A 20-year-old male patient with a known history of hemophilia A is brought to the emergency department with swelling and pain in his right knee after a minor fall. Which of the following is the most appropriate initial nursing intervention?
Prepare the patient for immediate surgical intervention.
Administer aspirin for pain relief.
Apply ice to the affected knee and elevate the leg.
Perform passive range of motion exercises on the affected knee.
The Correct Answer is C
Choice A Reason:
Preparing the patient for immediate surgical intervention is not the first-line treatment for hemophilia-related joint bleeding. Surgery is considered only if there is severe damage or if conservative measures fail. Initial management focuses on controlling bleeding and reducing inflammation.
Choice B Reason:
Administering aspirin for pain relief is contraindicated in patients with hemophilia. Aspirin inhibits platelet function and can exacerbate bleeding. Alternative pain management strategies that do not affect clotting should be used.
Choice C Reason:
Applying ice to the affected knee and elevating the leg is the most appropriate initial intervention. Ice helps to reduce swelling and pain, while elevation minimizes blood flow to the area, helping to control bleeding. This conservative approach is crucial in managing acute hemarthrosis in hemophilia patients.
Choice D Reason:
Performing passive range of motion exercises on the affected knee is not recommended during the acute phase of hemarthrosis. Movement can increase bleeding and worsen the condition. Rest and immobilization are preferred until the bleeding is controlled.
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Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Primary hyperparathyroidism is characterized by elevated PTH levels, which lead to increased serum calcium levels and decreased serum phosphate levels. The patient’s lab results show low PTH and low serum calcium, which are not consistent with primary hyperparathyroidism.
Choice B Reason:
Chronic kidney disease (CKD) can cause disturbances in calcium and phosphate metabolism, but it typically presents with elevated PTH levels due to secondary hyperparathyroidism. The patient’s low PTH levels make CKD an unlikely diagnosis in this context.
Choice C Reason:
Vitamin D deficiency can lead to low serum calcium levels, but it usually results in elevated PTH levels as the body attempts to compensate for the low calcium. The patient’s low PTH levels do not align with a diagnosis of vitamin D deficiency.
Choice D Reason:
Hypoparathyroidism is characterized by low serum calcium, low PTH levels, and elevated serum phosphate levels. This condition occurs when the parathyroid glands do not produce enough PTH, leading to the observed lab results and symptoms such as tingling, muscle cramps, and fatigue. The patient’s lab results are consistent with hypoparathyroidism.
Correct Answer is A
Explanation
Choice A Reason:
Administering propranolol intravenously is the most appropriate initial intervention for managing a thyroid storm. Thyroid storm is a life-threatening condition characterized by severe hyperthyroidism, leading to symptoms such as tachycardia, hypertension, and hyperthermia. Propranolol, a non-selective beta-blocker, helps control these symptoms by reducing heart rate and blood pressure. Additionally, propranolol inhibits the peripheral conversion of T4 to T3, the more active form of thyroid hormone, thereby reducing the overall thyroid hormone activity. This makes it a critical first step in stabilizing the patient.
Choice B Reason:
Administering dextrose 50% intravenously is not the most appropriate initial intervention for thyroid storm. Dextrose 50% is typically used to treat severe hypoglycemia by rapidly increasing blood glucose levels. While maintaining adequate glucose levels is important, it does not address the primary issue of excessive thyroid hormone activity in thyroid storm.
Choice C Reason:
Administering levothyroxine orally is inappropriate in the context of thyroid storm. Levothyroxine is a synthetic form of T4 used to treat hypothyroidism, not hyperthyroidism. Administering it in a thyroid storm would exacerbate the condition by increasing the levels of thyroid hormone in the body.
Choice D Reason:
Administering insulin to control hyperglycemia is not the primary intervention for thyroid storm. While hyperglycemia can occur in thyroid storm due to increased metabolic activity, the immediate priority is to control the excessive thyroid hormone activity. Insulin administration would be secondary to stabilizing the patient’s thyroid function.
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