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.
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Correct Answer is D
Explanation
Choice A rationale
A Power of Attorney (POA) cannot be revoked by a healthcare provider. It can only be revoked by the person who granted it or by a court under certain circumstances.
Choice B rationale
A POA does not need to be appointed by a court. It is a legal document that an individual can create to grant authority to another person to make decisions on their behalf. A Healthcare Proxy specifically grants authority over medical decisions.
Choice C rationale
A POA is not only applicable to minors. It can be used by adults to grant authority over financial matters, while a Healthcare Proxy grants authority over medical decisions.
Choice D rationale
A POA grants authority over financial matters, allowing the appointed person to manage finances, pay bills, and make financial decisions. A Healthcare Proxy grants authority over medical decisions, allowing the appointed person to make healthcare decisions if the individual is incapacitated.
Correct Answer is B
Explanation
Choice A rationale
Engaging in parallel play is a normal developmental behavior for an 18-month-old toddler. It indicates that the child is beginning to interact with peers, even if they are not yet playing cooperatively.
Choice B rationale
Walking with assistance at 18 months may indicate a potential developmental delay. By this age, most toddlers should be able to walk independently. If a child is still requiring assistance, it may warrant further evaluation.
Choice C rationale
Speaking at least 10 words is within the expected developmental range for an 18-month-old. This milestone indicates that the child is developing language skills appropriately.
Choice D rationale
Building a tower of 3 blocks is a typical developmental milestone for an 18-month-old. It demonstrates fine motor skills and cognitive development.