A nurse is caring for a client who has been diagnosed with heparin-induced thrombocytopenia (HIT). Which of the following clinical manifestations should the nurse recognize as the most concerning for a client with this condition?

Petechiae on the oral mucosa.

Hemoglobin of 14 g/dL.

Bleeding of the gums after oral care.

Pain and swelling in one leg.

Answer and Explanation

The Correct Answer is D

A.   Petechiae are tiny, pinpoint, red or purple spots on the skin or mucous membranes, caused by bleeding under the skin. While petechiae can indicate bleeding, they are not specific to HIT and can occur due to various reasons, including low platelet count or coagulation disorders. They do not necessarily indicate thrombotic complications associated with HIT.
B.   This hemoglobin level is within the normal range for adults and does not directly correlate with HIT. However, it is important to monitor hemoglobin levels in patients with HIT due to the risk of bleeding and thrombosis.
C.   Bleeding gums can occur due to various reasons, including gum disease or thrombocytopenia (low platelet count). In HIT, the concern is not just bleeding but also the paradoxical risk of thrombosis despite low platelet counts. Bleeding from mucosal surfaces can indicate underlying thrombocytopenia but does not specifically highlight the thrombotic risk of HIT.
D.   This symptom is concerning for deep vein thrombosis (DVT), which is a thrombotic complication associated with HIT. HIT predisposes patients to thrombosis due to the formation of antibodies against

platelet factor 4/heparin complexes, leading to platelet activation and clot formation. DVT is a serious complication that requires immediate intervention to prevent pulmonary embolism (PE).

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Correct Answer is C

Explanation

A. Medicare does cover individuals under 65 years old who have end-stage renal disease (ESRD) and meet certain criteria.
B. There are programs that allow individuals with both Medicare and low income to qualify for Medicaid, which can help cover additional healthcare costs that Medicare may not fully cover.
C. While Medicare does provide significant coverage for healthcare services, it is not entirely free of out- of-pocket costs. Medicare Part A typically covers hospital stays, skilled nursing facility care, hospice, and some home health care services with no premiums for most people.
D. Medicare is indeed federally-funded health insurance primarily for individuals aged 65 and older. It also covers certain younger individuals with disabilities and those with ESRD.

A. The client follows a strict vegetarian diet. B. The client takes rosuvastatin for hyperlipidemia. C. The client takes propranolol for hypertension. D. The client uses acetaminophen for headaches

Correct Answer is C

Explanation

A. A vegetarian diet typically does not directly contribute to bronchoconstriction. In fact, a diet rich in fruits and vegetables may provide antioxidants and anti-inflammatory compounds that can be beneficial for respiratory health. Therefore, this option is less likely to be a cause of the client's bronchoconstriction.
B. Rosuvastatin (and other statins) are generally well-tolerated, but some individuals may experience respiratory side effects, including cough or shortness of breath. However, bronchoconstriction as a direct side effect of statins is uncommon and typically not a primary concern unless there is a rare hypersensitivity reaction.
C. Propranolol is a non-selective beta-blocker that can lead to bronchoconstriction, particularly in individuals with asthma or other respiratory conditions. Beta-blockers can block beta-2 receptors in the lungs, potentially causing constriction of the airways and worsening of respiratory symptoms.
D. Acetaminophen (paracetamol) is generally considered safe and does not typically cause bronchoconstriction. It is a non-steroidal anti-inflammatory drug (NSAID) that works differently from medications like beta-blockers, which directly affect the airways.

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A nurse is caring for a client who has been diagnosed with heparin-induced thrombocytopenia (HIT). Which of the following clinical manifestations should the nurse recognize as the most concerning for a client with this condition?

Nursing Test Bank

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