A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?

Measure abdominal girth twice weekly.

Monitor for the presence of WBCs in the urine.

Apply pressure to needlestick sites for 10 min.

Assess core temperatures using a rectal thermometer.

Answer and Explanation

The Correct Answer is C

Rationale:
A. Measuring abdominal girth is not directly related to thrombocytopenia management.
B. Monitoring for WBCs in the urine is not related to thrombocytopenia.
C. Applying pressure to needlestick sites for 10 minutes helps prevent bleeding, which is crucial for clients with thrombocytopenia.
D. Using a rectal thermometer can increase the risk of bleeding and should be avoided in clients with thrombocytopenia.

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Correct Answer is B

Explanation

A. Stage 1 hypertension is defined as a systolic BP of 130-139 mm Hg or a diastolic BP of 80-89 mm Hg.
B. Elevated BP is defined as a systolic BP of 120-129 mm Hg and a diastolic BP of less than 80 mm Hg.
C. Stage 2 hypertension is defined as a systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher.
D. Normal BP is defined as a systolic BP of less than 120 mm Hg and a diastolic BP of less than 80 mm Hg.

A. Metabolic alkalosis B. Metabolic acidosis C. Respiratory acidosis D. Respiratory alkalosis

Correct Answer is B

Explanation

A. Metabolic alkalosis is characterized by an elevated HCO3 and pH.
B. Metabolic acidosis is indicated by a low HCO3 (18 mEq/L) and a low pH (7.30). The low PaCO2 is a compensatory response.
C. Respiratory acidosis is indicated by an elevated PaCO2 and a low pH.
D. Respiratory alkalosis is indicated by a low PaCO2 and an elevated pH.

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A nurse is planning care for a client who has thrombocytopenia. Which of the following interventions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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