The nurse is caring for a patient with thrombocytopenia who has a platelet count of 45,000/mm³. What nursing intervention will the nurse implement to manage this condition?

Administer platelet transfusion immediately.

Monitor the patient for signs of bleeding and educate about bleeding precautions.

Administer aspirin to reduce the risk of clot formation.

Encourage the patient to engage in regular physical exercise to improve circulation.

Answer and Explanation

The Correct Answer is B

Choice A reason: Administering a platelet transfusion immediately is not indicated for a platelet count of 45,000/mm³. While this is below the normal range, it is not critically low. Platelet transfusions are typically reserved for patients with life-threatening bleeding or extremely low platelet counts.

Choice B reason: Monitoring the patient for signs of bleeding and educating about bleeding precautions is the appropriate intervention. Patients with thrombocytopenia are at an increased risk of bleeding, and it is essential to educate them on how to minimize this risk, such as avoiding activities that can cause injury, using a soft toothbrush, and avoiding over-the-counter medications that can affect platelet function.

Choice C reason: Administering aspirin to reduce the risk of clot formation is incorrect. Aspirin is an antiplatelet agent that can increase the risk of bleeding in patients with thrombocytopenia. It should be avoided unless specifically prescribed for another condition with close monitoring.

Choice D reason: Encouraging the patient to engage in regular physical exercise to improve circulation is not appropriate in this context. While physical activity is generally beneficial, it should be done with caution in patients with thrombocytopenia to avoid injury and bleeding. The focus should be on safety and bleeding precautions.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A reason:

Normal blood pressure may indicate improved hydration, but deep respirations (often seen in metabolic acidosis or DKA) suggest that the patient is still experiencing distress. This combination does not reliably signal effective treatment for HHS.

Choice B reason:

Increased alertness shows that the patient’s mental status is improving, reflecting better cerebral perfusion and hydration.
A normal heart rhythm indicates that potassium levels are stable (thanks to the potassium chloride in the IV fluids) and that the insulin therapy is not causing dangerous shifts.
Together, these findings are the best indicators that the treatment is effective.

Choice C reason:

A high urine specific gravity reveals that the urine is still concentrated, which means dehydration persists.
Although the temperature is normal, the continued dehydration is not consistent with effective treatment of HHS.

Choice D reason:

A blood glucose of 250 mg/dL suggests that hyperglycemia is being corrected; however, persistent disorientation indicates that the patient’s mental status has not improved, meaning that the treatment has not fully resolved the critical aspects of HHS.

Thus, Choice B (Increased alertness, normal heart rhythm) is the best indicator of effective treatment.

A. Ulcers in the descending colon noted on colonoscopy B. Absence of narrowing of the colon and mucosal edema on barium studies C. Fistulas and perianal involvement D. Mild bleeding and abdominal mass E. Regional, discontinuous skip lesions noted on the barium studies

Correct Answer is ["A","C","E"]

Explanation

Choice A reason: Ulcers in the descending colon are indicative of Crohn's disease, which affects any part of the gastrointestinal tract.

Choice B reason: Absence of narrowing of the colon and mucosal edema is more indicative of ulcerative colitis rather than Crohn's disease.

Choice C reason: Fistulas and perianal involvement are common complications of Crohn's disease due to the transmural inflammation.

Choice D reason: Mild bleeding and an abdominal mass can be associated with both Crohn's disease and other gastrointestinal disorders, making it less specific.

Choice E reason: Regional, discontinuous skip lesions are a hallmark of Crohn's disease, seen on barium studies, indicating areas of inflammation separated by normal tissue.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The nurse is caring for a patient with thrombocytopenia who has a platelet count of 45,000/mm³. What nursing intervention will the nurse implement to manage this condition?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient with hyperosmolar hyperglycemic syndrome. The patient is receiving intravenous fluids of normal saline with 20 mEq of potassium chloride and a continuous insulin infusion. Which finding will indicate to the nurse that the treatment is effective?

Correct Answer is B

Explanation

The nurse is admitting a patient whose health history is suggestive of inflammatory bowel disease. Which clinical manifestations and diagnostic findings confirm the diagnosis of Crohn's disease? (Select All That Apply)

Correct Answer is ["A","C","E"]

Explanation

The nurse is assessing a patient who is diagnosed with inflammatory bowel disease and is requiring inpatient treatment at a hospital. What medication will the nurse provide when caring for this patient?

The nurse is caring for a patient after a recent kidney transplant. What statement will the nurse include when teaching the patient about preventing organ rejection?

The nurse is caring for a patient with systemic lupus erythematosus (SLE). What health education will the nurse teach the patient to prevent flares and complications of this condition?

The nurse is caring for a patient with respiratory alkalosis. Which clinical manifestations will the nurse expect to find?

The nurse is caring for a patient with diabetic ketoacidosis. Which assessment finding indicates to the nurse that the patient is experiencing fluid volume deficit?

The nurse is caring for a patient with diabetic ketoacidosis (DKA). What clinical manifestations will the nurse anticipate the patient to present? (Select All That Apply)

The nurse is caring for a patient with end-stage kidney disease (ESKD). Which arterial blood gas results (ABG) will the nurse correlate with the patient's condition?

The nurse is admitting a patient with type 1 diabetes. While reviewing the patient's laboratory results, the nurse notes the presence of ketones in the urine. What intervention will the nurse implement for this patient?