At hemophilia camp several children with injuries arrive at the clinic at the same time. Which of the following children require the most immediate care?
A child that was playing soccer when he collided with another child and now has a swollen knee
A child that was running and fell forward with abrasions on both arms
A child that stepped on a nail that has a puncture wound on the foot
A child that was running around the pool and fell and hit his head
The Correct Answer is D
A. While hemarthrosis (bleeding into joints) is common in hemophilia and requires prompt factor replacement and assessment, it is not immediately life-threatening unless associated with vascular compromise or severe pain that threatens circulation.
B. Minor abrasions are low-risk injuries. They may require cleaning and monitoring for infection, but they do not pose an immediate threat to life or major function.
C. Puncture wounds carry a risk for tetanus and infection, but they are not immediately life-threatening unless signs of severe infection or vascular compromise appear. Prompt cleaning, tetanus prophylaxis, and factor coverage are important, but urgency is lower than for head trauma.
D. Head trauma in a child with hemophilia is an emergency. Even a minor impact can cause intracranial hemorrhage, which may be rapidly life-threatening. Symptoms such as vomiting, lethargy, headache, or neurological changes require immediate assessment, factor replacement, and emergency intervention. Hemophilia increases the risk of severe bleeding even without external signs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Shakiness, tremors, anxiety, palpitations, and irritability are early signs of hypoglycemia, which occurs when blood glucose drops below the child’s target range (often <70 mg/dL). Prompt recognition allows immediate intervention, such as administering fast-acting carbohydrates (juice or glucose tablets), preventing progression to seizures or loss of consciousness.
B. Fruity or acetone-smelling breath is a hallmark of hyperglycemia with ketosis, commonly associated with diabetic ketoacidosis (DKA). It occurs because insufficient insulin causes the body to metabolize fat for energy, producing ketones. Other signs include nausea, vomiting, abdominal pain, and rapid breathing. Early recognition is crucial to prevent severe metabolic acidosis.
C. Hyperglycemia can lead to dehydration due to osmotic diuresis. The resulting fluid loss can cause warm, flushed skin, along with increased thirst (polydipsia) and frequent urination (polyuria). These signs often develop gradually, unlike hypoglycemia, which presents more suddenly.
D. Sweating, pallor, tremors, irritability, confusion, slurred speech, and weakness are classic signs of hypoglycemia, not hyperglycemia. Hypoglycemia develops rapidly and can progress to seizures, coma, or death if untreated. Misidentifying these symptoms as hyperglycemia could delay administering glucose and lead to serious complications.
Correct Answer is A
Explanation
A. Myelomeningocele is a type of spina bifida in which a portion of the spinal cord and meninges protrude through a defect in the vertebral column. The exposed sac is fragile and at high risk for infection and trauma. Covering it with a sterile, saline-moistened dressing maintains moisture, prevents desiccation, and reduces the risk of infection. This is the highest priority nursing intervention prior to surgical repair.
B. While thermoregulation is important in newborns, preventing cold stress is secondary to protecting the integrity of the myelomeningocele sac. The sac’s protection and prevention of infection take priority over temperature control.
C. Leaving the sac exposed and dry increases the risk of rupture and infection, which can lead to severe complications including meningitis or neurological damage. This approach is unsafe and contrary to standard preoperative care guidelines.
D. Positioning an infant with myelomeningocele requires caution to avoid pressure on the sac. Typically, the infant is placed prone or on the side with careful padding to prevent sac trauma. Frequent repositioning without proper support could injure the sac. Therefore, routine side-to-side turning is not recommended until after surgical repair and stabilization.
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