A nurse is planning care for a client who has leukemia and a platelet count of 130,000/mm3. Which of the following interventions should the nurse include in the plan of care?
Check the IV site for bleeding every 8 hr
Obtain a rectal temperature every 8 hr.
Check the client for proteinuria.
Limit, IM injections.
The Correct Answer is D
A. Checking the IV site for bleeding is important for clients with low platelet counts, but it should be monitored more frequently, ideally every 1-2 hours.
B. Obtaining a rectal temperature is routine nursing care but does not specifically address the risk associated with the client's platelet count.
C. Checking for proteinuria may be relevant in other conditions but is not directly related to the client's current hematologic condition.
D. Limiting IM injections is crucial in clients with leukemia and low platelet counts to prevent bleeding complications from puncture sites.
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Correct Answer is ["0.5"]
Explanation
To calculate the correct dose of digoxin, the nurse needs to convert the prescribed micrograms (mcg) to milligrams (mg) as the medication available is measured in mg. One milligram (mg) is equal to 1000 micrograms (mcg). Therefore, 125 mcg is equal to 0.125 mg. Since the available medication is 0.25 mg per tablet, the nurse would administer half a tablet to achieve the 0.125 mg dose.
Correct Answer is B
Explanation
A. Preparing a 60-mL syringe with saline may be necessary for gastric lavage but is not the first action.
B. For an unconscious patient who has ingested a significant quantity of lorazepam, securing the airway is the most critical first step to prevent aspiration and ensure the patient can breathe. Therefore, the nurse should assist with intubation of the patient.
C. The initial step is to ensure that the client’s airway is secured through intubation before administration of activated charcoal.
D. Inserting a large-bore orogastric tube may be necessary for gastric lavage but typically follows administration of activated charcoal.
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