A patient has recently started ferrous sulfate 500 mg by mouth two times per day for anemia. Which of the following data would indicate to the nurse that the therapy is successful?

Choice A reason: The client requires additional teaching if they state that they can have aspirin for pain after the bone marrow aspiration. Aspirin is a drug that inhibits platelet aggregation and increases the risk of bleeding. ¹ The client should avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 48 hours after the procedure. ² The client should use acetaminophen or another pain reliever that does not affect blood clotting.

Choice B reason: The client does not require additional teaching if they state that the nurse will check the puncture site at least every 4 hours after the procedure. This is a correct statement, as the nurse should monitor the site for signs of bleeding, infection, or hematoma. ² The nurse should also apply pressure and a sterile dressing to the site and instruct the client to keep it dry and clean for 24 hours.

Choice C reason: The client does not require additional teaching if they state that they will have some pain that is similar to a toothache. This is a correct statement, as the client may experience mild to moderate pain at the site of the aspiration, which may radiate to the hip or back. ² The pain usually subsides within a few hours or days.

Choice D reason: The client does not require additional teaching if they state that they understand that this is a sterile procedure. This is a correct statement, as the bone marrow aspiration is performed under sterile conditions to prevent infection. ² The nurse should wear gloves, gown, mask, and eye protection and use a sterile needle, syringe, and antiseptic solution.

Choice A reason: The nurse should not encourage vigorous tooth brushing with a soft bristle toothbrush. Thrombocytopenia is a condition where the blood has a low number of platelets, which are cells that help with clotting. ¹ Vigorous tooth brushing can cause bleeding of the gums, which can be hard to stop in a client with thrombocytopenia. The nurse should advise the client to use a soft sponge or swab to clean the teeth and mouth gently.

Choice B reason: The nurse should avoid needle sticks or other invasive procedures as much as possible. Needle sticks and other invasive procedures can cause bleeding, bruising, or infection in a client with thrombocytopenia. ¹ The nurse should use the smallest gauge needle possible, apply pressure for at least 10 minutes after the procedure, and monitor the site for any signs of bleeding or infection. The nurse should also avoid unnecessary blood draws or injections, and use non-invasive methods whenever possible.

Choice C reason: The nurse should not hold all stool softeners and laxatives until otherwise ordered. Stool softeners and laxatives can help prevent constipation and straining, which can cause hemorrhoids or anal fissures in a client with thrombocytopenia. ¹ The nurse should encourage the client to take stool softeners and laxatives as prescribed, drink plenty of fluids, and eat high-fiber foods to promote regular bowel movements.

Choice D reason: The nurse should not obtain a low temperature every 8 hours. A low temperature is not a relevant or accurate measurement for a client with thrombocytopenia. The nurse should obtain a normal temperature, which is around 98.6°F (37°C), using a non-invasive method, such as an oral or tympanic thermometer. ² The nurse should avoid using a rectal thermometer, as it can cause bleeding or infection in a client with thrombocytopenia.