A nurse is teaching a newly licensed nurse about advance directives. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

Choice A reason: Dark brown emesis may indicate old blood from surgical oozing, common post-tonsillectomy, but frequent swallowing suggests active bleeding, a higher priority. Assuming emesis is urgent risks delaying hemorrhage detection, critical for preventing airway compromise or shock, necessitating immediate intervention in postoperative tonsillectomy children.

Choice B reason: Blood-tinged mucus is expected post-tonsillectomy due to surgical trauma, not an immediate concern compared to frequent swallowing, which signals bleeding. Assuming mucus is priority risks overlooking hemorrhage, delaying critical interventions like surgical consultation, essential for ensuring airway safety and preventing complications in postoperative children.

Choice C reason: Sore throat is expected post-tonsillectomy due to surgical trauma, not urgent compared to frequent swallowing, indicating potential bleeding. Prioritizing sore throat risks missing hemorrhage, delaying life-saving interventions, critical for monitoring postoperative complications and ensuring child safety following tonsillectomy procedures.

Choice D reason: Frequent swallowing is the priority post-tonsillectomy, as it may indicate active bleeding into the throat, risking airway obstruction or hypovolemia. Immediate assessment and provider notification are critical to prevent life-threatening complications, ensuring rapid intervention, airway protection, and stabilization in children recovering from tonsillectomy surgery.

Choice A reason: Changing a tracheostomy inner cannula is within an RN’s scope, involving routine airway maintenance. It requires sterile technique and training but is a standard nursing procedure, not restricted to advanced practitioners, making it a permissible task.

Choice B reason: Irrigating an external ear canal is within an RN’s scope, used to remove cerumen or debris. It requires proper technique to avoid injury, but RNs are trained for this, making it a standard nursing intervention, not outside their legal scope.

Choice C reason: Inserting a tunneled central venous catheter is outside an RN’s scope, as it requires surgical skills and is performed by physicians or advanced practice providers. RNs may assist or manage catheters post-insertion, but insertion is restricted, making this the correct choice.

Choice D reason: Administering a platelet transfusion is within an RN’s scope, involving monitoring for reactions and following protocols. It is a standard nursing procedure in settings like oncology, not restricted to advanced practitioners, making it a permissible task.