A nurse is monitoring a child who is postoperative following a tonsillectomy for signs of hemorrhage. Which of the following findings is a sign of this postoperative complication?
Frequent swallowing
Reports of thirst
Reports of pain
Mouth breathing
The Correct Answer is A
A. Frequent swallowing is a common finding after a tonsillectomy due to postoperative throat discomfort and the sensation of having a foreign object in the throat (such as blood clots or mucus).
B. Reports of thirst may indicate dehydration, which can occur after surgery, especially if the child is not drinking enough fluids due to pain or discomfort. While dehydration can be a concern after a tonsillectomy, it is not a specific sign of hemorrhage.
C. Pain is common after a tonsillectomy and can be expected in the postoperative period. While increased pain may be present if hemorrhage occurs, it is not a specific sign of hemorrhage on its own.
D. Mouth breathing does not directly indicate bleeding and is more related to discomfort or difficulty breathing through the nose, especially if the child is experiencing throat pain. It is not a typical sign of hemorrhage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Wheezing, which is a high-pitched whistling sound heard during expiration, is a common symptom of asthma. It occurs due to narrowed airways and airflow obstruction, often in response to triggers such as allergens, respiratory infections, or exercise.
B. Low-grade fever in the afternoon is not typically associated with asthma. Fever is more commonly seen in response to infections, such as respiratory infections, which can exacerbate asthma symptoms but is not a direct manifestation of asthma itself.
C. Without the complete statement, it is difficult to assess its relevance to asthma symptoms. However, an abrupt onset of symptoms, such as sudden shortness of breath or chest tightness, may occur during an asthma attack or exacerbation.
D. Sharp pleuritic pain is not a typical finding in asthma. Pleuritic pain, which is sharp and worsened by breathing, is more commonly associated with conditions affecting the pleura, such as pneumonia or pleurisy.
Correct Answer is D
Explanation
D. This is the correct characteristic of decerebrate posturing. Decerebrate posturing is characterized by rigid extension and pronation (turning inward) of the arms and legs. It indicates severe neurological dysfunction and increased intracranial pressure, often involving damage to the brainstem.
A. This characteristic is not associated with decerebrate posturing. Adduction refers to movement toward the midline of the body, which is not typically observed in decerebrate posturing.
B. This description is not characteristic of decerebrate posturing. Decerebrate posturing involves extension, not flexion, of the upper extremities, along with extension and pronation (not adduction) of the lower extremities.
C. Flaccid paralysis refers to the absence of muscle tone and movement, which is not characteristic of decerebrate posturing. Decerebrate posturing involves increased muscle tone and abnormal, rigid extension of the arms and legs.
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