A nurse is assessing a child who is 2 hr postoperative following a cardiac catheterization and finds the dressing is saturated with blood. Which of the following actions should the nurse take first?
Apply pressure just above the insertion site.
Monitor the pulse distal to the insertion site.
Obtain vital signs.
Reinforce the dressing.
The Correct Answer is A
A. This is the first step to control bleeding and prevent further blood loss.
B. Monitoring the distal pulse is important, but controlling bleeding takes precedence.
C. Vital signs can wait momentarily until the bleeding is under control.
D. Reinforcing the dressing may be necessary, but controlling bleeding is the immediate priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Increased capillary refill time is not typically associated with hypoglycemia. It may indicate poor peripheral circulation.
B. Shakiness or tremors are common signs of hypoglycemia, as the body responds to low blood sugar levels.
C. Thirst is not typically associated with hypoglycemia. It may be a symptom of hyperglycemia, where blood sugar levels are high.
D. While decreased appetite can occur with hypoglycemia, it is not as specific a symptom as shakiness. It can also occur due to various other reasons.
Correct Answer is B
Explanation
A. Unopened bottles of formula are not typically sources of healthcare-associated infections.
B. Bedside computer keyboards can harbor pathogens and serve as fomites for transmitting infections.
C. Disposable diapers are not typically sources of healthcare-associated infections if used appropriately.
D. Protective plastic gowns are not typically sources of healthcare-associated infections if used appropriately.
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