A nurse is obtaining a blood specimen from a client who has a peripherally inserted central catheter. Which of the following actions should the nurse take?

A. Syphilis: Syphilis is a nationally notifiable disease in the United States. Healthcare providers are required to report cases to local or state public health authorities to facilitate disease tracking, outbreak management, and public health interventions.

B. Trichomoniasis: Trichomoniasis is not a nationally notifiable disease. While it is a common sexually transmitted infection, reporting is not required by law at the national level, though some states may have local reporting requirements.

C. Genital herpes: Genital herpes is not nationally reportable because it is highly prevalent and often managed in outpatient settings without mandatory reporting. Surveillance focuses on population studies rather than individual case reporting.

D. Human papillomavirus (HPV): HPV infections are not nationally notifiable. Although HPV is common and associated with cancers, individual cases are not reported to public health authorities. Reporting is limited to cancer registries for HPV-related malignancies.

Rationale for correct choices

• Inspect the child’s oropharynx: The child has bright red emesis and visible bleeding in the posterior pharynx, which indicates active post-tonsillectomy hemorrhage. Direct visualization helps confirm the bleeding source and severity. Early inspection supports rapid intervention because post-operative tonsillar bleeding can progress quickly and become life-threatening.

• Obtaining a set of vital signs: Active bleeding and vomiting bright red blood require immediate reassessment of vital signs to detect tachycardia, hypotension, or respiratory compromise. Hemoglobin and hematocrit are already low, increasing the child’s risk for hemodynamic instability. Timely vital signs guide urgent decisions about fluid resuscitation and notifying the provider.

Rationale for incorrect choices

• Offer the child a red popsicle: Providing red-colored fluids can mask ongoing bleeding and delay recognition of hemorrhage. The priority is to assess and stabilize the child with known bleeding, not to offer oral intake. This intervention risks obscuring the color of emesis or oral bleeding.

• Place the child in a supine position: Supine positioning increases the risk of aspiration when bleeding or vomiting is present. The child should be maintained upright to allow drainage and airway protection. Supine positioning does not address the current complication and may worsen respiratory safety.

• Encouraging the child to cough and deep breathe: Coughing can dislodge clots and worsen post-tonsillectomy bleeding. The child already has active bright red bleeding, so stimulating airway pressure would increase hemorrhage risk. This intervention is inappropriate in immediate postoperative bleeding scenarios.

• Requesting a prescription for codeine: Codeine is contraindicated in children after tonsillectomy due to risk of respiratory depression from ultra-rapid metabolism. Pain is mild, and bleeding—not pain—is the priority. Requesting codeine does not address the current danger of hemorrhage.