A nurse is caring for a client with a suspected bleeding disorder. Which nursing assessment is most essential to identify potential bleeding sources?
Neurological assessment
Skin integrity assessment
Abdominal assessment
Respiratory assessment
The Correct Answer is B
A) Incorrect. A neurological assessment is important to evaluate the client's central nervous system function, but it is not directly related to identifying bleeding sources.
B) Correct. A skin integrity assessment is essential to identify potential external bleeding sources, such as cuts, bruises, or petechiae, which may indicate underlying bleeding disorders.
C) Incorrect. While an abdominal assessment is crucial in identifying internal bleeding in the abdominal area, it is not the most essential assessment to identify bleeding sources overall.
D) Incorrect. A respiratory assessment is important for assessing oxygenation and respiratory status, but it is not the primary assessment to identify bleeding sources.
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Related Questions
Correct Answer is B
Explanation
A) Incorrect. Applying a warm compress may promote vasodilation and increase bleeding in the joint. It is not recommended for managing joint bleeding in a client with hemophilia.
B) Correct. The priority intervention for managing joint bleeding in a client with hemophilia is to administer prescribed clotting factor replacement therapy to promote clot formation and stop the bleeding.
C) Incorrect. Elevating the affected joint can help reduce swelling, but it is not the priority intervention when the client is experiencing an acute joint bleed.
D) Incorrect. Encouraging active range of motion exercises can worsen joint bleeding and is contraindicated in a client with acute joint bleeding due to hemophilia.
Questions
Correct Answer is B
Explanation
A) Incorrect. A neurological assessment is important to evaluate the client's central nervous system function, but it is not directly related to identifying bleeding sources.
B) Correct. A skin integrity assessment is essential to identify potential external bleeding sources, such as cuts, bruises, or petechiae, which may indicate underlying bleeding disorders.
C) Incorrect. While an abdominal assessment is crucial in identifying internal bleeding in the abdominal area, it is not the most essential assessment to identify bleeding sources overall.
D) Incorrect. A respiratory assessment is important for assessing oxygenation and respiratory status, but it is not the primary assessment to identify bleeding sources.
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