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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?

 

A.

Continuous swallowing.

B.

Blood pressure 95/56 mm Hg.

C.

Heart rate 54/min.

D.

Flushing of the face.

Answer and Explanation

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.


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View Related questions

Correct Answer is C

Explanation

Choice A rationale

Viral conjunctivitis does not require droplet precautions as it is primarily spread through direct contact with eye secretions.

Choice B rationale

Pediculosis capitis (head lice) does not require droplet precautions as it is spread through direct contact with infested hair or personal items.

Choice C rationale

Seasonal influenza requires droplet precautions as it is spread through respiratory droplets when the infected person coughs, sneezes, or talks.

Choice D rationale

Hepatitis A does not require droplet precautions as it is primarily spread through the fecal-oral route

Correct Answer is B

Explanation

Choice A rationale

An increase in potassium levels is not an indicator of the effectiveness of furosemide, which is a diuretic used to reduce fluid overload.

Choice B rationale

A decrease in peripheral edema indicates that furosemide is effectively reducing fluid retention in the body.

Choice C rationale

A decrease in cardiac output is not a desired effect of furosemide and may indicate worsening heart function.

Choice D rationale

An increase in venous pressure is not an indicator of the effectiveness of furosemide and may suggest fluid overload.

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