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NurseDive Free Nursing Practice Question
A nurse is monitoring a child for manifestations of hemorrhage following a tonsillectomy. Which of the following findings is a manifestation of this postoperative complication?
A. Mouth breathing
Mouth breathing: Mouth breathing may occur after a tonsillectomy due to swelling or discomfort in the throat, but it is not a specific sign of hemorrhage.
B. Frequent swallowing
Frequent swallowing: Frequent swallowing can be a sign of hemorrhage following a tonsillectomy, as the child may be swallowing blood that is oozing from the surgical site.
C. Reports of pain
Reports of pain: Pain is common after a tonsillectomy and can be managed with pain medication. However, it is not a specific sign of hemorrhage.
D. Reports of thirst
Reports of thirst: Thirst may occur after a tonsillectomy due to mouth breathing or fluid loss, but it is not a specific sign of hemorrhage.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Paediatrics Proctored Exam 1 Simmons U BSN. Take the full exam now
Similar Questions
The nurse administered prostaglandin E to an infant with transposition of the great vessels. The nurse expects which effect to occur form the medication?
A. ductus venosus closes and is dependent on the prostaglandins
Ductus venosus closes and is dependent on the prostaglandins: The ductus venosus is a fetal blood vessel that allows blood to bypass the liver, and it normally closes shortlyafter birth. Prostaglandin E does not affect the closure of the ductus venosus.
B. ductus arteriosus remains open
Ductus arteriosus remains open: This is the expected effect of administering prostaglandin E to an infant with transposition of the great vessels. Prostaglandin E1 is used to maintain ductal patency, which promotes pulmonary blood flow, increases left atrial pressure, and promotes left-to-right intercirculatory mixing at the atrial level.
C. deoxygenated blood traveling in infants body
Deoxygenated blood traveling in infants body: Deoxygenated blood traveling in the infant’s body is a result of transposition of the great vessels, not an effect ofadministering prostaglandin E.
D. ductus arteriosus closes allowing better oxygenation
Ductus arteriosus closes allowing better oxygenation: This statement is not accurate. Prostaglandin E is used to keep the ductus arteriosus open, not to close it.
A nurse is reviewing data for four children. Which of the following children should the nurse assess first?
A. A 1-year-old toddler who has roseola and a temperature of 39° C (102.2° F)
A 1-year-old toddler who has roseola and a temperature of 39° C (102.2° F): A fever is a common symptom of roseola, and this child’s temperature is not excessively high. The nurse should monitor the child’s temperature and provide appropriate care, but this is not the highest priority.
B. A 4-year-old child who has asthma and a PCO; of 37 mm Hg)
A 4-year-old child who has asthma and a PCO2 of 37 mm Hg: A PCO2 of 37 mm Hg is within the normal range for a child, so this finding does not indicate an urgent need for assessment.
C. A 10-year-old child who has sickle cell anemia who reports severe chest pain
A 10-year-old child who has sickle cell anemia who reports severe chest pain: Severe chest pain in a child with sickle cell anemia could be a sign of acute chest syndrome,which is a serious complication that requires immediate medical attention. This child should be assessed first.
D. A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016
A 7-year-old child who has diabetes insipidus and a urine specific gravity of 1.016: A urine specific gravity of 1.016 is within the normal range for a child, so this finding does not indicate an urgent need for assessment.
A nurse is caring for a child who is admitted with suspected acute appendicitis. Which of the following manifestations should indicate to the nurse that the child's appendix is perforated?
A. Flaccid abdomen
Flaccid abdomen is incorrect because a perforated appendix often leads to a rigid, not flaccid, abdomen due to inflammation and irritation of the peritoneum.
B. Low-grade fever
Low-grade fever is incorrect as both acute appendicitis and perforation can present with a fever, but it is not specific to perforation. Normal body temperature ranges from 36.1°C to 37.2°C (97°F to 99°F).
C. Absent Rovsing's sign
Absent Rovsing’s sign: Rovsing’s sign is a physical examination finding that can be present in acute appendicitis, but its absence does not specifically indicate a perforated appendix.
D. Sudden decrease in abdominal pain
Sudden decrease in abdominal pain. This symptom can indicate that the appendix has ruptured, leading to a temporary relief of pain as the pressure is relieved. However, this is usually followed by an increase in pain and symptoms of peritonitis.
Full Explanation
The correct answer is D.
Choice A:
Flaccid abdomen is incorrect because a perforated appendix often leads to a rigid, not flaccid, abdomen due to inflammation and irritation of the peritoneum.
Choice B:
Low-grade fever is incorrect as both acute appendicitis and perforation can present with a fever, but it is not specific to perforation. Normal body temperature ranges from 36.1°C to 37.2°C (97°F to 99°F).
Choice C:
Absent Rovsing's sign is incorrect because Rovsing's sign may or may not be present in cases of appendicitis and does not specifically indicate perforation. Rovsing's sign is positive when pain in the right lower quadrant is elicited by palpating the left lower quadrant.
Choice D:
Sudden decrease in abdominal pain. This symptom can indicate that the appendix has ruptured, leading to a temporary relief of pain as the pressure is relieved. However, this is usually followed by an increase in pain and symptoms of peritonitis.