Here’s a list of the common Post Tonsillectomy Bleeding NCLEX conditions, procedures, and diseases with their recommended position and rationale.
1. The nurse is reviewing the laboratory results for a child scheduled for tonsillectomy. The nurse determines that which laboratory value is most significant to review?
a) Creatinine level
b) Prothrombin time
c) Sedimentation rate
d) Blood urea nitrogen level
2. The nurse is preparing to care for a child after a tonsillectomy. The nurse documents on the plan of care to place the child in which position?
c) High Fowler’s
3. After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action?
a) Maintain NPO status.
b) Turn the child to the side.
c) Administer the prescribed antiemetic.
d) Notify the health care provider (HCP).
4. After a tonsillectomy, the nurse reviews the health care provider’s (HCP’s) postoperative prescriptions. Which prescription should the nurse question?
a) Monitor for bleeding.
b) Suction every 2 hours.
c) Give no milk or milk products.
d) Give clear, cool liquids when awake and alert.
5. The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the child is bleeding?
a) Frequent swallowing
b) A decreased pulse rate
c) Complaints of discomfort
d) An elevation in blood pressure
Post Tonsillectomy Bleeding NCLEX
Answers and Rationale
- Rationale: A tonsillectomy is the surgical removal of the tonsils. Because the tonsillar area is so vascular, postoperative bleeding is a concern. Prothrombin time, partial thromboplastin time, platelet count, hemoglobin and hematocrit, white blood cell count, and urinalysis are performed preoperatively. The prothrombin time results would identify a potential for bleeding. Creatinine level, sedimentation rate, and blood urea nitrogen would not determine the potential for bleeding.
- Test-Taking Strategy: Note the strategic word most. Focus on the surgical procedure and the subject of the question. The subject of the question relates to the potential for bleeding. Options A and D can be eliminated because they relate to kidney function. Option C can be eliminated because it is unrelated to the subject of the question.
- Post Tonsillectomy Bleeding NCLEX Rationale: A tonsillectomy is the surgical removal of the tonsils. The child should be placed in a prone or side-lying position after the surgical procedure to facilitate drainage. Options A, C, and D would not achieve this goal.
- Test-Taking Strategy: Focus on the subject, positioning after tonsillectomy. Focus on the surgical procedure and visualize each of the positions described in the options. Keeping in mind that the goal is to facilitate drainage will direct you to the correct option.
- Rationale: After tonsillectomy, if bleeding occurs, the nurse immediately turns the child to the side to prevent aspiration and then notifies the health care provider. NPO status would be maintained, and an antiemetic may be prescribed; however, the initial nursing action would be to turn the child to the side.
- Test-Taking Strategy: Note the strategic word initial in the event query. Although all the options may be appropriate to maintain physiological integrity, the initial action is to turn the child to the side to prevent aspiration.
- Rationale: A tonsillectomy is the surgical removal of the tonsils. After tonsillectomy, suction equipment should be available, but suctioning is not performed unless there is an airway obstruction because of the risk of trauma to the surgical site. Monitoring for bleeding is an important nursing intervention after any type of surgery. Milk and milk products are avoided initially because they coat the throat, cause the child to clear the throat, and increase the risk of bleeding. Clear, cool liquids are encouraged.
- Post Tonsillectomy Bleeding NCLEX Test-Taking Strategy: Focus on the subject, the prescription that the nurse questions. Option A can be eliminated first because this is a nursing action, not a medical prescription. From the remaining options, consider the anatomical location of the surgery. This should direct you to the correct option.
- Rationale: A tonsillectomy is the surgical removal of the tonsils. Frequent swallowing, restlessness, a fast and thready pulse, and vomiting bright red blood are signs of bleeding. An elevated blood pressure and complaints of discomfort are not indications of bleeding.
- Test-Taking Strategy: Focus on the subject, a sign of bleeding, and use the concepts related to the signs of shock. These concepts should assist in eliminating options B and D. From the remaining options, recalling that discomfort is expected and does not indicate bleeding will direct you to the correct option.
After you reviewed your answers through its rationale, you can now proceed to the next set of questions:
Post Tonsillectomy Bleeding NCLEX 6-10
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