An 83-year-old male with persistent unilateral epistaxis after blowing his nose and a history of atrial fibrillation should be managed by which action?

• A. Have him lean his head forward and pinch his nostril together
• B. Place him in a recovery position and apply a hemostatic agent
• C. Have him lean his head backward and apply a cold pack to his neck
• D. Place him supine and monitor his vital signs during transport

Answer: (A)

The action being tested is stopping anterior nasal bleeding with direct pressure while keeping the airway protected. For an elderly patient with persistent unilateral epistaxis, the first step is to have him lean forward slightly and firmly pinch the soft part of the nostrils together, holding for about 10–15 minutes. This directly compresses the bleeding vessels in the nasal mucosa (the common Kiesselbach’s plexus area) and promotes clotting, while the forward position prevents blood from running back into the throat, reducing the risk of choking or aspiration.

Tilting the head backward is discouraged because it drives blood toward the throat and airway, which can lead to swallowing blood, nausea, or aspiration. A recovery position or lying supine offers no advantage for stopping the bleed and can still expose the airway to blood. Applying a cold pack to the neck doesn’t address the actual source of bleeding in the nasal mucosa.

If bleeding persists after sustained pressure, further steps like nasal packing or topical vasoconstrictors may be needed, and medical evaluation should be pursued, especially given anticoagulation history.