Review Practice Exercise 2

Non-infectious Respiratory Disorders > Child Health

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Practice Exercise 2

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Total Questions : 4

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Question 1:

Which of the following measures should be implemented for a child with von Willebrand disease who has a nosebleed?

A. Apply pressure to the nose for at least 10 minutes. B. Have the child lie supine and quiet. C. Avoid packing of the nostrils. D. Encourage the child to swallow frequently.

Answer and Explanation

Choice A:

The first-line intervention for epistaxis in vWD is to apply firm, continuous pressure to the soft part of the nose just below the nasal bone for 10 minutes. The child should be instructed to lean forward slightly to prevent blood from flowing into the throat. This measure helps promote clot formation by allowing platelets and clotting factors to act locally.

Choice B:

Lying supine increases the risk of swallowing blood, which may cause nausea, vomiting, or aspiration. The child should instead sit upright and lean forward.

Choice C:

Nasal packing is sometimes necessary if bleeding persists despite direct pressure, but it should be done gently and by a healthcare provider to avoid trauma and further bleeding.

Choice D:

Swallowing blood should be discouraged, as it can irritate the stomach and lead to vomiting, which can worsen bleeding.

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Question 2:

A school-age pediatric client is brought to the emergency room experiencing significant blood loss following an episode of epistaxis. The nurse should assess the results of which priority laboratory tests? Select all that apply

A. Sodium B. Hemoglobin C. Hematocrit D. Blood urea nitrogen E. Creatinine

Answer and Explanation

Choice A:

Sodium is not a priority in acute blood loss. Sodium levels may change slightly due to fluid shifts but do not directly indicate the severity of hemorrhage.

Choice B:

Hemoglobin measures the amount of oxygen-carrying protein in red blood cells. In cases of acute or chronic bleeding, hemoglobin levels fall, reflecting the severity of blood loss. Monitoring Hgb helps guide interventions such as blood transfusion or fluid replacement.

Choice C:

Hematocrit (Hct) reflects the percentage of red blood cells in total blood volume. Decreased Hct indicates hemodilution or blood loss and helps assess the degree of anemia. It is commonly monitored alongside hemoglobin in any client with significant bleeding.Rationale for incorrect answers:

Choice D:

Blood urea nitrogen (BUN) may rise if blood is swallowed and digested or if dehydration occurs, but it is not an immediate priority compared to Hgb/Hct.

Choice E:

Creatinine reflects renal function, not blood loss. It is not an urgent indicator in the initial evaluation of acute hemorrhage.

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Question 3:

Which actions should a school nurse include in the emergency treatment of a child diagnosed with von Willebrand’s disease who is experiencing epistaxis? Select all that apply

A. Have the child lie down. B. Elevate the child’s feet. C. Apply pressure to the child’s nose with the thumb and forefinger. D. Keep pressure applied for at least 10 minutes. E. Apply ice or a cold cloth to the bridge of the child’s nose. F. Ask the child if he or she is carrying medication to treat the nosebleed.

Answer and Explanation

Choice A:

Lying down increases the risk of swallowing blood, which can lead to nausea or vomiting. The preferred position is sitting up, leaning slightly forward.

Choice B:

Elevating the child’s feet is not appropriate. This measure is for shock management, not for controlling localized bleeding.

Choice C:

Applying pressure to the child’s nose with the thumb and forefinger compresses blood vessels and helps stop bleeding. The child should sit up and lean forward slightly to prevent swallowing blood, which may cause nausea or vomiting.

Choice D:

Keeping pressure applied for at least 10 minutes provides continuous pressure is essential for clot formation. Releasing pressure too soon can disrupt clot stability and restart bleeding.

Choice E:

Applying ice or a cold cloth to the bridge of the child’s nose induces vasoconstriction, reducing blood flow and promoting hemostasis. It’s a simple, noninvasive measure that supports mechanical pressure.

Choice F:

Asking the child if he or she is carrying medication to treat the nosebleed is essential since some children with vWD carry desmopressin (DDAVP) nasal spray or clotting factor concentrate for emergency use. Prompt administration can enhance von Willebrand factor release and help control bleeding.

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Question 4:

A nurse is working in a clinic and answers a telephone call from a parent who states that a 6-year-old child has a nose bleed that is not stopping. Which direction should the nurse provide to the parent?

A. Tilt the child’s head back. B. Squeeze the child’s nares below the nasal bone for 10 to 15 minutes. C. Take the child to urgent care as soon as possible. D. Immediately insert a cotton ball or swab in each nare.

Answer and Explanation

Choice A:

Tilting the child’s head back causes blood to flow into the throat, increasing the risk of swallowing blood, nausea, vomiting, and aspiration.

Choice B:

The correct site for applying pressure is the soft part of the nose, just below the nasal bone. The child should sit upright and lean slightly forward to avoid swallowing blood. Continuous pressure for 10–15 minutes allows clot formation and effective hemostasis. This is the first-line management for most cases of anterior epistaxis.

Choice C:

Taking the child to urgent care as soon as possible is not immediately necessary unless bleeding persists beyond 20 minutes, or the child has recurrent or heavy bleeding or an underlying bleeding disorder. Home management is appropriate as the first response.

Choice D:

Immediately insert a cotton ball or swab in each nare is contraindicated. Inserting objects can dislodge clots, irritate mucosa, and worsen bleeding.

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Practice Exercise 2

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