Which of the following actions should a nurse plan for when providing care for a client diagnosed with thrombocytopenia?

Avoid needle sticks or other invasive procedures as much as possible.

Hold all stool softeners and laxatives until otherwise

Encourage vigorous tooth brushing with a soft bristle toothbrush,

Obtain a core temperature every 8 hours.

Answer and Explanation

The Correct Answer is A

A. Avoid needle sticks or other invasive procedures as much as possible: This is the most appropriate action for a client with thrombocytopenia. Since thrombocytopenia involves a low platelet count, the risk of bleeding is increased, and minimizing invasive procedures helps prevent complications.

B. Hold all stool softeners and laxatives until otherwise: This statement is not appropriate. Clients with thrombocytopenia should avoid straining during bowel movements, which can be facilitated by the use of stool softeners or laxatives if necessary.

C. Encourage vigorous tooth brushing with a soft bristle toothbrush: This is not advisable. While using a soft-bristled toothbrush is recommended, vigorous brushing could cause gum bleeding. Gentle oral hygiene practices should be emphasized instead.

D. Obtain a core temperature every 8 hours: While monitoring temperature is important, it is not specific to thrombocytopenia management. Other vital signs may be monitored more frequently, but this action does not directly address the primary concern of bleeding risk.

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Correct Answer is D

Explanation

A. Encourage oral fluids: While hydration is important, it is not the most immediate concern following the administration of prazosin.

B. Record the client's weight: Weight monitoring is not specifically indicated after the initial dose of prazosin and is not a priority action in this context.

C. Take a pulse oximetry reading: While monitoring oxygen saturation is important in many situations, it is not directly related to the administration of prazosin, which primarily affects blood pressure.

D. Place the call bell in reach of the client: This is the most appropriate action. Prazosin can cause orthostatic hypotension, particularly after the first dose, leading to dizziness or fainting. Ensuring that the call bell is within reach allows the client to request help if they feel lightheaded or need assistance.

A. increased fluid in the pericardial sac. B. dysfunction of one or more heart valves. C. an aneurysm of the descending aorta. D. an occlusion of the right coronary artery.

Correct Answer is B

Explanation

A. increased fluid in the pericardial sac: While fluid accumulation can affect heart sounds, it typically leads to muffled heart sounds rather than a loud murmur. Increased fluid in the pericardial sac (pericardial effusion) usually does not produce a classic heart murmur.

B. dysfunction of one or more heart valves: This statement is correct. Heart murmurs are often caused by turbulence in blood flow due to the dysfunction of heart valves, such as stenosis (narrowing) or regurgitation (leaking). A loud murmur suggests significant turbulence, which is often indicative of valvular heart disease.

C. an aneurysm of the descending aorta: While an aortic aneurysm can cause other types of heart sounds or signs of cardiovascular compromise, it is not primarily associated with heart murmurs.

D. an occlusion of the right coronary artery: An occlusion may lead to ischemia or myocardial infarction, which can cause changes in heart sounds, but it does not directly cause a heart murmur. Murmurs are more specifically related to blood flow dynamics, particularly involving valves.

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Which of the following actions should a nurse plan for when providing care for a client diagnosed with thrombocytopenia?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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