A nurse is assessing a child who is postoperative following a tonsillectomy. Which of the following findings is a manifestation of hemorrhage?
Poor fluid intake
Increased pain
Drooling
Frequent swallowing
The Correct Answer is D
A. Poor fluid intake may be a concern postoperatively, but it is not a specific manifestation of hemorrhage.
B. Increased pain is expected after a tonsillectomy, especially in the immediate postoperative period, but it is not a specific sign of hemorrhage.
C. Drooling is not related to haemorrhage post tonsillectomy.
D. This symptom may indicate that the child is swallowing blood that is oozing from the surgical site. It is important for healthcare providers to recognize this sign promptly as post-tonsillectomy hemorrhage can be a serious complication requiring immediate attention.
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Related Questions
Correct Answer is B
Explanation
A. A respiratory rate of 20/min is within the normal range, and while it should be monitored, it is not the priority in this case.
B. Blood pressure is a critical indicator of perfusion and can be affected by internal bleeding or other serious injuries. A low blood pressure may suggest significant blood loss and is the priority in assessing for shock.
C. A heart rate of 72/min is within the normal range for an adolescent. While it should be monitored, it is not the immediate priority.
D. Abdominal pain is a subjective measure and, while important, may not accurately reflect the severity of internal injuries. The priority is to assess the hemodynamic stability, as indicated by blood pressure.
Correct Answer is C
Explanation
A. The described behaviors, such as sitting quietly and turning away, may suggest the toddler is seeking comfort and self-soothing, which can be indicative of developing autonomy rather than anxiety.
B. Resentment toward the mother is a less likely interpretation of these behaviors, especially considering the age of the toddler.
C. Developing autonomy is a common developmental stage around this age. Toddlers begin to explore their independence and may engage in self-soothing behaviors.
D. Regression is a return to an earlier developmental stage. The behaviors described are more consistent with the development of autonomy rather than regression.
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