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 D
Explanation
Rationale:
A. Auscultating bowel sounds for 3 to 5 minutes is appropriate if sounds are not initially heard.
B. Clamping the NG tube prevents false bowel sounds from the tube.
C. Performing auscultation between meals ensures accurate assessment of bowel sounds.
D. Palpating the abdomen prior to auscultation can alter bowel sounds, making it important to auscultate before palpation.
Correct Answer is B
Explanation
A. Hypoglycemia is not a risk factor for metabolic syndrome; hyperglycemia is more relevant.
B. A large waist size (abdominal obesity) is a significant risk factor for metabolic syndrome, which includes a cluster of conditions such as increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels.
C. History of asthma is not directly related to metabolic syndrome.
D. Hypotension is not a risk factor for metabolic syndrome; hypertension is more relevant.
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