After noting that a patient with leukemia has thrombocytopenia, which action will the nurse plan to take?
Palpate lymph nodes for swelling.
Check temperature for elevation.
Inspect skin for bruising or petechiae.
Examine oral mucosa for ulceration.
The Correct Answer is C
Choice A rationale:
Palpating lymph nodes for swelling is not directly related to thrombocytopenia. Thrombocytopenia is a condition characterized by a low platelet count, which can lead to easy bruising and bleeding. Checking lymph nodes is more relevant in assessing for infection or malignancy.
Choice B rationale:
Checking temperature for elevation is important for assessing infection, which could be a cause of thrombocytopenia. However, in this context, inspecting the skin for bruising or petechiae is more specific to thrombocytopenia. Petechiae are small, red or purple dots that appear on the skin when platelet count is low.
Choice D rationale:
Examining oral mucosa for ulceration is essential in the assessment of conditions like oral cancer or infection. While thrombocytopenia could lead to bleeding in the oral mucosa, it is not the most specific or immediate concern in a patient with known thrombocytopenia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Skeletal pain is not a typical finding in stage I Hodgkin lymphoma. Hodgkin lymphoma typically presents with painless enlarged lymph nodes, which is a hallmark symptom of the disease.
Choice B rationale:
Enlarged lymph nodes are a characteristic feature of Hodgkin lymphoma. In stage I, the disease is localized to one group of lymph nodes.
Choice C rationale:
T-cell blasts in the lymph node are not specific to Hodgkin lymphoma. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, which are large abnormal B cells, not T-cell blasts.
Choice D rationale:
Lymphoblasts in the cerebrospinal fluid are not associated with Hodgkin lymphoma. Involvement of the central nervous system is rare in Hodgkin lymphoma and typically does not lead to the presence of lymphoblasts in the cerebrospinal fluid.
Correct Answer is C
Explanation
Choice A rationale:
While leukemia treatment does have severe side effects, not all of them are permanent. It is essential for the patient to be aware of potential complications but also to understand that some side effects might be temporary and can be managed with appropriate care.
Choice B rationale:
Using the call light to ask for help when getting out of bed is essential for patients receiving chemotherapy, as their immune system might be compromised, making them prone to infections and injuries. However, this information is not specific to leukemia treatment but is a general safety measure for these patients.
Choice C rationale:
Patients undergoing chemotherapy for leukemia are at an increased risk of infections due to the suppression of the immune system. Preventive measures, such as good hygiene practices and early detection of signs of infection, are crucial in managing these patients. Educating the patient about infection prevention is essential for their safety during treatment.
Choice D rationale:
Feeling isolated can be a common emotional response to any chronic illness, including leukemia. However, it is not an unavoidable consequence, and providing emotional support and involving the patient in support groups can help mitigate these feelings. This statement does not provide essential information about managing leukemia treatment.
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