An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/μL during chemotherapy is to
check all stools for occult blood.
encourage fluids to 3000 mL/day.
provide oral hygiene every 2 hours.
check the temperature every 4 hours.
The Correct Answer is A
A. Correct. A platelet count <20,000/μL increases bleeding risk. Checking for occult blood helps detect hidden gastrointestinal bleeding.
B. Incorrect. Hydration is important but does not directly address thrombocytopenia management.
C. Incorrect. While oral hygiene is important, frequent brushing could cause bleeding with low platelets.
D. Incorrect. Monitoring temperature is important for infection risk but does not address bleeding concerns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Incorrect → Insulin injections should be administered at a 90-degree angle unless the patient has minimal subcutaneous fat, in which case a 45-degree angle is used. A 25-degree angle is too shallow and may lead to improper absorption.
B. Rotating insulin injection sites helps prevent lipodystrophy and ensures consistent absorption. The patient’s decision to inject in the thigh after using the abdomen in the morning demonstrates proper site rotation.
C. Incorrect → Insulin should be administered with a U-100 insulin syringe (not a 1 mL syringe) to ensure accurate dosing.
D. Incorrect → While injecting an inch away from a previous site is reasonable, the preferred practice is rotating between different anatomical sites to prevent tissue damage and inconsistent absorption.
Correct Answer is B
Explanation
A. High glucose levels cause the body to use proteins for energy, causing lactic acidosis – While hyperglycemia can lead to ketosis, it does not directly cause lactic acidosis.
B. Chronic elevated blood glucose levels damage cells and cause long-term chronic organ dysfunction – Hyperglycemia leads to complications such as neuropathy, nephropathy, and retinopathy, making glucose control essential.
C. Early identification of hypoglycemia is easier to treat resulting in better outcomes – While important, the primary reason for frequent monitoring is to prevent long-term complications.
D. Carbohydrates are constantly being converted to glucose and utilized for extra energy stores – This statement is not specific to diabetes management.
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