A nurse is collecting data from a client who has thrombocytopenia. The nurse should identify which of the following findings increases the client's risk for injury.

Wears a face mask around others

Sleeps 8 to 10 hr per night

Uses a firm bristled toothbrush

Increased intake of green, leafy vegetables

Answer and Explanation

The Correct Answer is C

A.   Incorrect. Wearing a face mask around others is not directly related to thrombocytopenia and does not impact the risk of injury in this context.
B.   Incorrect. Sleep duration is not directly related to thrombocytopenia and does not impact the risk of injury in this context.
C.   Correct. Using a firm-bristled toothbrush can increase the risk of bleeding in a client with thrombocytopenia due to potential gum injury. Soft-bristled toothbrushes are recommended to minimize the risk of injury and bleeding.
D.   Incorrect. Increased intake of green, leafy vegetables is generally beneficial for health and does not increase the risk of injury in thrombocytopenia.

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Correct Answer is A

Explanation

A. Correct. This instruction helps ensure proper identification of the newborn, reducing the risk of mix-ups.
B. Incorrect. While verifying credentials is important, this action might not be feasible for every nurse and situation.
C. Incorrect. Leaving the newborn unattended is not a safe practice.
D. Incorrect. Carrying the newborn to the nursery might expose the newborn to unnecessary risks and separation.

A. "I will take two 325 milligram aspirin tablets at the same time." B. "I will stop what I am doing and lie down." C. "I will call the provider after taking one dose of nitroglycerin." D. "I will hold my breath and bear down."

Correct Answer is B

Explanation

The correct answer is choice b. “I will stop what I am doing and lie down.”

Choice A rationale:

Taking two 325 milligram aspirin tablets at the same time is not the recommended immediate action for chest pain. Aspirin can help in preventing blood clots, but it is not the first step in managing acute angina.

Choice B rationale:

Stopping activity and lying down is the correct initial response to chest pain. This helps reduce the heart’s workload and can alleviate the pain.

Choice C rationale:

Calling the provider after taking one dose of nitroglycerin is important, but it is not the first step. The client should first stop activity and lie down, then take nitroglycerin if prescribed.

Choice D rationale:

Holding the breath and bearing down (Valsalva maneuver) is not appropriate for managing chest pain and can actually increase the heart’s workload, potentially worsening the situation.

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A nurse is collecting data from a client who has thrombocytopenia. The nurse should identify which of the following findings increases the client's risk for injury.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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