A child who has undergone a tonsillectomy is observed to have frequent swallowing, pallor, and no complaint o… - AIIMS M.Sc. Nsg Entrance exam-2026

AIIMS M.Sc. Nsg Entrance exam-2026

Child Health Nursing (Pediatrics)

Medium

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

The combination of frequent swallowing and pallor are hallmark signs of post-tonsillectomy hemorrhage.
According to the nursing process (Assess, Diagnose, Plan, Implement, Evaluate), the first step when new, concerning signs appear is always to perform a focused assessment to confirm the problem.
Frequent swallowing is an early indicator as the child is trying to clear blood from the pharynx.
Pallor indicates potential blood loss, making immediate assessment critical to prevent progression to hypovolemic shock.

Option A: While reassurance and monitoring are part of care, they are not the first action. Delaying a direct assessment to confirm the cause of the concerning signs (frequent swallowing, pallor) can lead to a delayed response to a life-threatening hemorrhage.
Option B: Providing anything orally, including ice chips, is contraindicated when hemorrhage is suspected. The patient may require emergency surgery to stop the bleeding, and an NPO (nothing by mouth) status is essential to prevent aspiration under anesthesia.
Option D: Similar to providing ice chips, encouraging oral fluids is contraindicated. It poses a significant risk of aspiration if the patient needs to be urgently intubated and returned to the operating room.

Visual 1: Illustration - A diagram showing a nurse using a penlight and tongue depressor to inspect the posterior pharynx of a child, highlighting the tonsillar fossae where bleeding would occur.
Visual 2: Infographic - A chart listing the signs and symptoms of post-tonsillectomy hemorrhage, categorizing them into early signs (frequent swallowing, throat clearing, restlessness) and late signs (tachycardia, hypotension, vomiting bright red blood).

Clinical Relevance

Nursing practice connection: Use the key finding related to Assessment and management of postoperative complications, specifically post-tonsillectomy hemorrhage to guide bedside assessment, documentation, and the next nursing action.
Post-tonsillectomy hemorrhage is a critical, time-sensitive surgical emergency. The nurse's ability to recognize early, subtle signs like frequent swallowing is key to preventing severe blood loss and shock.
The highest risk for bleeding is within the first 24 hours post-op and again around 7-10 days later when the eschar (scab) may dislodge.
What if the child was also tachycardic and restless? These additional signs would increase the urgency, indicating more significant blood loss. The nurse should immediately call for help and notify the surgeon while simultaneously positioning the child to protect the airway (e.g., side-lying).

How to Approach the Question

First, identify the core clinical scenario: a child is postoperative from a tonsillectomy.
Next, analyze the presented signs and symptoms: 'frequent swallowing,' 'pallor,' and 'no complaint of pain.' Recognize that frequent swallowing is a classic, specific sign of a known complication.
Link the signs to a potential diagnosis. Frequent swallowing + pallor strongly suggests post-operative hemorrhage.
The question asks for the 'first' action. This signals a priority question. Apply the nursing process (ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation). The first step is always Assessment.
Evaluate the options based on the nursing process. Option C is a direct assessment to confirm the suspected hemorrhage. Options A, B, and D are interventions or monitoring actions that should follow, not precede, a focused assessment.
Eliminate unsafe options. Providing fluids or ice (Options B and D) is dangerous if the patient might need surgery, making them incorrect.

Concept Tested & Keywords

Concept Tested: Assessment and management of postoperative complications, specifically post-tonsillectomy hemorrhage.
Stem keywords: tonsillectomy, frequent swallowing, pallor, child
Lead-in keywords: first
Clinical cues: Frequent swallowing and pallor are classic signs of post-tonsillectomy bleeding.

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