A nurse is caring for a child with hemophilia.
Which of the following interventions should be included in your plan of care and teaching to the caregivers? Select all that apply.
The child should be able to participate in contact sports.
Immunizations should be given subcutaneously.
If the child has an injury to their knee, the joint should be immobilized.
Pain management should include only acetaminophen.
Episodes of epistaxis should be treated with compression and ice if needed.
Correct Answer : B,C,D,E
Choice A rationale
Children with hemophilia have a deficiency in a specific clotting factor (Factor VIII for Hemophilia A, Factor IX for Hemophilia B), which significantly impairs the coagulation cascade and places them at extremely high risk for life-threatening bleeds from trauma. Participation in high-impact or contact sports, such as football or hockey, must be strictly avoided to prevent spontaneous or injury-induced deep tissue, joint, or intracranial hemorrhage.
Choice B rationale
Due to the high risk of bleeding, any procedure that penetrates the muscle and potentially damages blood vessels, like intramuscular (IM) injections, should be minimized or avoided. Subcutaneous (SubQ) injections are preferred for necessary immunizations because they cause less trauma to blood vessels and have a lower risk of causing a deep hematoma, although firm pressure must still be applied afterward.
Choice C rationale
A joint injury, such as a knee hemarthrosis, is a common and serious complication of hemophilia, causing severe pain and swelling. Initial management involves RICE (Rest, Ice, Compression, Elevation). Immobilization of the affected joint is crucial to prevent further movement that could aggravate bleeding, reduce pain, and preserve joint function until the bleeding is controlled, usually with factor replacement therapy.
Choice D rationale
Pain management in a child with hemophilia must strictly avoid nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin, as these medications inhibit platelet aggregation and increase the risk of bleeding. Acetaminophen is the analgesic of choice because it does not affect platelet function or increase bleeding risk, providing a safe option for managing mild to moderate pain, including that from hemarthrosis.
Choice E rationale
Epistaxis (nosebleeds) is a common bleeding episode in children with hemophilia. The appropriate initial intervention is to apply direct, continuous compression to the soft lower part of the nose for at least 10 minutes while tilting the head forward to prevent blood from flowing down the throat. Applying an ice pack to the bridge of the nose or the back of the neck causes vasoconstriction, which can help to slow the bleeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C"]
Explanation
Choice A rationale
Lack of babbling, which typically begins around 4 to 6 months of age and involves repeated consonant-vowel sounds, is a red flag for language and auditory processing difficulties, but a deficit by only 6 months may be early for a definitive autism warning sign. More characteristic early indicators are often related to a lack of social interaction and non-verbal communication.
Choice B rationale
Inability to say a single word (meaningful, not just sound) by 16 months is a key developmental red flag and strongly suggests a significant delay in expressive language, a core area often affected in autism spectrum disorder (ASD). This milestone should typically be achieved between 12 and 15 months; the absence at 16 months warrants further evaluation.
Choice C rationale
Lack of gestures, such as pointing, waving, or showing objects, by 8 to 12 months is a very significant early warning sign for ASD. Non-verbal communication, including gestures, is crucial for social interaction and joint attention; the absence of these spontaneous actions by 8 months indicates a potential delay in critical social skills.
Choice D rationale
Inability to use two words together meaningfully (two-word phrases) by 18 months is a recognized language delay indicator. While this is a general developmental red flag, the more typical warning sign for ASD specifically focuses on the lack of single words by 16 months or the absence of symbolic play and joint attention earlier on.
Correct Answer is ["150"]
Explanation
Step 1 is to convert the child's weight from pounds to kilograms:. 33 pounds ÷ 2.2 kg/pound = 15 kg.
Step 2 is to calculate the total milliliters to be transfused per hour using the ordered rate:. 15 kg × 10 mL/kg/hour = 150 mL/hour. The nurse should transfuse the platelets at a rate of 150 milliliters per hour.
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