Review Pain assessment tools and scales in children

Pain Assessment and Management in Children > Pediatrics

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Pain assessment tools and scales in children

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Total Questions : 18

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Question 1:

A nurse is preparing to assess a non-verbal child’s pain level using the FLACC Scale.
The nurse knows that this scale rates five behavioral indicators.
Which of the following statements would be appropriate for the nurse to say during this assessment?

A. “I will observe your facial expression.”.. B. “I will watch how you move your legs.”.. C. “I will note your activity level.”.. D. “I will listen to your cry and observe your consolability.”..

Answer and Explanation

Choice A:

I will observe your facial expression.”.. This statement is not appropriate for assessing pain in a non-verbal child using the FLACC Scale because it does not address the five behavioral indicators the scale measures. The FLACC Scale assesses facial expression, leg movement, activity level, cry, and consolability.

Choice B:

I will watch how you move your legs.”.. This statement is also not appropriate for using the FLACC Scale as it only focuses on one of the five behavioral indicators. While leg movement is assessed, it's crucial to evaluate all indicators for a comprehensive pain assessment.

Choice C:

I will note your activity level.”.. This statement is partially correct, as the FLACC Scale does assess activity level. However, it does not cover all the indicators, and it's essential to mention the other components for a complete assessment.

Choice D:

I will listen to your cry and observe your consolability.”.. This statement is the most appropriate choice. The FLACC Scale rates five behavioral indicators, and this statement acknowledges two of them: cry and consolability. A comprehensive assessment should include all five indicators for an accurate pain evaluation in non-verbal children.

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Question 2:

A client’s child is about to undergo a painful procedure.
The nurse decides to use the Wong-Baker FACES Pain Rating Scale to assess the child’s pain level.
Which of the following statements would be appropriate for the nurse to say to the child during this assessment?

A. “Please point to the face that best represents your pain.”.. B. “Remember, the faces range from smiling to crying.”.. C. “This scale is used to represent different levels of pain intensity.”.. D. “The face you choose will help us understand how much pain you are in.”..

Answer and Explanation

Choice A:

Please point to the face that best represents your pain.”.. This statement is appropriate for using the Wong-Baker FACES Pain Rating Scale. The scale consists of faces with different expressions, and the child is asked to point to the one that best represents their pain intensity. This choice aligns with the scale's methodology.

Choice B:

Remember, the faces range from smiling to crying.”.. While this statement provides some information about the scale, it doesn't guide the child on how to express their pain level accurately. It's essential to ask the child to point to the face that matches their pain, as mentioned in choice A.

Choice C:

This scale is used to represent different levels of pain intensity.”.. This statement is informative but lacks the direct instruction for the child to choose a specific face. To assess pain using the Wong-Baker FACES Pain Rating Scale, it's important to instruct the child explicitly.

Choice D:

The face you choose will help us understand how much pain you are in.”.. This statement is informative but doesn't instruct the child to interact with the scale. It's crucial to involve the child actively in the pain assessment by having them select the face that best represents their pain.

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Question 3:

A nurse is educating a group of nursing students about pediatric pain assessment tools and scales.
Which of the following should be included in the teaching? (Select all that apply)

A. The FLACC Scale is designed for infants and non-verbal children. B. The Wong-Baker FACES Pain Rating Scale is utilized for children aged 3 years and older. C. The Numeric Rating Scale (NRS) is suitable for children aged 5 years and older. D. The FLACC Scale rates five behavioral indicators on a scale from 0 to 2, with a maximum score of 10. E. The Wong-Baker FACES Pain Rating Scale consists of a series of faces with different expressions, representing different levels of pain intensity.

Answer and Explanation

Choice A:

The FLACC Scale is designed for infants and non-verbal children.”.. This is a correct statement. The FLACC Scale is specifically designed for assessing pain in infants and non-verbal children who cannot self-report their pain.

Choice B:

The Wong-Baker FACES Pain Rating Scale is utilized for children aged 3 years and older.”.. This is also a correct statement. The Wong-Baker FACES Pain Rating Scale is suitable for children aged 3 years and older who can use it to express their pain intensity.

Choice C:

The Numeric Rating Scale (NRS) is suitable for children aged 5 years and older.”.. This statement is incorrect. The Numeric Rating Scale (NRS) is generally used for children aged 5 years and older who can understand and use numbers to rate their pain.

Choice D:

The FLACC Scale rates five behavioral indicators on a scale from 0 to 2, with a maximum score of 10.”.. This statement is accurate and describes how the FLACC Scale rates pain based on five behavioral indicators, each scored from 0 to 2, resulting in a maximum score of 10.

Choice E:

The Wong-Baker FACES Pain Rating Scale consists of a series of faces with different expressions, representing different levels of pain intensity.”.. This statement is correct and accurately describes the Wong-Baker FACES Pain Rating Scale, which uses facial expressions to represent various levels of pain intensity.

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Question 4:

A nurse is assessing a child’s pain using the Numeric Rating Scale (NRS)
The child rates their pain as ‘7’ on the scale.
Based on this rating, how should the nurse interpret the child’s pain intensity?

A. The child is experiencing moderate pain. B. The child is experiencing severe pain. C. The child is experiencing mild pain. D. The child is not experiencing any pain.

Answer and Explanation

Choice A:

A rating of '7' on the Numeric Rating Scale (NRS) typically indicates moderate pain. The NRS is commonly used to assess pain in individuals who can communicate their pain level numerically. The scale usually ranges from 0 to 10, with 0 indicating no pain and 10 indicating the worst possible pain. In this context, a score of 7 suggests that the child is experiencing moderate pain, as they have rated their pain above the midpoint of the scale.

Choice B:

A rating of '7' on the NRS does not indicate severe pain. Severe pain would usually be associated with a higher score, often closer to the upper limit of the scale (e.g., 9 or 10) Therefore, choice B is not the correct interpretation in this case.

Choice C:

A rating of '7' on the NRS is higher than what is typically considered mild pain. Mild pain would typically be represented by a lower score, such as 1 to 3 on the NRS. Therefore, choice C is not the correct interpretation.

Choice D:

D, which states that the child is not experiencing any pain, is not the correct interpretation based on the provided pain rating.

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Question 5:

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?

A. The child is experiencing mild pain. B. The child is pain-free. C. The child is in severe pain. D. The child's pain level cannot be determined from the given information.

Answer and Explanation

Choice A:

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:

B is not the correct answer.

Choice C:

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:

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.

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Question 6:

Select all that apply):
A nurse is caring for a group of pediatric patients and needs to assess their pain using appropriate tools.
Which of the following pain assessment tools are suitable for children aged 5 years and older?

A. FLACC Scale. B. Wong-Baker FACES Pain Rating Scale. C. Numeric Rating Scale (NRS) D. Visual Analog Scale (VAS) E. None of the above.

Answer and Explanation

Choice A:

The FLACC Scale (Face, Legs, Activity, Cry, Consolability) is typically used for infants and young children who cannot effectively communicate their pain through verbal means. This tool is not suitable for children aged 5 years and older as they can often express their pain verbally and can use more appropriate pain assessment tools.

Choice B:

The Wong-Baker FACES Pain Rating Scale is a suitable tool for children aged 5 years and older. It uses a series of faces depicting various levels of pain, making it easier for children to express their pain intensity. This tool is particularly useful for children who can understand and communicate their feelings but may have difficulty with numerical scales.

Choice C:

The Numeric Rating Scale (NRS) is a suitable tool for children aged 5 years and older. It asks the child to rate their pain on a scale from 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable. Children in this age group can often understand and use numerical scales effectively.

Choice D:

The Visual Analog Scale (VAS) is not typically recommended for children aged 5 years and older. It requires the ability to mark a point on a line to indicate pain intensity, which can be challenging for young children. Other tools like the Wong-Baker FACES Pain Rating Scale or the Numeric Rating Scale are more appropriate for this age group.

Choice E:

None of the above" is not the correct choice, as options B, C, and D are suitable for children aged 5 years and older.

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Question 7:

A nurse is educating the parents of an 8-year-old child on using the Visual Analog Scale (VAS) for pain assessment.
The child marks a point close to "worst pain imaginable" on the scale.
What does this indicate about the child's pain intensity?

A. The child is experiencing mild pain. B. The child is in severe pain. C. The child is pain-free. D. The child's pain level cannot be determined from the given information.

Answer and Explanation

Choice A:

If the child marked a point close to "worst pain imaginable" on the Visual Analog Scale (VAS), it would indicate severe pain, not mild pain. The child's indication suggests that they are experiencing a high level of pain.

Choice B:

This is the correct answer. When a child marks a point close to "worst pain imaginable" on the VAS, it indicates severe pain. The VAS is a linear scale, with one end representing no pain and the other end representing the most severe pain. Therefore, a mark close to the extreme end of severe pain suggests that the child's pain intensity is high.

Choice C:

If the child marked a point close to "worst pain imaginable," it would not indicate that the child is pain-free. It would actually suggest the opposite, that the child is in significant pain.

Choice D:

The child's pain level can be determined from the given information. By marking a point close to "worst pain imaginable" on the VAS, the child is indicating a high level of pain, which is consistent with the scale's interpretation.

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Question 8:

A client brings in their 6-year-old child to the emergency department.
The nurse decides to assess the child's pain using the Numeric Rating Scale (NRS)
If the child rates their pain as 3 on the scale, what does this numerical value represent regarding the child's pain intensity?

A. Mild pain. B. Moderate pain. C. Severe pain. D. No pain.

Answer and Explanation

Choice A:

If the child rates their pain as 3 on the Numeric Rating Scale (NRS), this numerical value represents mild pain. The NRS typically uses a scale from 0 to 10, with 0 indicating no pain and 10 indicating the worst pain imaginable. A rating of 3 falls on the lower end of the scale, signifying mild discomfort or pain.

Choice B:

An NRS rating of 3 is not considered moderate pain. It is more in the range of mild pain. Moderate pain would typically be rated higher on the scale, such as 4 to 6.

Choice C:

An NRS rating of 3 is not indicative of severe pain. Severe pain would typically be rated much higher on the scale, around 7 or higher.

Choice D:

An NRS rating of 3 does not represent no pain. It indicates the presence of pain, albeit at a relatively mild level. A rating of 0 on the NRS would signify the absence of pain.

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Question 9:

A 5-year-old child presents to the emergency department with a right arm fracture.
The child is crying and restless.
The nurse uses the Numeric Rating Scale (NRS) to assess the child's pain.
The child rates their pain as an 8/10.
Which of the following statements by the nurse is appropriate?

A. "I'm going to give you some pain medicine now.”.. B. "Your pain is not that bad. You'll be okay in a little while.”.. C. "You're probably just scared. There's no need to cry.”.. D. "I can tell that you're in a lot of pain. We're going to do everything we can to help you feel better.”..

Answer and Explanation

Choice A:

Offering pain medication immediately is not appropriate without proper assessment and a healthcare provider's order. It's essential to assess the child's pain properly before administering any medication.

Choice B:

Dismissing the child's pain and telling them it's not that bad is not appropriate. Pain is subjective, and the child's perception of pain is real. It's essential to acknowledge their pain and provide appropriate care.

Choice C:

Assuming the child is just scared and telling them not to cry is not the right approach. Pain should be assessed and addressed appropriately, and the child's feelings should be validated.

Choice D:

This is the correct choice. The nurse acknowledges the child's pain, expresses empathy, and assures them that everything will be done to alleviate their pain. This approach is comforting and therapeutic.

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Question 10:

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?

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.”..

Answer and Explanation

Choice A:

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:

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:

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:

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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Question 11:

A nurse is teaching a group of parents about pain assessment in children.
The nurse explains the importance of using age-appropriate pain assessment tools and scales.
The nurse also discusses the different types of pain assessment tools and scales available.
Which of the following statements by the nurse is accurate?

A. "The FLACC Scale is the best pain assessment tool for all children.”.. B. "The Wong-Baker FACES Pain Rating Scale is the best pain assessment tool for children aged 3 years and older.”.. C. "The Numeric Rating Scale (NRS) is the best pain assessment tool for children aged 5 years and older.”.. D. "The Visual Analog Scale (VAS) is the best pain assessment tool for children aged 8 years and older.”..

Answer and Explanation

Choice A:

The nurse should not state that the FLACC Scale is the best pain assessment tool for all children because pain assessment tools should be age-appropriate. The FLACC Scale is typically used for infants and young children who cannot effectively communicate their pain verbally. It assesses facial expression, leg movement, activity, cry, and consolability. However, it may not be suitable for older children who can use self-reporting pain scales.

Choice B:

This is the correct answer. The Wong-Baker FACES Pain Rating Scale is designed for children aged 3 years and older. It uses a series of faces to represent different levels of pain intensity, making it a useful tool for children who may not be able to describe their pain in words. The scale is widely recognized and accepted for this age group.

Choice C:

The Numeric Rating Scale (NRS) is typically used for older children and adults. It requires the child to assign a numerical value to their pain, usually on a scale from 0 to 10, with 0 representing no pain and 10 being the worst pain possible. It may not be the best choice for younger children, especially those under the age of 5, as they may have difficulty using numbers to describe their pain.

Choice D:

The Visual Analog Scale (VAS) is a pain assessment tool that requires a child to mark their pain level on a line, with one end indicating no pain and the other end indicating the worst pain imaginable. It is often used for older children and adults. Children aged 8 years and older may be able to use the VAS effectively, but it may not be the best choice for younger children, as it requires the ability to understand and use a visual representation of pain.

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Question 12:

A nurse is assessing the pain level of a 4-year-old child who has undergone a surgical procedure.
Which pain assessment tool would be most appropriate for this child?

A. FLACC Scale. B. Wong-Baker FACES Pain Rating Scale. C. Numeric Rating Scale (NRS) D. Visual Analog Scale (VAS)

Answer and Explanation

Choice A:

The FLACC Scale (Face, Legs, Activity, Cry, Consolability) is a pain assessment tool specifically designed for children who cannot effectively communicate their pain verbally. It assesses various aspects, including facial expression, leg movement, activity, cry, and consolability. It is particularly suitable for infants and young children who may not be able to describe their pain in words.

Choice B:

The Wong-Baker FACES Pain Rating Scale is designed for children aged 3 years and older and is based on facial expressions to assess pain intensity. While it is suitable for this age group, it may not be the most appropriate choice for a 4-year-old child who has just undergone surgery, as it may not accurately capture the child's pain experience.

Choice C:

The Numeric Rating Scale (NRS) requires the child to assign a numerical value to their pain, typically on a scale from 0 to 10. This may not be the most appropriate tool for a 4-year-old child, as they may have difficulty using numbers to describe their pain, especially immediately after surgery.

Choice D:

The Visual Analog Scale (VAS) requires the child to mark their pain level on a line, which may also be challenging for a 4-year-old child. This tool is typically used for older children and adults who can better understand and use a visual representation of pain.

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Question 13:

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?

A. FLACC Scale. B. Wong-Baker FACES Pain Rating Scale. C. Numeric Rating Scale (NRS) D. Visual Analog Scale (VAS)

Answer and Explanation

Choice A:

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:

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:

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:

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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Question 14:

Select all that apply.
A nurse is assessing the pain level of a 6-year-old child.
Which pain assessment tools can be used for this child?

A. FLACC Scale. B. Wong-Baker FACES Pain Rating Scale. C. Numeric Rating Scale (NRS) D. Visual Analog Scale (VAS) E. McGill Pain Questionnaire.

Answer and Explanation

Choice A:

The FLACC Scale, which stands for Face, Legs, Activity, Cry, and Consolability, is a suitable pain assessment tool for a 6-year-old child. It uses observable behaviors to assess pain, making it appropriate for young children who may not be able to express their pain verbally. The scale assigns scores to each of these categories, and the total score indicates the level of pain.

Choice B:

The Wong-Baker FACES Pain Rating Scale is another appropriate tool for assessing pain in a 6-year-old child. It uses a series of faces with different expressions, ranging from a happy face to a crying face, to help the child express their pain level. This visual scale is effective for young children who can point to the face that best represents their pain.

Choice C:

The Numeric Rating Scale (NRS) and

Choice D:

the Visual Analog Scale (VAS) are typically not suitable for a 6-year-old child. These scales require a level of cognitive and numerical understanding that may be beyond the capabilities of most 6-year-olds. NRS involves rating pain on a scale from 0 to 10, and VAS involves marking a point on a line to indicate pain severity, which may be too abstract for a child of this age.

Choice E:

The McGill Pain Questionnaire is a more complex and detailed tool designed for older children and adults. It involves a list of descriptive words and phrases to assess various aspects of pain, making it unsuitable for a 6-year-old child.

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Question 15:

A client has a cognitive impairment and is unable to comprehend pain scales effectively.
Which pain assessment tool would be most appropriate for this client?

A. FLACC Scale. B. Wong-Baker FACES Pain Rating Scale. C. Numeric Rating Scale (NRS) D. Visual Analog Scale (VAS)

Answer and Explanation

Choice A:

The FLACC Scale, as previously mentioned, is a suitable pain assessment tool for clients who may have cognitive impairments and cannot effectively comprehend more complex pain scales. It relies on observable behaviors, making it suitable for individuals who cannot express their pain verbally or understand more intricate pain assessment methods.

Choice B:

The Wong-Baker FACES Pain Rating Scale, while effective for many individuals, may still require some level of comprehension to point to the appropriate face on the scale. It may not be the best choice for individuals with severe cognitive impairments.

Choice C:

The Numeric Rating Scale (NRS) and

Choice D:

the Visual Analog Scale (VAS) both require an understanding of numbers and abstract concepts, which may be challenging for clients with cognitive impairments. These scales are not the most appropriate choice for this population.

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Question 16:

A nurse is assessing the pain level of a 10-year-old child who is able to understand and communicate effectively.
Which pain assessment tool would be most suitable for this child?

A. FLACC Scale. B. Wong-Baker FACES Pain Rating Scale. C. Numeric Rating Scale (NRS) D. Visual Analog Scale (VAS)

Answer and Explanation

Choice A:

The FLACC Scale, while suitable for younger children and those who may have difficulty expressing pain verbally, is generally not the best choice for a 10-year-old child who can understand and communicate effectively. At this age, the child is likely capable of using a more straightforward scale.

Choice B:

The Wong-Baker FACES Pain Rating Scale, while visually intuitive, may not be the most suitable choice for a 10-year-old who can understand and communicate effectively. It may be considered too simplistic for their age group.

Choice C:

The Numeric Rating Scale (NRS) is a suitable choice for a 10-year-old child who can understand and communicate effectively. It involves rating pain on a scale from 0 to 10, and a 10-year-old can provide a numerical rating to describe their pain severity.

Choice D:

The Visual Analog Scale (VAS) is also not the most suitable choice for a 10-year-old child, as it involves marking a point on a line to indicate pain severity, which may be considered more complex than necessary for this age group.

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Question 17:

A. The normal range for both scales is 0-10. B. The normal range for both scales is 0-2. C. The normal range for FLACC Scale is 0-2 and for Wong-Baker FACES Pain Rating Scale is 0-10. D. The normal range for FLACC Scale is 0-10 and for Wong-Baker FACES Pain Rating Scale is 0-2.

Answer and Explanation

Choice A:

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:

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:

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:

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.

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Question 18:

A nurse is caring for a group of children on a pediatric unit. The nurse is using a variety of pain assessment tools and scales to assess the children's pain. (Select all that apply).
The nurse should use which of the following pain assessment tools or scales?

A. FLACC Scale. B. Wong-Baker FACES Pain Rating Scale. C. Numeric Rating Scale (NRS). D. Visual Analog Scale (VAS). E. Pediatric Pain Questionnaire (PPQ).

Answer and Explanation

Choice A:

The FLACC Scale is appropriate for assessing pain in non-verbal children, particularly those with limited communication abilities or cognitive impairments.

Choice B:

The Wong-Baker FACES Pain Rating Scale is suitable for children who can use a simple visual scale to indicate their pain level.
It's especially helpful for children who can express themselves through drawings or symbols.

Choice C:

The Numeric Rating Scale (NRS) is a reliable tool for assessing pain in children who can understand and use numbers.
It allows children to rate their pain on a numerical scale.

Choice D:

The Visual Analog Scale (VAS) is another tool for older children who can comprehend and use a visual representation to indicate their pain level.
It involves marking a point on a line to represent pain severity.
The Pediatric Pain Questionnaire (PPQ) is not a commonly used pain assessment tool for children, and its effectiveness may be limited.
Therefore, it's not one of the recommended options for pain assessment in children.

Choice E:

The Pediatric Pain Questionnaire (PPQ) is not a commonly used pain assessment tool for children, and its effectiveness may be limited.
Therefore, it's not one of the recommended options for pain assessment in children.

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