A nurse is planning care for a client who has idiopathic thrombocytopenic purpura (ITP). Which of the following manifestations is most appropriate for the nurse to monitor?
Elevated WBC
Fever
Fatigue
Ecchymosis
The Correct Answer is D
A. Elevated WBC is not typically associated with ITP, which primarily affects platelet counts.
B. Fever may indicate infection but is not specific to ITP.
C. Fatigue can occur in clients with ITP due to anemia or chronic illness but is not specific to the condition.
D. Ecchymosis (bruising) is a hallmark manifestation of ITP due to low platelet counts and increased bleeding tendencies.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
A. Implementing a recorded order message is not a standard practice and may not be permissible in all healthcare settings.
B. Transcribing the order into the client's health record is essential to ensure accurate documentation.
C. Repeating the order back to the provider ensures that the nurse has correctly understood the prescription.
D. Questioning any part of the order that is unclear or inappropriate ensures patient safety and accuracy.
E. While obtaining the provider's signature is necessary, the timeframe may vary depending on facility policies and regulations. The focus should be on ensuring the accuracy and clarity of the order first.
Correct Answer is ["200"]
Explanation
To calculate the infusion rate in mL/hr for administering clindamycin 900 mg in 100 mL dextrose 5% over 30 minutes, you would use the formula: (Total Volume in mL / Time in hours) = Rate in mL/hr. Since the medication needs to be administered over 30 minutes, you convert 30 minutes into hours, which is 0.5 hours. Using the formula, you get (100 mL / 0.5 hours) = 200 mL/hr. Therefore, the nurse should set the IV pump to deliver 200 mL/hr.
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