Difficulty: Medium
Average Score: 84%
Simulated
Passage / Scenario
Preschool-age child in the immediate postoperative period following a tonsillectomyA nurse is assessing a preschool-age child who is in the immediate postoperative period following a tonsillectomy. Which of the following assessment findings is the priority?
Correct answer
D
Rationale
The correct answer is D: The child swallows frequently. This is the priority assessment finding because it could indicate postoperative bleeding, a potentially life-threatening complication after a tonsillectomy. Swallowing frequently may suggest blood pooling in the throat, leading to the need for prompt intervention to prevent further complications. Crying often (A), refusing clear liquids (B), and increased throat pain (C) are common postoperative symptoms that can be managed with appropriate interventions. Therefore, they are not as urgent as the possibility of postoperative bleeding indicated by frequent swallowing.