A school-age child has epistaxis. Which intervention by the school nurse is the most appropriate?
1. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose
2. Tilting the child's head back, squeezing the bridge of the nose, and applying a warm, moist pack to the nose
3. Lying the child down and applying no pressure, ice, or warm pack
4. Immediately packing the nares with a cotton ball soaked with Neo-Synephrine
Correct Answer: 1
Rationale: The correct initial treatment for a nosebleed is to tilt the head forward, squeeze the nares below the nasal bone for 10 to 15 minutes, and apply ice to the nose or back of the head. Tilting the child's head back may cause the blood to trickle down the throat. Warmth can cause an increase in bleeding because of vasodilation. Lying the child down without application of pressure to the nares may not stop the bleeding. A cotton ball soaked with Neo-Synephrine would only be used if the bleeding does not stop with pressure and ice.
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