A nurse is planning care for a client who has leukemia and a platelet count of 130,000/mm3. Which of the following interventions should the nurse include in the plan of care?

Check the IV site for bleeding every 8 hr

Obtain a rectal temperature every 8 hr.

Check the client for proteinuria.

Limit, IM injections.

Answer and Explanation

The Correct Answer is D

A. Checking the IV site for bleeding is important for clients with low platelet counts, but it should be monitored more frequently, ideally every 1-2 hours.
B. Obtaining a rectal temperature is routine nursing care but does not specifically address the risk associated with the client's platelet count.
C. Checking for proteinuria may be relevant in other conditions but is not directly related to the client's current hematologic condition.
D. Limiting IM injections is crucial in clients with leukemia and low platelet counts to prevent bleeding complications from puncture sites.

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Correct Answer is C

Explanation

A. WBCs (White Blood Cells) may be decreased in multiple myeloma due to bone marrow suppression.
B. ANC (Absolute Neutrophil Count) can be decreased due to bone marrow suppression from the disease or treatment.
C. Calcium levels are often elevated in multiple myeloma due to bone breakdown and release of calcium from bone.
D. Platelets may be decreased due to bone marrow suppression as well.

A. Insertion of an arteriovenous graft for hemodialysis B. Testing for human leukocyte antigen (HLA) match C. Placement of the patient on the transplant waiting list D. Administer Mycophenolate

Correct Answer is D

Explanation

A. Insertion of an arteriovenous graft is not directly related to treating acute rejection but may be necessary if dialysis is needed.
B. Testing for HLA match is done before transplantation, not typically after acute rejection occurs.
C. Placement on the transplant waiting list is for patients who do not have a current functioning transplant.
D. Mycophenolate is an immunosuppressive medication commonly used to prevent or treat rejection in transplant patients.

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A nurse is planning care for a client who has leukemia and a platelet count of 130,000/mm3. Which of the following interventions should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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