The nurse notices that a child is spitting up small amounts of blood in the immediate postoperative period after a tonsillectomy. What would be the best intervention?
Notify the health care immediately.
Continue to assess for bleeding.
Suction the back of the throat.
Encourage the child to cough.
The Correct Answer is A
A. Notifying the healthcare provider immediately is the best intervention because spitting up blood post-tonsillectomy could indicate bleeding, which requires prompt medical evaluation and intervention.
B. While continuing to assess for bleeding is important, immediate notification of the healthcare provider takes precedence to address potential complications.
C. Suctioning the throat might be contraindicated and could increase the risk of further bleeding.
D. Encouraging coughing is not appropriate as it could increase bleeding risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Testing urine for ketones is crucial during illness because it helps in early detection of diabetic ketoacidosis, which can be life-threatening.
B. Withholding insulin is dangerous during illness, as the body may require more insulin, not less.
C. While it is important to notify the provider if blood glucose levels are elevated, monitoring for ketones takes precedence to prevent complications.
D. Limiting fluid intake is not recommended, as fluids are essential for maintaining hydration and helping to manage blood glucose levels during illness.
Correct Answer is A
Explanation
A. Toddlers are beginning to cooperate in simple chores and tasks, which aligns with their developmental stage.
B. Toddlers often struggle with separation anxiety and do not separate easily from their caregivers.
C. Understanding the difference between right and wrong is a skill that develops later, typically around age 4 or older.
D. Printing letters and numbers is beyond the developmental capabilities of a toddler and is expected later in early childhood.
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