A nurse is caring for a client who has thrombocytopenia due to chemotherapy treatment. Which of the following actions should the nurse take?

Choice A reason: Thrombocytopenia from chemotherapy reduces platelets, impairing clotting and increasing bleeding risk. A soft-bristled toothbrush minimizes gum trauma, preventing hemorrhage in oral tissues, a common bleeding site. This instruction protects the client from excessive blood loss, aligns with bleeding precautions, and promotes safety during daily hygiene. It’s a practical, evidence-based measure to reduce mucosal injury, critical in managing low platelet counts effectively.

Choice B reason: Administering a rectal suppository risks rectal mucosal tearing in thrombocytopenia, where low platelets hinder clot formation, potentially causing significant bleeding. Chemotherapy-induced bone marrow suppression heightens this danger, making invasive procedures contraindicated. Safer alternatives, like oral medications, avoid this hazard. This action contradicts standard care, increasing harm in a client already prone to hemorrhage.

Choice C reason: A low-residue diet reduces bowel bulk, easing digestion, but doesn’t address thrombocytopenia’s bleeding risk, the primary concern here. It’s used in conditions like diverticulitis, not for platelet issues. Chemotherapy-related bleeding stems from vessel integrity, not diet, so this action lacks relevance. It fails to mitigate the client’s key vulnerability, making it inappropriate.

Choice D reason: Encouraging a safety razor in thrombocytopenia heightens bleeding risk, as even minor skin nicks won’t clot properly with low platelets from chemotherapy. Electric razors are recommended instead, minimizing cuts. This advice endangers the client, opposing bleeding precautions critical for safety. It ignores the condition’s pathophysiology, where external trauma must be avoided to prevent uncontrolled bleeding.

Choice A reason: Blood pressure of 100/70 mm Hg may suggest fluid overload, a component of pulmonary edema, but it’s not a specific indicator for furosemide use. This finding reflects systemic effects rather than direct lung involvement. Furosemide targets fluid in the alveoli, not just blood pressure changes. Without lung-specific signs like crackles, this alone doesn’t confirm the need for the diuretic, as hypotension could also indicate other issues unrelated to pulmonary edema’s primary pathology.

Choice B reason: Vesicular breath sounds are soft, normal sounds heard over healthy lung fields, indicating no fluid accumulation. Pulmonary edema, however, presents with abnormal sounds like crackles due to fluid in alveoli. Furosemide is prescribed to clear this fluid, so normal vesicular sounds suggest the lungs are clear, not requiring diuretic intervention. This finding contradicts the condition furosemide treats, making it an inappropriate indicator for the prescription in this context.

Choice C reason: Bilateral coarse crackles are hallmark signs of pulmonary edema, caused by fluid leaking into alveoli from increased left heart pressure. Furosemide, a loop diuretic, reduces this fluid by enhancing renal excretion, relieving lung congestion. This finding directly correlates with the drug’s purpose—removing excess fluid to improve oxygenation and reduce respiratory distress. Thus, crackles confirm the prescription’s appropriateness, targeting the core pathophysiology of pulmonary edema effectively.

Choice D reason: Potassium at 3.2 mEq/L is below normal (3.5-5.0 mEq/L), often a side effect of furosemide due to increased urinary potassium loss. However, this isn’t an indication for starting the drug; it’s a consequence to monitor post-administration. Pulmonary edema’s treatment focuses on fluid removal, not electrolyte levels initially. Low potassium might require correction, but it doesn’t justify the prescription, making this finding unrelated to furosemide’s therapeutic intent.