The nurse is caring for a client diagnosed with secondary immune thrombocytopenic purpura (ITP). The nurse should expect the client to be tested for which of the following possible causes?

Choice A rationale

Right-sided heart failure with thickened heart muscle refers specifically to the impaired filling capacity due to diastolic dysfunction. Diastolic dysfunction affects the filling phase, not the pumping phase. It may involve one side or both sides but is not explicitly described as right and left-sided diastolic in this context.

Choice B rationale

Right-sided systolic heart failure affects the pumping ability, while diastolic affects filling. Both conditions together do not explain the thickened myocardium impairing filling. A combination of systolic and diastolic failure typically includes both pumping and filling abnormalities rather than isolated thickening with poor filling.

Choice C rationale

Right-sided diastolic failure results from impaired ventricular relaxation and thickened myocardium, leading to reduced filling capacity. This type of failure involves the heart's inability to accommodate blood during diastole, consistent with the description of thickened heart muscle and poor filling on the right side.

Choice D rationale

Right-sided systolic failure involves impaired contractility and pumping of blood to the lungs, not poor filling caused by thickened muscle. Systolic dysfunction decreases the heart's output rather than affecting the filling phase described in this scenario.

Choice A rationale

Reducing caffeine consumption decreases bladder irritation and helps manage urinary incontinence symptoms. Caffeine stimulates bladder activity and exacerbates urgency and frequency. Clinical evidence supports its reduction as part of an effective urinary incontinence management strategy.

Choice B rationale

Grapefruit juice is acidic and irritates the bladder lining, worsening symptoms of urinary incontinence. Substituting orange juice with grapefruit juice does not mitigate bladder irritation. Both contain acids and should be avoided to manage urinary incontinence effectively. Citrus juices are contraindicated in clients managing urinary incontinence.

Choice C rationale

Kegel exercises improve pelvic floor muscle strength, reducing urinary incontinence episodes. They enhance the function of the urinary sphincter and support better bladder control. Kegel exercises are widely recommended in clinical practice for patients managing urinary incontinence and are supported by robust scientific evidence.

Choice D rationale

Scheduled bathroom visits prevent bladder overdistension and manage urinary incontinence symptoms effectively. Timed voiding trains the bladder to hold urine for specific periods, reducing the frequency of urgency episodes. It is an effective behavioral approach supported by clinical guidelines for managing urinary incontinence.