# An 8-year-old with severe hemophilia A presents with painful right knee swelling after a fall. Which is the nurse priority intervention?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375013&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: SIPC

## Question

An 8-year-old with severe hemophilia A presents with painful right knee swelling after a fall. Which is the nurse priority intervention?

## Option

1. Apply heat to the knee to relax muscle spasm
2. Administer factor VIII concentrate or, given inhibitor history, a bypassing agent immediately **✔ Correct answer**
3. Aspirate the joint to remove blood and reduce pain
4. Give aspirin for pain and inflammation

**Correct answer: 2**

## Explanation

Acute hemarthrosis in severe hemophilia is treated with factor concentrate FIRST — within minutes — before imaging or analgesia, to limit joint damage. With known factor VIII inhibitor, bypassing agents (FEIBA or recombinant factor VIIa) are used because additional factor VIII will be neutralized. RICE (rest, ice, compression, elevation) follows factor replacement. Heat increases bleeding. Aspiration is avoided in routine hemarthrosis. Aspirin and NSAIDs inhibit platelets and worsen bleeding — acetaminophen is preferred for analgesia.

## In-depth explanation

Inhibitor screen: low-titer can use higher-dose factor; high-titer requires bypassing agents. Emicizumab now used as prophylaxis even with inhibitors.

## Clinical scenario

Knee swollen, warm, decreased range of motion. No external bleeding. Has factor VIII inhibitor history. Last factor replacement 2 weeks ago.

## Key concepts

- **hemarthrosis** — Bleeding into a joint; classic complication of severe hemophilia.
- **factor inhibitor** — Antibody against infused factor that neutralizes its effect.
- **bypassing agent** — Therapy that bypasses the factor blocked by an inhibitor (FEIBA, rFVIIa).

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