A home health nurse is developing a plan of care for the parents of a toddler who has hemophilia A. Which of the following instructions should the nurse include?

Administer aspirin for pain.

Place knee pads on the child.

Perform passive range-of-motion exercises following an acute episode.

Use a firm-bristled toothbrush for dental care.

Answer and Explanation

The Correct Answer is B

A. Administer aspirin for pain. Aspirin increases the risk of bleeding and is contraindicated in clients with hemophilia. Acetaminophen is recommended instead.
B. Place knee pads on the child. Protective gear like knee pads can help prevent joint injuries, which are common in toddlers with hemophilia.
C. Perform passive range-of-motion exercises following an acute episode. Active range-of-motion exercises are preferred after an acute episode to prevent joint damage. Passive exercises can exacerbate bleeding.
D. Use a firm-bristled toothbrush for dental care. A soft-bristled toothbrush should be used to minimize gum bleeding.

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Correct Answer is A

Explanation

A. Face, legs, activity, cry, consolability (FLACC) scale: The FLACC scale is appropriate for children aged 2 months to 7 years and assesses pain based on non-verbal cues such as facial expression, leg movement, activity, crying, and consolability.
B. Oucher scale and C. FACES scale are more appropriate for children aged 3 years and older who can self-report their pain.
D. Visual analog scale (VAS) is suitable for older children (typically 8 years and older) who can understand the concept of a continuum of pain.

A. Trunk, arms, and hands warm to palpation B. Edema noted to hands, feet, and periorbital area C. Weak bilateral femoral pulses D. Lower extremities cool to palpation E. Mucous membranes pink and moist F. Blood pressure 98/60 mm Hg right arm: 60/40 mm Hg right leg Heart rate 168/min G. Respiratory rate 34/min

Correct Answer is ["B","C","D","F"]

Explanation

Findings that require follow-up:

Edema noted to hands, feet, and periorbital area: Edema in these areas, especially periorbital edema, could indicate fluid retention, possibly from heart failure, kidney issues, or circulatory problems. This should be further evaluated to determine the underlying cause.
Weak bilateral femoral pulses: Weak femoral pulses could suggest a circulatory problem or arterial insufficiency. This is concerning as it could indicate a vascular or cardiac issue that requires immediate investigation.
Lower extremities cool to palpation: Cool lower extremities may indicate poor circulation, which can be caused by a cardiovascular issue, such as shock or impaired circulation, which needs immediate attention.
Blood pressure discrepancy (right arm: 98/60 mm Hg, right leg: 60/40 mm Hg): A significant difference in blood pressure readings between the arms and legs (known as a differential blood pressure) can indicate conditions like coarctation of the aorta (a congenital heart defect), which requires immediate follow-up.

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A home health nurse is developing a plan of care for the parents of a toddler who has hemophilia A. Which of the following instructions should the nurse include?

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