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A nurse is admitting a 56-year old male patient who has leukemia and a critically low platelet count. Which of the following precautions should the nurse initiate?

Neutropenic

Contact

Droplet

Bleeding

Answer and Explanation

The Correct Answer is D

A. Neutropenic – Used for low WBC count, not platelets.

B. Contact – Used for infections like C. diff or MRSA.

C. Droplet – Used for respiratory illnesses like flu or meningitis.

D. Bleeding – Correct Answer. A low platelet count increases the risk of bleeding, so bleeding precautions are necessary (e.g., soft toothbrush, avoiding IM injections, fall precautions).

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Correct Answer is B

Explanation

A. Infuse the transfusion at a rate of 200 mL/hr. – Incorrect. The initial infusion should be slow (e.g., 75-100 mL/hr) to monitor for reactions.

B. Check the patient's vital signs every hour during the transfusion. – Correct Answer. Frequent monitoring is necessary to detect adverse reactions, such as fever or hypotension.

C. Leave the patient 5 minutes after beginning the transfusion. – Incorrect. The nurse should remain with the patient for the first 15 minutes, as most transfusion reactions occur early.

D. Flush the blood tubing with dextrose 5% in water. – Incorrect. Only normal saline should be used to flush blood tubing, as dextrose can cause hemolysis.

A. High fever B. Constipation C. Bradycardia D. Pain

Correct Answer is D

Explanation

A. High fever. – Incorrect. Fever can occur with infection but is not a hallmark sign of sickle cell crisis.

B. Constipation. – Incorrect. Constipation is not a defining symptom of sickle cell crisis.

C. Bradycardia. – Incorrect. Tachycardia, not bradycardia, is common due to pain and hypoxia.

D. Pain. – Correct Answer. Severe pain is the most common symptom of sickle cell crisis due to vaso-occlusion and ischemia.

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A nurse is admitting a 56-year old male patient who has leukemia and a critically low platelet count. Which of the following precautions should the nurse initiate?

Nursing Test Bank

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