Question

A nurse is providing discharge teaching to client newly diagnosed with thrombocytopenia. Which statement by the client indicates the teaching was ineffective?

Answer 1

Correct Answers:

“I will take ibuprofen when I have a headache.”

Rationale :

✨ Ibuprofen is an NSAID that inhibits platelet aggregation and can further increase the risk for bleeding in a client with thrombocytopenia.

✨ Clients with a low platelet count should avoid medications that impair platelet function, including aspirin and many NSAIDs, unless specifically prescribed.

✨ Even minor bleeding can become significant when circulating platelets are reduced.

✨ The client should discuss safer pain-relief options, such as acetaminophen when appropriate, with the provider.

✨ This statement shows that additional teaching is required about bleeding precautions and medication safety.

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Answer 2

Correct Answers:

"I will need to receive vitamin b12 supplements for the rest of my life."

Rationale :

✳️ Following gastrectomy, reduced or absent intrinsic factor production can prevent adequate absorption of vitamin B12 from the gastrointestinal tract.

✳️ Vitamin B12 is necessary for normal red blood cell formation and neurologic function.

✳️ When intrinsic factor is permanently deficient, the client generally requires lifelong vitamin B12 replacement.

✳️ Replacement may be administered parenterally or by another prescribed route that bypasses the impaired normal absorption pathway.

✳️ Lifelong therapy prevents recurrence of megaloblastic anemia and potentially irreversible neurologic complications.

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Answer 3

Correct Answers:

Frequent temperature monitoring

Rationale :

💎 Clients with aplastic anemia can have severe neutropenia, greatly reducing their ability to mount a normal inflammatory response to infection.

💎 Fever may be the earliest or only sign of infection because redness, swelling, and pus formation can be minimal when white blood cells are deficient.

💎 Frequent temperature checks therefore provide a rapid and practical method for detecting possible infection early.

💎 Any significant fever in a neutropenic client requires prompt evaluation because infection can progress rapidly to sepsis.

💎 Early recognition allows cultures and antimicrobial therapy to be initiated before severe systemic deterioration occurs.

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Answer 4

Correct Answers:

"Fluid excess"

Rationale :

⚽ Fluid excess is not a typical trigger for a vaso-occlusive sickle cell crisis.

⚽ Vaso-occlusion occurs when sickled erythrocytes obstruct small blood vessels, particularly under conditions that promote dehydration, hypoxia, acidosis, or increased metabolic demand.

⚽ Adequate hydration is actually an important preventive strategy because it decreases blood viscosity and reduces sickling.

⚽ Known triggers include infection, stress, dehydration, cold exposure, and reduced oxygenation.

⚽ Identifying fluid excess as a risk factor therefore indicates that the client needs additional teaching.

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Answer 5

Correct Answers:

"I will take my iron supplement with milk to reduce Gl upset."

Rationale :

🎯 Milk and calcium-containing products decrease iron absorption in the gastrointestinal tract.

🎯 Iron should therefore not be taken at the same time as milk, calcium supplements, or many antacids.

🎯 Taking iron with vitamin C, such as orange juice, enhances absorption by keeping iron in a more absorbable form.

🎯 If gastrointestinal upset occurs, the client may take iron with a small amount of food if prescribed, while avoiding foods that significantly impair absorption.

🎯 This statement indicates a need for further teaching about maximizing oral iron absorption.

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Answer 6

Correct Answers:

2:00pm

Rationale :

🖊️ Packed red blood cells should generally be started within 30 minutes of being released from the blood bank.

🖊️ The unit was received at 1:30 pm, so the latest appropriate initiation time is 2:00 pm.

🖊️ Delaying longer allows the blood product to remain outside controlled refrigeration for an unsafe period.

🖊️ Once initiated, the transfusion should generally be completed within 4 hours to reduce the risk for bacterial growth.

🖊️ The nurse should also obtain baseline vital signs and verify the blood product with another qualified clinician before starting the transfusion.

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Answer 7

Correct Answers:

"Heparin is causing your platelets to form dangerous blood clots."

Rationale :

🌻 Heparin-induced thrombocytopenia (HIT) is an immune-mediated reaction in which heparin triggers antibodies that activate platelets rather than simply destroying them.

🌻 Activated platelets are consumed, causing the platelet count to fall, while at the same time promoting formation of dangerous arterial and venous thromboses.

🌻 The major complication of HIT is therefore thrombosis, not bleeding, despite the thrombocytopenia.

🌻 Heparin must be discontinued immediately, and the client is usually started on a non-heparin anticoagulant to prevent clot progression.

🌻 Explaining that heparin is paradoxically causing both a low platelet count and increased clotting risk gives the client the most accurate understanding of why the medication is being stopped.

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Answer 8

Correct Answers:

Apply cold therapy to joints as needed for pain
Restrict fluid intake

Rationale :

Apply cold therapy to joints as needed for pain

🌼 Cold therapy causes vasoconstriction, which can further reduce blood flow through already compromised small vessels during a vaso-occlusive crisis.

🌼 Reduced perfusion promotes additional sickling of red blood cells and can worsen ischemic pain.

🌼 Warmth is generally preferred because it promotes vasodilation and circulation to affected tissues.

🌼 Pain management should also include adequate opioids, hydration, rest, and oxygen when indicated.

🌼 This order should therefore be questioned because cold exposure can intensify the underlying vascular occlusion.

Restrict fluid intake

🌼 Dehydration is a major trigger for sickling because it increases blood viscosity and promotes red blood cell aggregation.

🌼 Clients in vaso-occlusive crisis typically require increased oral or IV fluids, unless another condition contraindicates aggressive hydration.

🌼 Adequate hydration helps improve circulation and decreases the concentration of sickled cells within the bloodstream.

🌼 Restricting fluids could worsen tissue ischemia and prolong the painful crisis.

🌼 This order should be questioned because maintaining adequate hydration is a core component of treatment for vaso-occlusive sickle cell crisis.

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Answer 9

Correct Matches:

Lovenox matches with Do not expel air bubble from prefilled syringe
Previous platelet aggregating; given for MI. matches with ASA
Warfarin matches with Requires monitoring INR
Heparin matches with Requires monitoring aPTT

Rationale :

Lovenox — Do not expel air bubble from prefilled syringe

🔆 Lovenox (enoxaparin) is a low-molecular-weight heparin commonly administered subcutaneously for prevention and treatment of thromboembolic disorders.

🔆 Prefilled enoxaparin syringes contain a small air bubble that should not be expelled before administration.

🔆 The air bubble helps ensure delivery of the full prescribed dose and can reduce medication tracking back through the injection site.

🔆 The injection is usually administered into the abdomen, and the site should not be rubbed afterward because rubbing can increase bruising.

🔆 Correct injection technique helps decrease bleeding, bruising, and medication loss while maintaining therapeutic anticoagulation.

Prevents platelet aggregation; given for MI — ASA

🌹 Aspirin (ASA) inhibits platelet aggregation by irreversibly blocking cyclooxygenase and reducing thromboxane A₂ formation.

🌹 This effect decreases platelet activation and helps prevent extension of coronary artery thrombosis.

🌹 Aspirin is commonly administered during suspected or confirmed myocardial infarction unless contraindicated.

🌹 Early aspirin therapy can reduce the risk for additional clot formation and improve outcomes in acute coronary syndromes.

🌹 The nurse should monitor for signs of bleeding, gastrointestinal irritation, and hypersensitivity during therapy.

Warfarin — Requires monitoring INR

♦️ Warfarin is an oral anticoagulant that inhibits synthesis of vitamin K-dependent clotting factors II, VII, IX, and X.

♦️ The therapeutic effect is monitored using prothrombin time and INR.

♦️ INR monitoring helps determine whether the client is within the prescribed therapeutic range while minimizing the risk for bleeding or thrombosis.

♦️ The exact target INR depends on the indication, but many conditions use a goal around 2.0 to 3.0.

♦️ Clients should maintain a consistent intake of vitamin K-containing foods and report unusual bleeding promptly.

Heparin — Requires monitoring aPTT

🖊️ Unfractionated heparin enhances the activity of antithrombin and inhibits clotting factors, particularly thrombin and factor Xa.

🖊️ Its anticoagulant effect is commonly monitored using activated partial thromboplastin time (aPTT) or an anti-Xa level according to facility protocol.

🖊️ Frequent monitoring is necessary because unfractionated heparin has a variable dose-response between clients.

🖊️ The nurse should also monitor platelet counts because heparin can cause heparin-induced thrombocytopenia.

🖊️ Excessive anticoagulation can result in serious bleeding and may require protamine sulfate as the reversal agent.

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QLexNursing

1 :
A nurse is providing discharge teaching to client newly diagnosed with thrombocytopenia. Which statement by the client indicates the teaching was ineffective?

2 :
A nurse is providing teaching to a client post gastrectomy with newly diagnosed pernicious anemia. Which statement by the client indicates the teaching was effective?

3 :
What is the most efficient method to identify the presence of infection in a client with aplastic anemia?

4 :
A nurse is teaching a client with sickle cell anemia about the risk factors for developing vaso-occlusive pain crisis. Which risk factor stated by the client, indicates the teaching was ineffective?

5 :
The nurse is teaching a client with iron deficiency anemia about iron supplementation. Which statement indicates the need for further teaching?

6 :
The nurse received a unit of packed red blood cells (PRBCs) from the blood bank at 1:30 pm to administer to a client. Which time must the blood transfusion be initiated by?

7 :
A client diagnosed with HIT asks why the heparin is being discontinued when their platelet count is low. Which response by the nurse is most appropriate?

8 :
A nurse is reviewing the admission orders for a client admitted for treatment of vaso-occlusive crisis. Which order(s) should the nurse question? Select all that apply.

9 :
Mix & Match.

Items to Match

Matching Options

QLexNursing

1 : A nurse is providing discharge teaching to client newly diagnosed with thrombocytopenia. Which statement by the client indicates the teaching was ineffective?

2 : A nurse is providing teaching to a client post gastrectomy with newly diagnosed pernicious anemia. Which statement by the client indicates the teaching was effective?

3 : What is the most efficient method to identify the presence of infection in a client with aplastic anemia?

4 : A nurse is teaching a client with sickle cell anemia about the risk factors for developing vaso-occlusive pain crisis. Which risk factor stated by the client, indicates the teaching was ineffective?

5 : The nurse is teaching a client with iron deficiency anemia about iron supplementation. Which statement indicates the need for further teaching?

6 : The nurse received a unit of packed red blood cells (PRBCs) from the blood bank at 1:30 pm to administer to a client. Which time must the blood transfusion be initiated by?

7 : A client diagnosed with HIT asks why the heparin is being discontinued when their platelet count is low. Which response by the nurse is most appropriate?

8 : A nurse is reviewing the admission orders for a client admitted for treatment of vaso-occlusive crisis. Which order(s) should the nurse question? Select all that apply.

9 : Mix & Match.

Items to Match

Matching Options

1 :
A nurse is providing discharge teaching to client newly diagnosed with thrombocytopenia. Which statement by the client indicates the teaching was ineffective?

2 :
A nurse is providing teaching to a client post gastrectomy with newly diagnosed pernicious anemia. Which statement by the client indicates the teaching was effective?

3 :
What is the most efficient method to identify the presence of infection in a client with aplastic anemia?

4 :
A nurse is teaching a client with sickle cell anemia about the risk factors for developing vaso-occlusive pain crisis. Which risk factor stated by the client, indicates the teaching was ineffective?

5 :
The nurse is teaching a client with iron deficiency anemia about iron supplementation. Which statement indicates the need for further teaching?

6 :
The nurse received a unit of packed red blood cells (PRBCs) from the blood bank at 1:30 pm to administer to a client. Which time must the blood transfusion be initiated by?

7 :
A client diagnosed with HIT asks why the heparin is being discontinued when their platelet count is low. Which response by the nurse is most appropriate?

8 :
A nurse is reviewing the admission orders for a client admitted for treatment of vaso-occlusive crisis. Which order(s) should the nurse question? Select all that apply.

9 :
Mix & Match.