A 15-year-old patient with hemophilia is admitted with hemarthrosis. Which nursing action should be implemented?
Maintaining supplemental oxygen.
Elevating the head of the bed 45 degrees.
Providing passive range-of-motion exercises to all extremities.
Immobilizing the affected joint.
The Correct Answer is D
Choice A rationale:
Maintaining supplemental oxygen is not directly relevant to the management of hemarthrosis in a patient with hemophilia. Hemarthrosis is bleeding into a joint due to impaired clotting factors in hemophilia, and oxygen supplementation is not a primary intervention.
Choice B rationale:
Elevating the head of the bed 45 degrees is not the most appropriate action for hemarthrosis. Elevation would not address the joint bleeding, and it could potentially cause discomfort to the patient.
Choice C rationale:
Providing passive range-of-motion exercises to all extremities is contraindicated in this scenario. Active or passive range-of-motion exercises could exacerbate bleeding and further damage the affected joint in a patient with hemarthrosis.
Choice D rationale:
Immobilizing the affected joint is the correct nursing action. Immobilization helps to prevent further bleeding and joint damage. By limiting movement, the risk of exacerbating the bleeding is minimized, promoting healing and reducing pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Painful joints are not a common side effect of prednisone. Prednisone can cause musculoskeletal issues, but painful joints are not a prominent manifestation.
Choice B rationale:
A decrease in appetite is a possible side effect of prednisone. However, it's not the focus of this question, as other choices are more relevant.
Choice C rationale:
A yellow tinge to the whites of the eyes (jaundice) is not a commonly associated side effect of prednisone. Jaundice is usually linked to liver dysfunction or other conditions affecting bilirubin metabolism.
Choice D rationale:
A round face, often referred to as "moon face,”. is a well-recognized side effect of prednisone. It occurs due to fluid retention and fat redistribution, leading to a characteristic facial appearance.
Correct Answer is B
Explanation
Choice A rationale:
Allowing the patient to remain in the chosen position is inappropriate as the patient's position indicates distress. This choice should not be chosen.
Choice B rationale:
Placing the patient in semi-Fowler's position is the correct action. This position optimizes lung expansion and promotes easier breathing, which is crucial in managing status asthmaticus.
Choice C rationale:
Administering 100% oxygen via a face mask might be necessary eventually, but optimizing positioning takes precedence. Semi-Fowler's position should be established first.
Choice D rationale:
Encouraging consumption of cool, clear fluids is not the immediate priority in managing status asthmaticus. Respiratory support and positioning are more crucial.
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