A nurse in the emergency department is caring for a preschool-age child who has hemophilia A and sustained an abdominal trauma following a motor vehicle crash. Which of the following actions should the nurse take?

Select all that apply.

Assess for changes in level of consciousness.

Administer factor VIII.

Perform passive range of motion hourly.

Administer factor IX.

Apply a warming blanket over the child.

Answer and Explanation

Correct Answer : A,B

A. Assess for changes in level of consciousness. Abdominal trauma can lead to internal bleeding, which might increase intracranial pressure if bleeding occurs in the brain. Monitoring for neurological changes is essential.
B. Administer factor VIII. Hemophilia A results from factor VIII deficiency, and replacing it prevents further bleeding.
C. Perform passive range of motion hourly. Movement may exacerbate bleeding into the joints or injured tissues. Rest is essential during acute bleeding episodes.
D. Administer factor IX. Factor IX is used for hemophilia B, not hemophilia A.
E. Apply a warming blanket over the child. Hypothermia management may be necessary in some trauma cases, but there is no indication it is needed here based on the scenario provided.

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Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"}}

Explanation

Feed infant in a supine position: Contraindicated

Supine feeding increases the risk of aspiration and exacerbates reflux.

Offer smaller, more frequent feedings: Appropriate

Smaller, frequent feedings reduce gastric distension and reflux episodes.

Thicken formula feedings with rice cereal: Appropriate

Thickened feedings can help reduce reflux by increasing the weight of the stomach contents.

Place infant in a side-lying position for sleep: Contraindicated

The recommended sleep position for infants is supine (on the back) to reduce the risk of sudden infant death syndrome (SIDS).

A. Insert the tip of the thermometer 5 cm (2 in) into the rectum. B. Place the child in prone position. C. Stabilize the thermometer at the distal end. D. Direct the tip of the thermometer toward the spine during insertion.

Correct Answer is C

Explanation

A. Insert the tip of the thermometer 5 cm (2 in) into the rectum. The correct insertion depth is 2.5 cm (1 inch) for toddlers to avoid rectal injury.
B. Place the child in prone position. The child should be placed in the side-lying or supine position with legs flexed.
C. Stabilize the thermometer at the distal end. Stabilizing the thermometer ensures it remains in position during the procedure, minimizing risk of injury.
D. Direct the tip of the thermometer toward the spine during insertion. The thermometer should be directed toward the umbilicus to follow the natural rectal curve.

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A nurse in the emergency department is caring for a preschool-age child who has hemophilia A and sustained an abdominal trauma following a motor vehicle crash. Which of the following actions should the nurse take? Select all that apply.

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Naxlex Comprehensive Predictor Exams

The nurse is continuing to care for the infant. The nurse is providing teaching to the parents of the infant. For each instruction, click to specify if the instruction is appropriate or contraindicated for the infant.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"B"}}

Explanation

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Correct Answer is C

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A nurse in the emergency department is caring for a preschool-age child who has hemophilia A and sustained an abdominal trauma following a motor vehicle crash. Which of the following actions should the nurse take?

Select all that apply.