Which of the following priority interventions should a nurse include in the care plan for a client experiencing myxedema coma? Select all that apply.

Rationale:

A. This is correct guidance. Ibuprofen and other NSAIDs are contraindicated in hemophilia because they inhibit platelet function, increasing the risk of bleeding and complicating hemostasis. For pain or fever, acetaminophen is preferred, as it does not affect platelet function or clotting. Educating caregivers on safe medication choices is a key aspect of hemophilia management.

B. Hemophilia is a genetic, lifelong condition caused by a deficiency in clotting factors (usually factor VIII or IX). There is no natural cure or resolution with age, and affected individuals will require ongoing prophylactic factor replacement, bleeding management, and careful monitoring throughout life. Believing a child can outgrow hemophilia can lead to dangerous gaps in care, delayed treatment during bleeding episodes, and increased risk of joint damage or life-threatening hemorrhage. This statement reflects a critical misunderstanding of the disease process.

C. This is appropriate guidance. Immediate first aid for bleeding includes direct pressure, immobilization, and elevation of the affected area. If bleeding persists beyond 10–15 minutes, administration of clotting factor replacement is indicated. Prompt recognition and intervention prevent complications such as hemarthrosis, soft tissue damage, and anemia.

D. This statement is partially correct in that children with hemophilia should avoid high-risk contact sports (e.g., football, hockey) that increase the risk of trauma. However, participation in safe, low-impact activities such as swimming, cycling, or walking is encouraged to promote muscle strength, joint stability, and overall physical health. Activity recommendations should be individualized and balanced with safety precautions.

Rationale:

A. While assessing extremity strength is important for overall neuromuscular function, it is not the immediate priority in a myasthenic crisis. Muscle weakness in the limbs does not pose an immediate threat to life, whereas respiratory compromise does.

B. Myasthenic crisis can cause severe weakness of the respiratory muscles, leading to hypoventilation, respiratory failure, and potential respiratory arrest. Assessing airway patency, respiratory rate, oxygen saturation, and effort is the highest priority because preserving oxygenation and ventilation is critical to prevent life-threatening complications.

C. Gathering a history is important for understanding contributing factors and planning long-term care, but it is secondary to addressing immediate life-threatening respiratory compromise.

D. Blood glucose monitoring is not directly related to the acute management of a myasthenic crisis. It does not address the critical risk of respiratory failure, which takes precedence.