The nurse is providing care for a client diagnosed with leukemia and thrombocytopenia. Following a bone marrow biopsy, the nurse's priority of care is to:
1. Hold pressure on the wound for approximately five minutes.
2. Label and refrigerate the specimen obtained by the physician.
3. Evaluate the client's understanding of the purpose of the test.
4. Clean the supplies used for the procedure and dispose of used equipment.
1
Rationale: The client with a low platelet count is at risk for bleeding, so pressure should be held on the site for at least 5-10 minutes, and a pressure dressing may be placed. The specimen should be labeled after the nurse is done holding pressure and sent to the lab. Evaluation of the client's understanding should have been done before the procedure. After the specimen is sent to the lab, the nurse will remove and clean supplies according to facility policy.
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