Which of the following instructions is most important when teaching home management of a child with hemophili… - HPSSC - 2015

HPSSC - 2015

Child Health Nursing (Pediatrics)

Medium

Appeared in: HPSSC - 2015

Explanation

Children with hemophilia are highly susceptible to gum bleeding (gingival hemorrhage), which can be difficult to manage.
Soaking a toothbrush in warm water is a simple, effective technique to soften the bristles, which minimizes trauma to the delicate gum tissue during brushing.
This instruction is a key part of preventative care. Maintaining excellent oral hygiene prevents gingivitis, which would otherwise increase the frequency and severity of spontaneous gum bleeding.

Option B: Aspirin and other NSAIDs inhibit platelet function, which is a critical component of clotting. In a patient with hemophilia, whose clotting cascade is already impaired, this significantly increases the risk of severe and prolonged bleeding.
Option C: Placing a bleeding extremity in a dependent (lowered) position uses gravity to increase blood flow to the area, which will worsen the hemorrhage and swelling.
Option D: This instruction increases the child's risk of injury. Hard floors offer no protection from falls, which can cause serious joint or muscle bleeds.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Patient education and home care management for a child with hemophilia as background academic context rather than a clinical decision trigger.
Proactive patient and family education is the cornerstone of managing chronic conditions like hemophilia. It empowers them to prevent complications and respond correctly to emergencies, reducing hospitalizations.
A nurse's primary role is to ensure safety by teaching not only what to do (use soft toothbrushes, apply RICE) but, just as importantly, what not to do (give aspirin, lower a bleeding limb).
What if? If the child experiences a head injury, even a minor one, the priority shifts from home care to emergency action. This is a medical emergency requiring immediate factor infusion (if available) and transport to the hospital for evaluation to rule out a life-threatening intracranial bleed.

How to Approach the Question

First, identify the core of the question: finding the most important safety instruction for a child with hemophilia.
Analyze the pathophysiology: Hemophilia is a bleeding disorder, so any action that increases bleeding risk is wrong, and any action that prevents bleeding is correct.
Evaluate each option against this principle.
Option B (Aspirin) and Option C (Dependent position) actively increase bleeding and are therefore dangerously incorrect. Eliminate them immediately.
Option D (No carpeting) increases the risk of injury, which leads to bleeding. This is also incorrect.
Option A (Soften toothbrush) is a preventative measure to avoid a common source of bleeding (gums). This is the only option that promotes safety and prevents bleeding, making it the best answer.

Concept Tested & Keywords

Concept Tested: Patient education and home care management for a child with hemophilia.
Stem keywords: home management, child, hemophilia, teaching
Lead-in keywords: most important
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 pp. 158-159, 152-154