month-old infant.
B. The COMFORT pain rating scale is generally used for children who are unable to communicate their pain, typically in older children or adolescents, and is less suitable for this age group.
C. The FACES pain rating scale is designed for children aged 3 and older who can identify facial expressions but is not appropriate for a 5-month-old infant.
D. The CRIES pain rating scale is also used for infants but is more specific to neonates (0-6 months) and measures crying, oxygen requirement, increased vital signs, and facial expressions, making it less applicable than the FLACC scale for this specific postoperative context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A) The Tdap vaccine is recommended for adolescents at 11-12 years of age for protection against tetanus, diphtheria, and pertussis (whooping cough) as a booster dose.
B) The Hib vaccine is typically administered during infancy and is not routinely given at 11 years of age.
C) The IPV vaccine is typically administered during infancy and is not routinely given at 11 years of age.
D) The RV vaccine is routinely given during infancy and is not given at 11 years of age.
Correct Answer is A
Explanation
Rationale:
A) Using an automated lancet device provides a controlled and consistent depth of puncture for the heel stick, minimizing discomfort and risk of injury.
B) Applying limb restraints is unnecessary and could cause distress to the infant.
C) Puncturing the heel at the inner aspect may not be the appropriate site for the heel stick.
D) Cleansing the area with povidone iodine is not necessary for a routine heel stick procedure.
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