A nurse receives a telephone call from a parent reporting that their school-age child has a nosebleed and that they cannot stop the bleeding. Which of the following instructions should the nurse provide to the parent?
"Place a warm, wet washcloth over your child's forehead and the bridge of their nose."
"Use your thumb and forefinger to apply pressure to the sides of your child's nose."
"Have your child lie down and turn their head to the side for 10 minutes."
“Tell your child to blow their nose gently, and then sit down and tilt their head backward."
The Correct Answer is B
A. "Place a warm, wet washcloth over your child's forehead and the bridge of their nose." Warm compresses may actually dilate blood vessels, which can worsen the bleeding. Cold compresses are preferred to help constrict vessels.
B. "Use your thumb and forefinger to apply pressure to the sides of your child's nose." This is the correct first-aid measure for epistaxis. The parent should pinch the soft part of the nose continuously for 10–15 minutes while the child leans forward.
C. "Have your child lie down and turn their head to the side for 10 minutes." Lying down can increase blood flow to the nose and may cause blood to be swallowed, which can lead to nausea or vomiting.
D. “Tell your child to blow their nose gently, and then sit down and tilt their head backward." Tilting the head back can cause blood to drain into the throat, increasing the risk of aspiration and stomach upset. Leaning forward is the proper position.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Perform the Credé’s maneuver. This technique, involving manual pressure on the bladder, is used to promote urination in clients with bladder retention. It is not appropriate for a client with a catheter and continuous bladder irrigation in place.
B. Maintain the irrigation solution rate. Pink-tinged urine is an expected finding 4 hours after a TURP as minor bleeding can occur. There is no need to adjust the irrigation rate unless clots form or the urine becomes bright red or obstructed.
C. Warm the irrigation solution. Warming the solution is not a standard intervention and does not directly manage postoperative bleeding or pink urine. Room temperature solution is typically used unless otherwise specified by the provider.
D. Replace the indwelling urinary catheter. There is no indication the catheter is malfunctioning or obstructed. Pink urine alone does not warrant replacement, and unnecessary catheter changes can increase infection risk.
Correct Answer is D,A,B,C
Explanation
D. Transport the client to another area of the nursing unit. The first priority is rescue ensuring the client’s safety by removing them from the immediate area of danger, which is consistent with the "RACE" fire safety protocol (Rescue, Alarm, Contain, Extinguish).
A. Activate the facility's fire alarm system. Once the client is safe, the next step is to activate the fire alarm to notify other staff and initiate emergency protocols throughout the facility.
B. Close all nearby windows and doors. Containing the fire by closing doors and windows limits the spread of smoke and flames, buying time for response teams to arrive and control the situation.
C. Use the unit's fire extinguisher to attempt to put out the fire. If it is safe and the fire is small and manageable, the final step is to extinguish the fire using a fire extinguisher, following appropriate safety procedures.
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