A nurse is assigned to care for a client diagnosed with autoimmune or idiopathic thrombocytopenic purpura (ITP). When reviewing the client's plan of care prior to caring for the client, the nurse should recognize that the priority concern in caring for the client is to monitor for:

Fatigue

Side effects of immunosuppressants

Thrombocytopenia

Infection

Answer and Explanation

The Correct Answer is C

Choice A reason: Fatigue is a common symptom of ITP but is not the primary concern for monitoring, as it does not directly indicate the severity of the condition.

Choice B reason: While monitoring for side effects of immunosuppressants is important, it is not the priority concern. The primary issue in ITP is the low platelet count, which poses a risk of bleeding.

Choice C reason: Thrombocytopenia, or low platelet count, is the hallmark of ITP and the main concern for monitoring, as it increases the risk of bleeding and bruising.

Choice D reason: Infection is a risk due to the potential use of immunosuppressants in treatment; however, the immediate concern in ITP management is the platelet count and associated bleeding risk.

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Correct Answer is B

Explanation

Choice A reason: Pain is a common postoperative symptom and should be managed appropriately. However, it is not typically considered a priority over other complications that can have more immediate and severe consequences.

Choice B reason: Hemorrhage is a significant risk after TURP and can be life-threatening. It is considered a priority because active bleeding can lead to shock and requires immediate intervention.

Choice C reason: Infection is a potential complication after any surgery, including TURP. While important to monitor for, it is generally not as immediately life-threatening as hemorrhage.

Choice D reason: Urinary retention can occur after TURP, but it is often anticipated and managed with the placement of a urinary catheter. It is a concern but not the highest priority immediately following surgery.

A. "I will have a camera put down my throat so they can see my gallbladder." B. "They are going to examine my gallbladder and ducts." C. "They'll put medication into my gallbladder to dissolve the stones." D. "Soon those shock waves will get rid of my gallstones."

Correct Answer is B

Explanation

Choice A reason: This choice is incorrect because an oral cholangiogram does not involve putting a camera down the throat. That procedure is more akin to an endoscopy.

Choice B reason: This statement is correct. An oral cholangiogram involves taking an Xray examination of the gallbladder after the patient has taken an iodine based contrast agent orally. The procedure is used to diagnose problems related to the gallbladder, such as gallstones or issues with bile flow.

Choice C reason: This choice is incorrect because an oral cholangiogram does not involve putting medication into the gallbladder to dissolve stones. That description is more consistent with nonsurgical treatments for gallstones, such as oral bile acid pills.

Choice D reason: This choice is incorrect as it describes a different procedure known as extracorporeal shock wave lithotripsy (ESWL), which uses shock waves to break up gallstones.

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A nurse is assigned to care for a client diagnosed with autoimmune or idiopathic thrombocytopenic purpura (ITP). When reviewing the client's plan of care prior to caring for the client, the nurse should recognize that the priority concern in caring for the client is to monitor for:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is postoperative following a transurethral resection of the prostate (TURP). Which of the following complications is the priority for the nurse to monitor?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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