A nurse is developing a care plan for a patient who has been diagnosed with idiopathic thrombocytopenic purpura (ITP). Which of the following symptoms is most important for the nurse to monitor?

Elevated WBC count.

Fever.

Ecchymosis.

Fatigue.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While an elevated WBC count can indicate an infection, it is not the most important symptom to monitor in a patient with idiopathic thrombocytopenic purpura (ITP). ITP is primarily a platelet disorder, and while infection can trigger or exacerbate the condition, an elevated WBC count is not a direct symptom of ITP78.

Choice B rationale

Fever can be a sign of infection, which can trigger or exacerbate ITP. However, it is not the most important symptom to monitor in a patient with ITP78.

Choice C rationale

Ecchymosis, or bruising, is a key symptom of ITP. Because ITP involves a decrease in platelets, which are necessary for clotting, patients with this condition are prone to bruising and bleeding. Therefore, monitoring for ecchymosis is crucial.

Choice D rationale

Fatigue can be a symptom of ITP, but it is not the most important symptom to monitor. While fatigue can impact a patient’s quality of life, it does not directly indicate the severity of the condition.

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Correct Answer is B

Explanation

Choice A rationale

Hematuria, or blood in the urine, is not typically a symptom of postpartum endometritis.

Choice B rationale

Pelvic pain is a common symptom of postpartum endometritis. It is often one of the first symptoms to appear, along with lower abdominal pain and uterine tenderness.

Choice C rationale

While a moderate amount of dark red lochia with a bloody odor can be a normal part of the postpartum period, it is not specifically indicative of endometritis.

Choice D rationale

Localized area of breast tenderness is not typically a symptom of postpartum endometritis.

A. 2 cm above the umbilicus. B. One fingerbreadth above the symphysis pubis. C. At the level of the umbilicus. D. To the right of the umbilicus.

Correct Answer is A

Explanation

Choice A rationale

At about 12 hours after delivery, the uterine fundus can be palpated at 1 cm above the umbilicus. This is the correct answer.

Choice B rationale

One fingerbreadth above the symphysis pubis is not where the uterine fundus is expected to be found 12 hours after a vaginal delivery.

Choice C rationale

At the level of the umbilicus is not where the uterine fundus is expected to be found 12 hours after a vaginal delivery.

Choice D rationale

To the right of the umbilicus is not where the uterine fundus is expected to be found 12 hours after a vaginal delivery.

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A nurse is developing a care plan for a patient who has been diagnosed with idiopathic thrombocytopenic purpura (ITP). Which of the following symptoms is most important for the nurse to monitor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is evaluating a postpartum client for potential endometritis.Which of the following symptoms should the nurse identify as a need for further assessment?

Correct Answer is B

Explanation

A nurse is caring for a patient who had a vaginal delivery 12 hours ago.Where should the nurse expect to find the uterine fundus when palpating the patient’s abdomen?

Correct Answer is A

Explanation

A 23 weeks pregnant client calls the clinic and reports leakage of vaginal fluid.What should be the appropriate response by the nurse?

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