A 5-year-old is admitted to the unit following a tonsillectomy. Which of the following would indicate a complication of surgery?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Constant or frequent swallowing is a classic sign of post-tonsillectomy hemorrhage, the most serious complication of this surgery.
The child is swallowing blood that is trickling down the back of the throat from the surgical site.
This is a subtle sign that requires vigilant nursing assessment, as it indicates active bleeding.
Other signs of hemorrhage include tachycardia, pallor, restlessness, and vomiting bright red blood.

Option A: Decreased appetite is an expected finding after a tonsillectomy due to odynophagia (painful swallowing).
Option B: A low-grade fever is a common and expected inflammatory response following surgery.
Option C: Chest congestion is not a direct or common complication of a tonsillectomy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Post-Tonsillectomy Complications as background academic context rather than a clinical decision trigger.
Early detection of post-tonsillectomy hemorrhage is a critical nursing responsibility. Children can compensate for blood loss initially but can deteriorate rapidly into hypovolemic shock.
Nurses must educate parents at discharge to watch for frequent swallowing or vomiting of blood, as delayed hemorrhage can occur up to 10-14 days post-surgery.
What if? If the child with constant swallowing also has a heart rate of 140 bpm (normal for a 5-year-old is 75-115) and appears pale and restless, the suspicion for significant hemorrhage is extremely high. This constitutes a medical emergency requiring immediate surgical intervention.

How to Approach the Question

First, identify the core of the question: you are looking for a sign of a complication, not an expected outcome.
Analyze each option to determine if it is an expected finding or an abnormal one after a tonsillectomy.
Recall that pain (leading to decreased appetite) and a low-grade fever are normal post-operative responses.
Consider the most life-threatening complication of a tonsillectomy, which is hemorrhage.
Connect the options to the signs of hemorrhage. Recognize that in children, swallowing blood is more common than spitting it out.
This leads to the conclusion that 'Constant swallowing' is the most specific indicator of a serious complication among the choices.

Concept Tested & Keywords

Q5Zjh_dNtGUA9rD7M2BIw8

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 37-39

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 350-352

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