Nokea
When a febrile episode occurs in a patient with neutropenia, at what time should antibiotic therapy be initiated?
- A. Within 1 hour
- B. After the causative agent is identified from the culture
- C. Once the fever drops below 38°C (100.4°F)
- D. For long-term therapy over 3 months.
Correct Answer: A
Rationale: When a febrile episode occurs in a patient with neutropenia, antibiotic therapy must be initiated immediately (within 1 hour), even before the determination by culture of a specific causative organism. Treatment does not wait until the fever drops. Long-term therapy over 3 months is not required at this time.
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The nurse is caring for a patient with immune thrombocytopenic purpura (ITP) who has a prescription for a platelet transfusion. Which of the following patient information will cause the nurse to question the transfusion order?
- A. The platelet count is 52 x 10^9/L.
- B. Blood pressure is 94/56 mm Hg.
- C. Blood is oozing from the venipuncture site.
- D. Petechiae are present on the chest and arms.
Correct Answer: A
Rationale: Platelet transfusions are not usually indicated unless the patient is actively bleeding, so the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP is occurring and support the need for the platelet transfusion.
The nurse is caring for a patient who has been receiving a heparin infusion and warfarin for a deep vein thrombosis (DVT) with a diagnosis of heparin-induced thrombocytopenia (HIT). Which of the following actions should the nurse include in the plan of care?
- A. Use low-molecular-weight heparin (LMWH) only.
- B. Flush all intermittent IV lines using normal saline.
- C. Administer platelet transfusions.
- D. Teach the patient that heparin cannot be used in the future.
Correct Answer: D
Rationale: All heparin is discontinued when HIT is diagnosed. The patient should be instructed to never receive heparin or LMWH. Warfarin is usually not given until the platelet count has returned to 150 x 10^9/L. The platelet count does not drop low enough in HIT for a platelet transfusion, and platelet transfusions increase the risk for thrombosis.
The nurse is admitting a patient with type A hemophilia who has severe pain and swelling in the right knee. Which of the following actions should the nurse implement initially?
- A. Immobilize the knee
- B. Apply heat to the joint
- C. Assist the patient with light weight bearing
- D. Perform passive range of motion to the knee
Correct Answer: A
Rationale: The initial action should be total rest of the knee to minimize bleeding. Ice packs are used to decrease bleeding. Range of motion (ROM) and weight-bearing exercise are contraindicated initially, but after the bleeding stops, ROM and physical therapy are started.
Which of the following assessment data obtained by the nurse when caring for a patient with thrombocytopenia should be immediately communicated to the health care provider?
- A. The platelet count is 52 x 10^9/L.
- B. The patient is difficult to arouse.
- C. There are large bruises on the back.
- D. There are purpura on the oral mucosa.
Correct Answer: B
Rationale: Difficulty in arousing the patient may indicate a cerebral hemorrhage, which is life-threatening and requires immediate action. The other information should be documented and reported, but would not be unusual in a patient with thrombocytopenia.
The nurse is caring for a patient with polycythemia vera. Which of the following actions should the nurse implement during treatment?
- A. Place the patient on bed rest.
- B. Administer iron supplements.
- C. Avoid use of aspirin products.
- D. Monitor fluid intake and output.
Correct Answer: D
Rationale: Monitoring hydration status is essential in polycythemia vera to prevent thrombosis due to increased blood viscosity. Aspirin therapy is used to decrease risk for thrombosis. The patient should be encouraged to ambulate to prevent deep vein thrombosis (DVT). Iron is contraindicated in patients with polycythemia vera.