A nurse is reviewing a client's CBC findings and discovers that the client's platelet count is 9,000/mm3. The nurse should monitor the client for which of the following conditions?

Spontaneous bleeding

Infection

Oliguria

Hyperactive deep tendon reflexes

Answer and Explanation

The Correct Answer is A

A.   Thrombocytopenia (low platelet count) predisposes the client to spontaneous bleeding. This can manifest as petechiae (small red or purple spots on the skin), purpura (larger areas of purple discoloration), mucosal bleeding (such as nosebleeds or bleeding gums), or internal bleeding (such as gastrointestinal or intracranial bleeding). Monitoring for signs of bleeding is essential to promptly intervene and prevent complications.
B.   While infections can occur in any client, a low platelet count does not directly predispose the client to infection. Thrombocytopenia primarily affects hemostasis rather than immune function.
C.   Oliguria refers to decreased urine output, typically less than 400 mL/day in adults. It is not directly related to thrombocytopenia but may occur in conditions affecting kidney function or fluid balance.
D.   Hyperactive deep tendon reflexes can indicate neurological conditions or electrolyte imbalances but are not associated with thrombocytopenia.

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Correct Answer is C

Explanation

A. Potassium levels are important for assessing electrolyte balance and are not directly indicative of protein intake or synthesis.
B. Calcium levels are important for bone health, nerve function, and muscle contraction. They are not directly indicative of protein intake or synthesis.
C. Albumin is a plasma protein that reflects the body's nutritional status and liver function. It has a relatively long half-life (approximately 20 days), making it a useful marker for assessing protein intake and synthesis over time. Low albumin levels can indicate malnutrition, liver disease, or other conditions affecting protein metabolism.
D. Sodium levels are important for fluid balance and nerve function. They are not directly indicative of protein intake or synthesis.

A. Patient with lung surgery has 20 ml/hr of urine output via catheter. B. Patient with appendix surgery has thready pulse and blood pressure is 90/60. C. Patient with knee surgery has approximated incision. D. Patient with femoral artery surgery has strong pedal pulse. E. Patient with bladder surgery has bloody urine within the first 12 hours.

Correct Answer is ["A","B","E"]

Explanation

A. A urine output of 20 ml/hr is considered inadequate and may indicate decreased kidney perfusion or function. This client likely needs immediate assessment and intervention to address potential renal complications.
B. A patient with appendix surgery exhibiting a thready pulse and a blood pressure of 90/60 should be followed up immediately, as these signs can indicate shock, which is a medical emergency.
C. An approximated incision indicates that the wound edges are well-aligned and healing is progressing as expected. This does not typically warrant immediate follow-up unless there are signs of infection or other complications.
D. A strong pedal pulse suggests adequate blood flow distal to the surgical site. This is a positive finding and does not typically require immediate follow-up unless there are signs of vascular compromise or other complications.
E. A patient with bladder surgery having bloody urine within the first 12 hours can be expected, but if the bleeding is heavy or increases, it would warrant immediate follow-up.

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A nurse is reviewing a client's CBC findings and discovers that the client's platelet count is 9,000/mm3. The nurse should monitor the client for which of the following conditions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is well-hydrated and who demonstrates no evidence of anemia. Which of the following laboratory values gives the nurse an assessment of the adequacy of the client's protein uptake and synthesis?

Correct Answer is C

Explanation

Which of the following post-surgical clients warrant an immediate follow up by the nurse? (Select all that apply.)

Correct Answer is ["A","B","E"]

Explanation

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