A child has epistaxis while at school. The school nurse appropriately intervenes by:
1. Lying the child down and applying a warm pack.
2. Tilting the child's head back, squeezing the bridge of the nose, and applying a warm moist pack to the nose.
3. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose.
4. Immediately packing the nares with a cotton ball soaked with Neo-Synephrine.
3
Rationale 1: Lying the child down would allow the blood to drain down the throat, which could lead to aspiration. Warmth would promote the bleeding.
Rationale 2: Tilting the child's head back could cause the blood to trickle down the throat. Warmth can cause an increase in bleeding because of vasodilation.
Rationale 3: The correct initial treatment for a nosebleed is to tilt the head forward, squeeze the nares below the nasal bone for 10-15 minutes, and apply ice to the nose or back of the head.
Rationale 4: A cotton ball soaked with Neo-Synephrine would only be used if the bleeding did not stop with pressure and ice.
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