A nurse is caring for a 5-year-old child following a tonsillectomy and adenoidectomy. Which of the following findings should the nurse identify as an indication of hemorrhage?
Continuous swallowing.
Blood pressure 95/56 mm Hg.
Heart rate 54/min.
Flushing of the face.
The Correct Answer is A
Choice A rationale
Continuous swallowing can be an indication of hemorrhage following a tonsillectomy and adenoidectomy. This is because the child may be swallowing blood that is coming from the surgical site.
Choice B rationale
Blood pressure of 95/56 mm Hg is within the normal range for a 5-year-old child and does not specifically indicate hemorrhage.
Choice C rationale
A heart rate of 54/min is lower than the normal range for a 5-year-old child and may indicate bradycardia, but it is not a specific sign of hemorrhage.
Choice D rationale
Flushing of the face is not a specific sign of hemorrhage. It may indicate other conditions but is not typically associated with bleeding following a tonsillectomy and adenoidectomy.
Free Nursing Test Bank
- Free Pharmacology Quiz 1
- Free Medical-Surgical Quiz 2
- Free Fundamentals Quiz 3
- Free Maternal-Newborn Quiz 4
- Free Anatomy and Physiology Quiz 5
- Free Obstetrics and Pediatrics Quiz 6
- Free Fluid and Electrolytes Quiz 7
- Free Community Health Quiz 8
- Free Promoting Health across the Lifespan Quiz 9
- Free Multidimensional Care Quiz 10
View Related questions
Correct Answer is D
Explanation
Choice A rationale
Rinsing the child’s mouth with chlorhexidine mouthwash if they develop stomatitis is not recommended. Chlorhexidine can be harsh and may cause further irritation in a child with stomatitis.
Choice B rationale
Ensuring the administration of an antiemetic for 12 hours after chemotherapy is not sufficient. Antiemetics should be given before, during, and after chemotherapy to effectively manage nausea and vomiting.
Choice C rationale
Encouraging eating by providing the child with their favorite foods is not always appropriate. Some foods may exacerbate nausea or be contraindicated during chemotherapy.
Choice D rationale
Using a soft-bristled toothbrush when platelet levels are low is correct. This helps prevent gum bleeding and injury, which is important for children with low platelet counts due to chemotherapy.
Correct Answer is A
Explanation
Choice A rationale
Requesting a provider prescription for ferrous sulfate is correct. Ferrous sulfate is an iron supplement used to treat iron deficiency anemia by increasing iron levels in the blood.
Choice B rationale
Preparing to administer factor VII concentrate is not appropriate for iron deficiency anemia. Factor VII is used for bleeding disorders, not anemia.
Choice C rationale
Encouraging the use of a soft sponge toothbrush for oral hygiene is not directly related to treating iron deficiency anemia. While it is good practice for children with low platelet counts, it does not address the anemia.
Choice D rationale
Placing the child in protective precautions is not necessary for iron deficiency anemia. Protective precautions are typically used for patients with compromised immune systems or infectious diseases.