Pediatrics

A child presents at the pediatrician's office with a small wound surrounded by redness, swelling, tenderness, and lymphangitis of the lower leg. Mom also report to the child had malaise and elevated temperature. Antibiotics are prescribed and homecare instructions are given. Which of the following statements by the parent indicates understanding of management of this child at home? a. "I will be able to wash the skin marking off when I bathe my child tonight." b. "I will put warm soaks on my child's leg." c. "I will put icepacks on my child's leg to relive the swelling." d. "I should continue antibiotics until the redness and swelling goes away."

"I should continue antibiotics until the redness and swelling goes away."

The nurse is educating the family of 3yo regarding post cardiac catheterization care. Which statement by the parent demonstrated understanding? a. "Restricting fluids slightly will decrease his need to get up to use the restroom." b. "The head of the bed can be elevated 30-45 degrees" c. "We must keep the leg straight for 4-6 hours" d. "We will need to check for bleeding every few hours."

"We must keep the leg straight for 4-6 hours"

The nurse is providing education for an adolescent female newly diagnosed with scoliosis regarding brace use. What statement by the nurse demonstrates correct use of the appliance? a. "A soft fabric shirt over the braces increases comfort." b. "You may remove the brace for comfortable sleep." c. "Wear the brace strictly as instructed for 16-23hrs." d. "Wearing the brace may decrease the need for X-Rays"

"Wear the brace strictly as instructed for 16-23hrs.

Correction of hypospadias should take place by what age? a. 1 year of age b. 4 years of age c. 3 years of age d. 2 years of age

1 year of age

Order: aminophylline 30mg/hr IV, Label: 1gram/500ml of fluid. What is the rate of infusion per hour?

15 ml/hr

A nurse caring for a child with dehydration knows that the most reliable data in assessment of the hydration status is: a. Length of time since last void b. Blood pressure changes c. Weight loss d. Skin turgor

weight loss

Which of the following would the nurse recommend as the most appropriate play activity for a 4-year-old child in spica cast?

A Playing with Duplos (large Legos)

The nurse providing care for a child with congenital heart distress should encourage which of the following? a. A diet with limited protein b. A diet with increased calories c. A diet with decreased fat d. Increased fluid intake

A diet with increased calories

A nurse meeting a 5y/o patient for the first time needs the child's cooperation during a dressing change. The nurse does a simple magic trick using gauze. This should be interpreted as which of the following? a. Acceptable, if there is adequate time b. A method to establish rapport with the child c. Inappropriate, because of the child's age d. Too distracting when cooperation is important.

A method to establish rapport with the child

A child with a brain tumor is undergoing radiation therapy. The nurse should include which information in the discharge instructions to the child's parents? SATA a. Apply over-the-counter creams to the area daily. b. Avoid excessive skin exposure to the sun. c. Use a washcloth when cleaning the area receiving radiation. d. Plan for adequate rest periods for the child. e. A darkening of the skin receiving radiation is expected.

A. Avoid excessive exposure to the sun B. Plan for adequate rest periods for the child E. A darkening of the skin receiving radiation is expected

Nursing intervention for a 1-month-old infant with biliary atresia awaiting a liver transplant should include which expected outcomes?

Adequate nutrition with vitamins and relief of symptoms

Before giving a dose of Digitalis (Digoxin), the nurse checked an infant's apical heart rate, and it was 114 beat per minutes. What should the nurse do next? a. Administer the digitalis (Digoxin) dose as ordered b. Recheck the apical heart rate in 30 minutes c. Hold the medication until the next dose d. Notify the physician about the infant's heart rate

Administer the digitalis (Digoxin) dose as ordered

When assessing a child for possible congenital defects, where would the nurse measure blood pressure? a. All four extremities b. One upper extremity and lower extremity c. The left upper and lower extremities d. The right and left lower extremities

All four extremities

The parent of a child biliary atresia questions the nurse about the reason their child is receiving phenobarbital? The best explanation would include what information? a. The obstruction of bile may lead to seizure b. There is possibility of excessive edema which may cause seizures c. The sedation aspect of the drug allows the child rest and assists with the digestion process d. An action of the medication is bile acid binding which aids in decreasing pruritus

An action of the medication is bile acid binding which aids in decreasing pruritus

A nurse is caring for an infant who has a myelomeningocele. Which intervention should the nurse include in the preoperative plan of care? a. Position the infant supine after applying saline soaked gauze b. Assist the parent with careful swaddling of the infant c. Active ROM with lower limbs to decrease risk of deformities. d. Apply a sterile, moist dressing over the exposed vertebral sac

Apply a sterile, moist dressing over the exposed vertebral sac

Atopic dermatitis (eczema) in the infant in which of the following? a. Worse in humid climates b. Easily cured; but reoccurs c. Associated with upper respiratory infections d. Associated with allergies and has a hereditary tendency

Associated with allergies and has a hereditary tendency

Discussing home care of a 12-month-old with atopic dermatitis (eczema) should include which information? a. Using long sleeve shirts at night b. Using fabric softener to soften rough clothing c. Keep affected areas dry d. Avoid oil-bases toiletries

Using long sleeve shirts at night

A 1 month old is diagnosed with a ventricular septal defect. What explanation is correct regarding blood flow in this lesion? a. Pressure in the left atrium is increased, impeding circulation of oxygenated blood b. Blood shunts left to right, increasing pulmonary flow and no cyanosis c. Blood shunts right to left, decreasing pulmonary...... d. No shunting occurs bc of high......

Blood shunts left to right, increasing pulmonary flow and no cyanosis

Parents of a school age child with hemophilia ask the nurse. "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend? SATA a. Bowling b. Golf c. Basketball d. Soccer e. Swimming

Bowling Golf Swimming

What is the best nursing response to a mother who asks if her 5 months old can have cow's milk? a. You need to wait until she is 8 months old and eating solids well. b. Yes, if you think that she will eat enough meat to get the iron she needs. c. Infants younger than 12 months need iron-rich formula to get the iron they need. d. Try it and see how she tolerates it.

C. Infants younger than 12 months need iron-rich formula to get the iron they need.

Possible complication in giving nursing care to a child with burns included? a. Contractures and anemia b. Oliguria and hyperproteinemia c. Hypertension and ecchymosis d. Anorexia and diarrhea

Contractures and anemia

A 2-day old infant in the nursery is acyanotic, but has tachypnea, dyspnea, retractions, wheezing and grunting. What is the expected cardiac diagnosis? a. Truncus arteriosus b. Ventricular septal defect c. Pulmonary atresia d. Tetralogy of Fallot

Ventricular septal defect

A child present with symmetrical muscle weakness to the lower extremities, a wadding wide-based gait, and a positive Gower's sign. Discharge teaching should include immediate notification of the physician for which problem? a. Increased fatigue b. Constipation c. Respiratory infection d. Diminished appetite

Respiratory infection

A nurse assessing a 6 month old suspected of having cerebral palsy would most likely expect the child to exhibit a. Delay or failure to control head and roll over b. Frequent episodes of seizure activity c. Inability to stand while being supported d. Frequent respiratory infections

Delay or failure to control head and roll over

Nurses understand that children with Cerebral Palsy (CP) are often at risk for deficits due to which of the following problems? a. Difficulty controlling the muscles of chewing and swallowing. b. Decreased metabolic rate due to immobility. c. Frequent episodes of vomiting related to muscle spasticity. d. GI impairment with decreased absorption of nutrients

Difficulty controlling the muscles of chewing and swallowing.

The child has small red macules and vesicles around her mouth that change into honey crusted lesions. Which information should be including when teaching parents? a. Family members should use good handwashing and the child should be kept home from school until 24hrs after beginning antibiotic treatment b. The child may return to school 48hrs after the start of treatment if all lesions are dried and scabbed over c. Widespread itching is common, but medication is not required. Fingernails should be clipped short to prevent spread of infections d. Wash the lesions gently with a warm soapy cloth every day, leaving the crusty areas intact.

Family members should use good handwashing and the child should be kept home from school until 24hrs after beginning antibiotic treatment

Which of the following information should the nurse include when teaching parents about caring for their 4-month-old with hip dysplasia who is in a Pavlik harness? a. The harness is only the 1st step of ongoing treatment, followed ......... b. Harness provides reduction of the hips by maintaining the flexion and external rotation. c. Harness is generally only worn for 2wks, followed by a period..... d. The harness is removed every diaper change to ensure good cleaning ......

Harness provides reduction of the hips by maintaining the flexion and external rotation.

The mother of a newborn asks the nurse what is generally for the infant's clubfoot deformity. Which is the best response by the nurse? a. He will have surgical correction and then will wear casts for few months b. Treatment for clubfoot is very complicated and depends on the degree of severity c. He may wear casts for a period of time. He may also have to wear special braces/ shoes d. He will be closely monitored, and surgical correction will be required if not improved

He may wear casts for a period of time. He may also have to wear special braces/ shoes

Which of the following is the most appropriate question for the nurse to ask when interviewing an adolescent to encourage conversation? a. How do your parents feel about your grades? b. How is school going for you? c. Are you doing well in school? d. Are you in school?

How is school going for you?

A child is admitted in a sickle cell vaso-occlusive crisis. Which of the following should the child's care include? a. Oxygenation, administration of hydroxyurea b. Oxygenation, administration of factor VIII c. Hydration, administration of intravenous morphine d. Hydration, administration of intravenous Demerol

Hydration, administration of intravenous morphine

Which change in serum lab values would most likely indicate the onset of osteomyelitis? a. Increase creatine phosphokinase (CPK) b. Decreased calcium c. Decrease hemoglobin (Hgb) d. Increase erythrocyte sedimentation rate (ESR)

Increase erythrocyte sedimentation rate (ESR)

Parents of child with Transposition of the Great Arteries have asked why their child is receiving the medication prostaglandin E1-PGE 1(Prostine VR). What is the explanation for the medication? a. It keeps the ductus arteriosus open and allow mixing blood b. It closes the ductus venosus and allows more pulmonary blood flow c. It maintains a patent ductus arteriosus and decreases pulmonary blood flow d. It will shunt or move blood away from congested lungs

It keeps the ductus arteriosus open and allow mixing blood

A mother wants to breastfeed her baby born with a cleft and palpate and asks the nurse if this will be possible. Which of the following is the nurse best response? a. I really wish you could breastfeed, but with both the cleft lip and palate, it is so difficult. You can get frustrated and decrease milk production do I would not recommend it b. It's done in rare cases where the mother is determined to breastfeed and is willing to keep offering the breast for several days until the baby learns to latch on. c. It will be easier for you and your baby will get more needed nutrition if you use formula and the special nipples designed for a cleft lip or palate d. It may be possible to breastfeed. We can try and if it does not work out, you can use a breast pump and feed the baby breast milk with the special nipples.

It may be possible to breastfeed. We can try and if it does not work out, you can use a breast pump and feed the baby breast milk with the special nipples.

Treatments are started for a patient admitted with a history of frequent infections, nosebleeds, bruising, fatigue. Which of the following in the priority diagnosis? a. Disturbed body image related to alopecia b. Impaired skin integrity relates to radiation therapy c. Risk for infection related to immunosuppression d. Risk for fluid volume deficit related to nausea/ vomiting.

Risk for infection related to immunosuppression

A school-aged child with scabies received 2 treatments of Nix (Permethrin 5%). The mother reports that she does not think the treatments have worked bc the child is still experiencing a rash and itching. What should be the nurse's response? a. Itching may last after the mites have been eliminated, use soothing lotions, and avoid scratching. b. These are indications of incorrect administration of the treatment and noncompliance c. Administer another treatment of the Nix (Permethrine 5%) and leave the lotion on for 24hr before removal d. These are indications of a developing secondary infection and will require antibiotic therapy.

Itching may last after the mites have been eliminated, use soothing lotions, and avoid scratching.

You are admitting 4 months old, who weight 6.5kg with severe dehydration from vomiting and diarrhea. The child is lethargic, has no tears, and has nor voided in the past 6hrs. The nurse would question all of the IV maintenance 1 orders except: a. Lactated ringer's at 30ml/hr b. D5 ½ NS AT 15 ml/hr c. NS with 20 mEq KCL at 30 ml/hr d. D10 W at 50 ml/hr

Lactated ringer's at 30ml/hr

The patient is admitted with a diagnosis of rule out retinoblastoma. What finding would be seen in the photo that the parents are showing to the nurse? a. Ecchymosis b. Conjunctivitis c. Leukocoria d. Petechiae

Leukocoria

A newborn is suspected of having a coarctation of the aorta. What finding does the nurse expect when measuring 4 extremity BP? a. Higher pressure on the right side b. Blood shunts left to right, increasing pulmonary flow and no cyanosis c. Lower pressure in the legs than the arms d. Higher pressure on the left side

Lower pressure in the legs than the arms

Parents of a newborn diagnosis with Hypoplastic Left Heart Syndrome are having a difficult time understanding the course of treatment. What information does the nurse need to reinforce regarding the course of treatment for the type of defect? a. Several cardiac catheterizations will be done with repairs being completed during catheterizations b. The repair will involve one surgical procedure and then will require a heart transplantation c. Maintaining a PDA pharmacologically until the first stage of the repair is completed d. Immediate closure of the VSD during catheterization with future staged repairs to be scheduled

Maintaining a patent ductus arteriosus pharmacologically until the first stage of the repair is completed.

Which of the following order should the nurse question when caring for a child following pull through surgery for Hirschsprung's disease? a. Monitor rectal temperature every 4 hours b. Maintain IV fluids at ordered rate and replacing hourly output c. Assess wound for swelling, redness, and drainage every 4 hours d. Monitor the NG tube on low suction with hourly output

Monitor rectal temperatures every 4 hours.

A mother of an infant with umbilical hernia expresses concern over the appearance of the defect. What are the best responses by the nurse? a. Most umbilical hernias close on their own by 1 year of age b. Do not place the infant prone until the hernia has been repaired c. You might try strapping the area with a belly band until it is repaired d. If it doesn't close by one year of age, it will have to be repaired surgically.

Most umbilical hernias close on their own by 1 year of age

A child presents with intermittent fever, morning joint stiffness, tender, painful joints, and limited ROM. What should be included in discharge planning? a. A low calories diet to control weight in the less mobile child b. Avoiding ibuprofen use due to concern for joint bleeding c. Routine ophthalmologic examinations to assess for visual problem d. Apply cold compresses to prevent or limit joints swelling

Routine ophthalmologic examinations to assess for visual problem

Order: Furosemide 40mg IV every 3hours, weight: 10.6 pounds, safe/therapeutic range: 1-6mg/kg/dose. Is the order safe/therapeutic? (Yes or No)

No

The nurse working with a child on a pediatric unit received a lab report which show an absolute neutrophil count (ANC) of less than 500 per cubic millimeter. The lab result indicates which of the following? a. An iron rich diet that included oranges, bananas, broccoli and spinach should be encouraged b. Vital signs including a rectal temp need to be taken at least 4hrs c. The neutrophil count is approaching a normal value and that the child is on the way to recovery d. Normal body flora can put the child at risk for serious life-threatening bacterial infections

Normal body flora can put the child at risk for serious life-threatening bacterial infections

The nurse is caring for a 10yo child who had an infected ventriculoperitoneal shunt removed 2days ago. She has talkative and very.....The priority nursing intervention would be: a. Assess using the Glasgow Coma Scale and document the findings b. Dim the lights and provide a quiet non-stimulating environment c. Contact the child life specialist to provide her with play activities d. Notify the physician immediately with the findings

Notify the physician immediately with the findings

A 4 month old with Tetralogy of Fallot is being seen in the emergency department. While blood is being drawn, he becomes acutely cyanotic and tachypneic. What should be the nurse's immediate action? a. Call a Code Blue due to imminent cardiac arrest b. Place in a semi-Flower's position and administer oxygen c. Call for a STAT respiratory treatment and assessment d. Place in a knee chest position to relieve the hypoxic spell

Place in a knee chest position to relieve the hypoxic spell

Surgical closure of the ductus arteriosus will do which of the following? a. Prevent movement of unoxygenated blood to systemic circulation b. Increase oxygenated blood returning to the lungs c. Prevent the return of oxygenated blood to the lungs d. Decrease the edema in the lower extremities

Prevent the return of oxygenated blood to the lungs

Which of the following symptoms would be apparent with a child who has been admitted with a possible pyloric stenosis? sata a. Progressive projectile vomiting b. Acholic stool c. Bile-stained vomitus d. Guaiac positive stool e. Non-bile-stained vomitus

Progressive projectile vomiting Non-bile-stained vomitus

Strategies for nursing care related to the nonsurgical management of scoliosis in an adolescent are primarily directed toward what goals? a. Preserving heart and lung function b. Promoting healthy body image and self-esteem c. Preventing physical immobility d. Preventing orthosis-related breaks in skin integrity

Promoting healthy body image and self-esteem

Which of the following is a priority care objective for the child with nephrotic syndrome? a. Increase ability of tissues to retain fluid b. Reduce blood pressure c. Reduced excretion of protein in urine d. Increased excretion of protein in urine

Reduced excretion of protein in urine

In discussing the use of Isotretinoin for acne, the nurse should include which of the following when counseling females' adolescents? a. She will have to limit her indoor tanning sessions to twice a week b. She can be required to use contraceptives, even if not currently sexually active c. She will have blood work done to monitor her hematocrit and hemoglobin d. She can keep her scheduled appointment to get new contacts

She can be required to use contraceptives, even if not currently sexually active

The parent of a preschool child with severe aplastic anemia is discussing her child's care. Which statement by the parent indicated a need for further teaching? a. She loves raw carrots and broccoli especially with ranch dressing b. We will ensure that she receives her Flu vaccine injections c. She uses a toothette sponge for brushing her teeth d. We make sure all visiting friends wash their hand

She loves raw carrots and broccoli especially with ranch dressing

A three month old has failure to thrive, excessive irritability, frequent coughing, choking with feedings, and frequent spitting up. What should be included in nursing care? a. Small, frequent feeds with frequent burping b. Positioning in the Trendelenburg position c. Using half-strength formula with rice cereal d. Use car seat to elevate head after feeding

Small, frequent feeds with frequent burping

The priority nursing care for a child with Transposition of the Great Vessels would include which of the following?

Taking vital signs and administering medications on a routine schedule

Which of the following is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? a. Have the parents keep an accurate record of intake and output b. Teach parents to position the infant on the stomach c. Reinforce the parent's knowledge of the infant's developmental needs d. Teach the parents how to do infant cardiopulmonary resuscitation (CPR)

Teach the parents how to do infant cardiopulmonary resuscitation (CPR)

A nurse is conducting discharge teaching to parents about care of their 2-month-old infant after cardiac surgery. The nurse instructs the parents to notify the physician it which of the following occurs? SATA a. Respiratory rate of 36 at rest b. Temperature above 37.7 C (100F) c. Discomfort at incision site d. Turning blue or bluer than normal e. New, frequent coughing

Temperature above 37.7 C(100F) Turning blue or bluer than normal New, frequent coughing

When introducing hospital equipment to a preschooler who seems afraid the nurse's approach should be based on which of the following? a. The child is too young to understand what the equipment does b. One brief explanation will be enough to reduce the child's fear c. The child may think that all the equipment is alive d. Using extended explanation periods increase understanding

The child may think that all the equipment is alive

A 9 month of infant is diagnosed with mild (grade II) vesicoureteral reflux (VUR). Home care instruction for this client would include which intervention? a. Use of prophylactic antibiotics b. Therapeutic fluid restriction c. Encourage prompt toilet training d. Frequent urine cultures

Use of prophylactic antibiotics

A 3 year old child is hospitalized after a near drowning accident. The child's mother complains to the nurse. This seems unnecessary when he is perfectly fine. The nurse's best reply would be which of the following? a. We need to be sure you know how to prevent this from happening again b. He still needs a little extra oxygen c. I'm sure he fine but the doctor wants to make sure d. The reason for this is that complications could still occur with occur within 72hrs

The reason for this is that complications could still occur with occur within 72hrs

Parents of a 10 month old ask why their child has experienced a febrile seizure. What is the correct response by the nurse? a. They occur when the temperature rises quickly b. They can be controlled with anticonvulsant medications c. They occur when the body temperature exceeds 38.3C (101.1F) d. They are considered a specific form of epilepsy

They occur when the temperature rises quickly

A well-nourished 18 month old, with no history of gastrointestinal problems is brought to the emergency department. She presents with intense intermittent crying and a rigid abdomen with a palpable sausage shaped mass. Which initial orders would be expected? a. NG tube placement, IV morphine every 2hrs, and Pedialyte every 2hrs b. Vital signs every 4hrs, guaiac stools, and saline or air enema c. IV insertion and administration of polyethylene glycol-electrolyte solution until the passage of stool d. Vital signs every 4 hours, with rectal temperature, fleets enema, and Pedialyte ad lib

Vital signs every 4hrs, guiac stools, and saline or air enema

A child with sickle cell disease is experiencing mild to moderate pain while at school. The school nurse may provide pain medication and which of the following treatments?

Warm moist pack to painful area

Which statement would indicate to the nurse that the parents of a child with Hemophilia A need further teaching?

We gave our child Pepto-Bismol for his stomach ache.

When an adolescent with a new diagnosis of Ewing's sarcoma asks the nurse about treatment the nurse's response should be based on which information ? sata a. Ewing's sarcoma is usually not responsive to either chemotherapy or radiation b. Management includes chemotherapy, surgery, and radiation c. Affected bones such as ribs and proximal fibula may be removed to exercise the tumor. d. This type of tumor invades the bone

b. Management includes chemotherapy, surgery, and radiation c. Affected bones such as ribs and proximal fibula may be removed to exercise the tumor. d. This type of tumor invades the bone

A 2-month-old infant being treated for bacterial meningitis has developed Syndrome of Inappropriate Antidiuretic Hormone (SIADH) during the course of treatment. What S&S would this patient present with? SATA a. Intake equals output b. Sodium levels <125 mEq/L c. Increased blood pressure d. High level of antidiuretic hormone (ADH) e. Polyuria

b. Sodium levels <125 mEq/L c. Increased blood pressure d. High level of antidiuretic hormone (ADH)

A child presents with a history of frequent respiratory infections, bruising, anemia, elevated white count, and blast cells on the blood smear. Which test will provide a definitive diagnosis for the cause of the symptoms? a. Complete blood count (CBC) with differential b. Bone marrow aspiration and biopsy c. Bone scan and CT scan with contrast d. Lumbar puncture with CSF cytology

bone marrow aspiration and biopsy

The nurse understands that a young adolescent with a spinal curve of 35 degrees is best treated by which of the following? a. The Harrington rod surgical device b. A TENS unit and cold packs c. Regular visits to the chiropractor d. Bracing and exercise

bracing and exercise

What instruction would the nurse include in a teaching oral care of a child receiving chemotherapy? a. Inspect the mouth weekly for ulcerations b. Use commercial mouthwash c. Meticulous flossing to free blood particles d. Clean teeth with a soft toothbrush

clean teeth with a soft toothbrush

An infant with congestive heart failure is receiving digoxin. What does the nurse recognize as a sign of digoxin toxicity? a. Restlessness b. Vomiting c. Decreased respiratory rate d. Increase urinary output

vomiting

The nurse would expect which of the following as a hallmark symptom of a brain tumor in a child? a. Headache late in the day b. Vomiting in the morning c. Severe nuchal rigidity d. Constantly blurred vision

vomiting in the morning

To assess the child with severe burns for adequate end organ perfusion, the nurse monitors which of the following? a. Skin turgor b. Distal pulses c. Urine output d. Mucous membranes

distal pulses

Which of the following assessment categories are includes in the Glasgow Coma Scale (GCS)? SATA a. Deep tendon reflexes b. Eye opening c. Verbal response d. Muscle strength e. Motor response

eye opening verbal response motor response

A 7-month old infant with a hemoglobin of 6.5g/dL will have which of the following assessment findings? a. Anorexic, lethargic, with vomiting b. Thin, energetic, and sleeps little c. Lethargic, pale and irritable d. Flushed, fussy, and energetic

lethargic, pale, and irritable

Nursing care of the infant who has a myelomeningocele repair should include which intervention? a. Measurement of head circumference b. Administration of seizure medications c. Securely fastening the diaper d. Measurement of meningocele size

measurement of head circumference

Which of the following is an early sign of increased intracranial pressure in a 10yo child ? a. Hypertension b. Decrease appetite c. Mood swings d. Tachypnea

mood swings

Which physical assessment technique will the nurse omit when caring for a 2 year old diagnosed with Wilms' tumor? a. Palpation of the abdomen b. Range of motion for lower extremities c. Muscle strength of lower extremities d. Assessing bowel sounds

palpation of the abdomen

Which of the following assessment finding should cause the greatest concern when caring for a child with severe hemophilia? a. Large amounts of visible hematuria b. Bilateral persistent nosebleed c. Vomiting, confusion, and lethargy. d. A joint bleed which continues to swell

vomiting, confusion, and lethargy