Which of the following actions should a nurse plan for when providing care for a client diagnosed with thrombocytopenia?
Avoid needle sticks or other invasive procedures as much as possible.
Hold all stool softeners and laxatives until otherwise
Encourage vigorous tooth brushing with a soft bristle toothbrush,
Obtain a core temperature every 8 hours.
The Correct Answer is A
A. Avoid needle sticks or other invasive procedures as much as possible: This is the most appropriate action for a client with thrombocytopenia. Since thrombocytopenia involves a low platelet count, the risk of bleeding is increased, and minimizing invasive procedures helps prevent complications.
B. Hold all stool softeners and laxatives until otherwise: This statement is not appropriate. Clients with thrombocytopenia should avoid straining during bowel movements, which can be facilitated by the use of stool softeners or laxatives if necessary.
C. Encourage vigorous tooth brushing with a soft bristle toothbrush: This is not advisable. While using a soft-bristled toothbrush is recommended, vigorous brushing could cause gum bleeding. Gentle oral hygiene practices should be emphasized instead.
D. Obtain a core temperature every 8 hours: While monitoring temperature is important, it is not specific to thrombocytopenia management. Other vital signs may be monitored more frequently, but this action does not directly address the primary concern of bleeding risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Have biannual renal function studies: While monitoring renal function can be important, it is not specifically required for all patients on rosuvastatin. The focus should be on liver function and muscle-related side effects.
B. Stop the medication if you develop a headache: Headaches are not a common or serious side effect of rosuvastatin. Patients should not stop the medication without consulting their healthcare provider unless they experience severe symptoms.
C. Report muscle weakness or pain: This is critical information to provide. Statins, including rosuvastatin, can cause muscle-related side effects such as myopathy or rhabdomyolysis. Patients should be instructed to report any unexplained muscle weakness, pain, or tenderness.
D. Monitor body weight weekly: While maintaining a healthy weight is important, weekly weight monitoring is not a standard recommendation for patients taking rosuvastatin.
Correct Answer is ["A","B","C","D","E"]
Explanation
A) Allow for rest periods between activities throughout the day: This intervention is essential for a client with activity intolerance. Incorporating rest periods helps to manage fatigue and allows for recovery, particularly when hypoxemia is a concern due to sickle cell anemia.
B) Provide supplemental oxygen when the pulse oximetry falls below 96%: Administering supplemental oxygen when oxygen saturation levels drop below 96% is crucial for preventing further hypoxemia and ensuring adequate tissue perfusion, thus addressing the client's activity intolerance.
C) Perform serial neurologic assessments to maintain safety and prevent injury: Regular neurologic assessments are vital, especially in clients with sickle cell anemia, who are at risk for complications like stroke. This intervention helps monitor for changes in neurological status, ensuring prompt action if needed.
D) Assess ability to perform activities of daily living (ADLs): Evaluating the client’s ability to perform ADLs provides valuable information on their functional status and helps tailor interventions to promote independence while considering their limitations due to hypoxemia.
E) Monitor blood pressure, pulse, and respirations after activity: This monitoring is important to evaluate the client’s response to activity and to detect any changes that could indicate distress or worsening hypoxemia. This information helps guide further interventions and ensures the client’s safety.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.