A nurse is reviewing the laboratory values of an eight-month-old infant who is newly diagnosed with leukemia. Their most recent platelet count is 120,000/mm3 (200,000 to 475,000/mm3). Which of the following provider prescriptions should the nurse anticipate?
Administer packed red blood cells transfusion (PRBC)
Avoid taking rectal temperatures
Place child in protective environment precautions
Swab the oral cavity with viscous lidocaine
The Correct Answer is B
A. Administer packed red blood cells transfusion (PRBC):
While anemia may also be a concern in leukemia, the primary issue here is thrombocytopenia, not anemia. Administering packed red blood cells transfusion would address anemia, not the low platelet count.
B. Avoid taking rectal temperatures:
This is the correct option. Taking rectal temperatures carries the risk of causing bleeding or trauma, especially in individuals with thrombocytopenia. It is essential to avoid invasive procedures or activities that may increase the risk of bleeding in a patient with a low platelet count.
C. Place child in protective environment precautions:
Protective environment precautions, also known as reverse isolation, are typically implemented for patients who are immunocompromised to protect them from exposure to infectious agents. While patients with leukemia may be immunocompromised, the low platelet count is the primary concern here, not infection risk.
D. Swab the oral cavity with viscous lidocaine:
Swabbing the oral cavity with viscous lidocaine is not indicated for thrombocytopenia. Lidocaine may have local anesthetic properties but does not address the underlying issue of low platelet count.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "Expect the medication to cause constipation for the first few days of therapy.": This statement is incorrect. Metformin commonly causes gastrointestinal side effects such as diarrhea, abdominal discomfort, and nausea, especially when therapy is initiated. Constipation is not typically associated with metformin use.
B. "Take the medication at the same time each day.": This is a correct instruction. It is important for the adolescent to take metformin at the same time each day to maintain consistent blood levels of the medication and optimize its effectiveness.
C. "This medication is used for short-term therapy until your symptoms improve.": This statement is incorrect. Metformin is typically used for long-term management of type 2 diabetes mellitus to help control blood sugar levels. It is not intended for short-term therapy.
D. "Take this medication 1 hour before meals.": This statement is incorrect. While metformin can be taken with meals to reduce gastrointestinal side effects, it is not necessary to take it specifically 1 hour before meals. It can be taken with meals or shortly after meals.
Correct Answer is B
Explanation
A. A child who is postoperative following a tonsillectomy and reports moderate throat pain.
While postoperative pain management is important, moderate throat pain in a child who has undergone a tonsillectomy is expected. This client's condition is stable, and their pain can be managed with appropriate interventions. It is not the most urgent situation among the options provided.
B. A child who had a cardiac catheterization using the femoral artery and has blanching of the toes.
Blanching of the toes following a cardiac catheterization using the femoral artery can indicate compromised circulation, potentially leading to ischemia or necrosis. This requires immediate assessment to prevent further complications.
C. A child who has bacterial pneumonia and is due for their initial dose of IV antibiotics.
While timely administration of antibiotics is important in the treatment of bacterial pneumonia, missing the initial dose by a short period of time is not likely to result in significant harm compared to a potential circulatory compromise in option B.
D. A child who has juvenile idiopathic arthritis and needs assistance with the application of prescribed splints.
While providing assistance with splint application is necessary for comfort and mobility, it is not as urgent as assessing potential circulatory compromise or initiating antibiotic therapy for pneumonia.
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