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 C
Explanation
Choice A rationale:
Monitoring the cast daily for foul odors is a proper action to identify potential infection.
Choice B rationale:
Bringing the child for frequent checkups to the clinic is important to ensure the cast is healing properly.
Choice C rationale:
Using the cast stabilizing bar to turn the child can be concerning. There's no mention of a cast stabilizing bar, so this statement suggests a lack of understanding or misinformation.
Choice D rationale:
Massaging the skin around the edges of the child's cast can help prevent skin irritation, so it's an appropriate action.
Correct Answer is C
Explanation
Choice A rationale:
Waiting to discuss the surgery until the child asks specific questions might lead to increased anxiety as the child may be apprehensive about the surgery but unable to express their concerns.
Choice B rationale:
Setting aside an hour a day to talk about the child's feelings concerning the surgery can be overwhelming for a 5-year-old, potentially increasing anxiety and making the procedure seem more daunting.
Choice C rationale:
Reading the child a story about children of similar age who go to the hospital for surgery provides a developmentally appropriate approach. It helps the child understand the process through relatable characters, reducing fear and uncertainty about the upcoming experience.
Choice D rationale:
Having the child visit a family whose preschool child has just been discharged from the hospital might expose the child to unfamiliar situations, possibly leading to more confusion and anxiety.
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