The nurse is monitoring the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse prepares to implement bleeding precautions if the child becomes thrombocytopenic and the platelet count is less than _____ cells/mm3
1. 80,000
2. 100,000
3. 120,000
4. 150,000
1
Rationale: If a child is thrombocytopenic, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to pre-vent straining with constipation. Additionally, suppositories and rectal temperatures are avoided. The normal platelet count ranges from 150,000 to 400,000 cells/mm3.
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A client with coronary artery disease (CAD) is having frequent premature ventricular contractions (PVCs) and dysrhythmias. It is most important for the nurse to:
1. Maintain client on complete bed rest. 2. Administer p.r.n. antianxiety medications. 3. Maintain patency of the intravenous line. 4. Document the ECG rhythm hourly.
Men with an initial PSA level below 2.5 ng/ml can reduce their screening frequency to what intervals?
A. Every 6 months B. Yearly C. Every 2 years D. Every 2 to 4 years
A nurse is caring for a 36-year-old client who is divorced and who has major depression, severe with psychotic features
During the admission assessment, the client talks about feeling depressed and hearing voices that tell her to cut her wrists with the plastic knives from the unit's cafeteria. She already has several cuts on her wrists from a recent suicide attempt that occurred before she was brought to the emergency department. She will not complete a contract for safety at this time. Which is the most appropriate nursing intervention under these circumstances? A) Obtain an order for locked seclusion until she denies suicidal intent. B) Conduct 15-minute checks on her to ensure her safety. C) Place her on one-to-one staff observation until she can verbalize and demonstrate that she is no longer an imminent danger to herself. D) Remove the plastic wear from the unit's cafeteria and order finger food for all clients.
The nurse is assessing a 13-year-old girl with a family history of kidney cancer who has come to the clinic complaining of abdominal pain, nausea, and vomiting. Which finding would the nurse identify as least likely indicative of cancer in a child?
A) The child reports rectal bleeding and diarrhea. B) Observation reveals an asymmetric abdomen. C) The child experiences a broken bone without trauma. D) Palpation determines an abdominal mass.