The nurse is caring for a client with severe thrombocytopenia who is scheduled for a bone marrow biopsy.
The provider prescribes a platelet transfusion for the client. When should the nurse anticipate administering the platelets?

This scenario involves end of life care and ethical communication regarding physiological changes during the dying process. Knowledge of palliative care principles and the natural slowing of metabolic processes is required to address the family's concerns and provide reassurance.

Choice A rationale

Explaining that anorexia is a natural part of the dying process validates the physiological reality that the body no longer requires fuel. Discussing aspiration risk helps the wife understand that forced feeding could cause harm or discomfort.

Choice B rationale

Nutritional consults and preferred foods are ineffective when a client is actively dying. The focus shifts from nutritional maintenance to comfort. Interventions aimed at increasing caloric intake do not prolong life or improve quality at this terminal stage.

Choice C rationale

While keeping foods available seems supportive, it can create pressure on the client and frustration for the family. In the final stages of life, many clients lack the physical strength or reflex capability to safely consume bedside snacks.

Choice D rationale

Encouraging the wife to feed the client as much as possible increases the risk of choking and aspiration. It places an undue burden on the caregiver and may cause the client physical distress, as their digestive system slows.

Managing disseminated intravascular coagulation involves identifying secondary complications of microvascular thrombosis and hemorrhage. Knowledge of coagulation pathways and end-organ perfusion assessment is required to differentiate between laboratory markers of the disease process and clinical indicators of worsening organ failure.

Choice A rationale

A prolonged prothrombin time, where the normal range is 11 to 13.5 seconds, is a diagnostic laboratory finding for this condition. However, it represents a hematological marker of the clotting cascade exhaustion rather than organ dysfunction.

Choice B rationale

Elevated D-dimer, with a normal range usually less than 500 ng/mL, indicates active fibrinolysis. While it confirms the presence of the disorder and ongoing clot breakdown, it is a laboratory value, not a clinical cue.

Choice C rationale

Capillary refill greater than 3 seconds indicates poor peripheral tissue perfusion. In this condition, microthrombi obstruct small vessels, leading to ischemia. A refill of 5 seconds signals significant circulatory compromise and potential progression toward multi-organ failure.

Choice D rationale

Petechiae and purpura are classic integumentary signs of bleeding due to thrombocytopenia and clotting factor depletion. While they signify active bleeding, they are considered standard symptoms of the disease rather than specific markers of organ dysfunction.

Choice E rationale

Decreased urine output, typically defined as less than 30 mL per hour, indicates impaired renal perfusion or acute kidney injury. This occurs due to microvascular thrombi in the renal capillaries, signaling significant organ dysfunction.

Choice F rationale

A normal platelet count, ranging from 150,000 to 450,000 cells/mm, would indicate improvement rather than worsening. In active cases, platelets are rapidly consumed, leading to severe thrombocytopenia as the body attempts to form micro-clots throughout the vasculature.