A nurse is performing medication reconciliation for a client newly admitted. Which of the following actions should the nurse take?

Choice A reason: A parent with type 2 diabetes indicates a genetic risk for metabolic issues, possibly relevant to liver disease progression, like NAFLD. However, it’s historical data, not an immediate threat to transplant success. The priority lies with factors affecting post-operative care, like adherence, over family history. This statement, while useful, isn’t urgent for reporting now.

Choice B reason: Childhood asthma history suggests past respiratory issues, potentially complicating anesthesia or recovery, but if resolved, it’s low priority. End-stage liver disease focuses on hepatic function, not dormant lung conditions. Without current symptoms, this doesn’t impact transplant candidacy urgently, making it less critical than adherence concerns.

Choice C reason: Poor medication adherence is a red flag for transplant listing, as post-operative immunosuppressants prevent rejection, requiring strict compliance. Non-adherence risks graft failure, a life-threatening outcome in end-stage liver disease. This statement demands immediate provider attention to assess candidacy and plan interventions, prioritizing it over other concerns here.

Choice D reason: Lack of family support affects emotional coping and post-transplant care logistics, potentially stressing recovery, but it’s not an immediate medical risk. Adherence to medications directly impacts survival, outweighing psychosocial factors in urgency. This statement, while relevant, doesn’t necessitate urgent reporting compared to compliance issues.

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.