A 55-year-old male patient is admitted to the hospital with a diagnosis of thrombocytopenia. Upon assessment, you note petechiae on his lower extremities, and he reports fatigue and occasional nosebleeds. Which of the following interventions should be prioritized for this patient?
Monitor platelet counts and assess for signs of bleeding.
Administer aspirin to manage pain and prevent clot formation.
Administer a diuretic to reduce fluid retention and swelling.
Encourage the patient to increase physical activity to improve circulation.
The Correct Answer is A
Choice A Reason:
Monitoring platelet counts and assessing for signs of bleeding is crucial for managing thrombocytopenia. Thrombocytopenia is characterized by a low platelet count, which increases the risk of bleeding. Regular monitoring helps in detecting any significant drops in platelet levels, allowing for timely interventions to prevent severe bleeding. Assessing for signs of bleeding, such as petechiae, bruising, or nosebleeds, is essential to manage the condition effectively and prevent complications.
Choice B Reason:
Administering aspirin to manage pain and prevent clot formation is not appropriate for patients with thrombocytopenia. Aspirin is an antiplatelet agent that inhibits platelet function, which can exacerbate bleeding tendencies in patients with low platelet counts. Using aspirin in this context could increase the risk of bleeding and is therefore contraindicated.
Choice C Reason:
Administering a diuretic to reduce fluid retention and swelling is not relevant for managing thrombocytopenia. Diuretics are used to manage conditions like hypertension and edema but do not address the underlying issue of low platelet counts. In fact, diuretics can lead to electrolyte imbalances, which may complicate the patient’s condition further.
Choice D Reason:
Encouraging the patient to increase physical activity to improve circulation is not a priority intervention for thrombocytopenia. While physical activity is generally beneficial for overall health, it can increase the risk of trauma and bleeding in patients with low platelet counts. It is important to avoid activities that could lead to injury and bleeding in these patients.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
Administering intravenous fluids is not the most appropriate initial action for managing hypopituitarism. While IV fluids may be necessary in cases of acute adrenal crisis or severe dehydration, they do not address the underlying hormone deficiencies caused by hypopituitarism. The primary treatment focuses on replacing the deficient hormones to restore normal physiological functions.
Choice B Reason:
Performing a transsphenoidal hypophysectomy is a surgical procedure used to remove pituitary tumors. While this may be necessary if a tumor is causing hypopituitarism, it is not the initial action for managing the condition. The first step is to stabilize the patient with hormone replacement therapy before considering surgical interventions.
Choice C Reason:
Initiating hormone replacement therapy is the most appropriate initial action for managing hypopituitarism. This condition results in the deficiency of one or more pituitary hormones, and replacing these hormones is crucial to restore normal body functions. Hormone replacement therapy may include cortisol, thyroid hormone, sex hormones, and growth hormone, depending on which hormones are deficient.
Choice D Reason:
Recommending dietary modifications alone is not sufficient to manage hypopituitarism. While a balanced diet can support overall health, it does not address the specific hormone deficiencies associated with this condition. Hormone replacement therapy is essential for managing hypopituitarism effectively.
Correct Answer is ["A","C","D"]
Explanation
Choice A Reason:
Encouraging a high-sodium diet is essential for patients with Addison’s disease because they often suffer from hyponatremia (low sodium levels) due to the lack of aldosterone, a hormone that helps regulate sodium and potassium balance. Increasing sodium intake helps to counteract this deficiency and maintain proper electrolyte balance.
Choice B Reason:
Administering potassium supplements is not recommended for patients with Addison’s disease because they already have hyperkalemia (high potassium levels) due to the lack of aldosterone. Adding more potassium could exacerbate this condition and lead to serious complications such as cardiac arrhythmias.
Choice C Reason:
Administering intravenous corticosteroids is a critical intervention for managing Addison’s disease, especially during an adrenal crisis. Corticosteroids like hydrocortisone help replace the deficient hormones and stabilize the patient’s condition by reducing inflammation and supporting metabolic functions.
Choice D Reason:
Monitoring blood glucose levels regularly is important because patients with Addison’s disease can experience hypoglycemia (low blood sugar levels) due to cortisol deficiency. Regular monitoring helps in timely detection and management of hypoglycemia, preventing potential complications.
Choice E Reason:
Administering diuretics is not appropriate for patients with Addison’s disease as it can lead to further electrolyte imbalances, particularly worsening hyponatremia and hyperkalemia. Diuretics increase the excretion of sodium and potassium, which is counterproductive in managing Addison’s disease.
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