Which of the following methods is most effective for a nurse to assess pain in a 4-year-old child?

Asking the child to rate their pain using descriptive words like 'mild,' 'moderate,' or 'severe

Using a faces pain scale to allow the child to point to the face that best represents their pain

Observing the child's facial expressions and body movements without any other assessment

Asking the child to rate their pain on a scale of one to ten, with ten being the worst

Answer and Explanation

The Correct Answer is B

A. Descriptive words might be confusing for a 4-year-old and may not accurately capture their experience of pain.

B. The faces pain scale is effective for young children as it uses visual cues that they can relate to, making it easier for them to express their pain level.

C. While observing the child’s behavior can provide insights, it does not give a direct assessment of pain.

D. Rating pain on a scale of one to ten may be difficult for a child this age, as they may not fully understand numerical values.

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Correct Answer is B

Explanation

A. Administering oxygen is unnecessary, as the respiratory rate is within the normal range for a 3-week-old (30-60 breaths/min).

B. A respiratory rate of 35 breaths/minute is normal for an infant, so the nurse should document this finding.

C. Reassessing the respiratory rate is unnecessary unless other symptoms are present.

D. There is no need to notify the healthcare provider, as the respiratory rate is within normal limits.

A. "We will need to go by the weight and height of the child when deciding to change to a booster seat." B. "I will place the infant safety seat in the middle of the back seat, away from the windows." C. "When my baby is sick, the car seat can temporarily go in the front seat." D. "My baby will be able to watch me drive while sitting in the back seat."

Correct Answer is C

Explanation

A. This statement demonstrates understanding of safety guidelines regarding car seats and boosters based on the child's size.

B. Placing the safety seat in the middle of the back seat is a recommended practice for maximizing safety.

C. This statement indicates a lack of understanding as it is unsafe to place a car seat in the front seat, regardless of the child’s health status.

D. This statement reflects a common misconception, as infants should not be in the front seat, but it doesn't indicate a complete lack of understanding.

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Which of the following methods is most effective for a nurse to assess pain in a 4-year-old child?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing the vital signs of a 3-week-old infant with a respiratory infection and notes that the respiratory rate is 35 breaths/minute. On the basis of this finding, what is the most appropriate action?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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