A nurse is caring for a child in the emergency department (ED).

Exhibits
For each potential intervention, click to specify if the potential intervention is expected or unexpected for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Have child tilt head back

Insert cotton into nostril

Apply ice to bridge of nose

Apply pressure to tip of nose for at least 10 min

Prepare to administer factor VIII

Prepare to administer topical antifibrinolytic agent

Prepare to administer packed red blood cells

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"A"},"G":{"answers":"B"}}

Potential Intervention	Expected	Unexpected	Rationale
Have child tilt head back		✅	Tilting the head back increases the risk of blood being swallowed, which can cause nausea or aspiration.
Insert cotton into nostril		✅	Cotton can be ineffective and may dislodge, worsening bleeding. Use gauze or a nasal tampon if needed.
Apply ice to bridge of nose	✅		Cold vasoconstricts blood vessels, helping reduce nasal bleeding.
Apply pressure to tip of nose for at least 10 min	✅		First-line measure for anterior epistaxis. Correct site is the soft part (lower third) of the nose.
Prepare to administer factor VIII	✅		The child has a Factor VIII deficiency (35%), which is diagnostic of Hemophilia A. Factor VIII replacement is the treatment.
Prepare to administer topical antifibrinolytic agent	✅		These agents help stabilize clots and are used for mucosal bleeds in hemophilia.
Prepare to administer packed red blood cells		✅	Not indicated unless there is severe blood loss with signs of anemia or hemodynamic instability, which is not present here.

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Correct Answer is A

Explanation

A. Oucher pain rating scale:

Appropriate for children aged 3 to 12 years. It uses photographs of children's faces that show increasing discomfort and is helpful for preschoolers like this 4-year-old.

B. Word-Graphic rating scale:

Designed for older children (usually 6 years and above) who can read and understand descriptive words; not ideal for a 4-year-old.

C. Numeric rating scale:

Requires the child to understand numerical concepts and rank pain on a 0–10 scale; suitable for children 8 years and older.

D. Visual analog scale:

Also more suitable for older children and adults who can understand and interpret the abstract concept of a visual continuum.

A. Have child tilt head back B. Insert cotton into nostril C. Apply ice to bridge of nose D. Apply pressure to tip of nose for at least 10 min E. Prepare to administer factor VIII F. Prepare to administer topical antifibrinolytic agent G. Prepare to administer packed red blood cells

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

Explanation

Potential Intervention	Expected	Unexpected	Rationale
Have child tilt head back		✅	Tilting the head back increases the risk of blood being swallowed, which can cause nausea or aspiration.
Insert cotton into nostril		✅	Cotton can be ineffective and may dislodge, worsening bleeding. Use gauze or a nasal tampon if needed.
Apply ice to bridge of nose	✅		Cold vasoconstricts blood vessels, helping reduce nasal bleeding.
Apply pressure to tip of nose for at least 10 min	✅		First-line measure for anterior epistaxis. Correct site is the soft part (lower third) of the nose.
Prepare to administer factor VIII	✅		The child has a Factor VIII deficiency (35%), which is diagnostic of Hemophilia A. Factor VIII replacement is the treatment.
Prepare to administer topical antifibrinolytic agent	✅		These agents help stabilize clots and are used for mucosal bleeds in hemophilia.
Prepare to administer packed red blood cells		✅	Not indicated unless there is severe blood loss with signs of anemia or hemodynamic instability, which is not present here.

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A nurse is caring for a child in the emergency department (ED). Exhibits For each potential intervention, click to specify if the potential intervention is expected or unexpected for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a 4-year-old child following a surgical procedure. Which of the following pain rating scales should the nurse use?

Correct Answer is A

Explanation