When the nurse records a platelet count of 20,000/mm³, the most appropriate nursing action is to
A) encourage iron-rich foods.
B) increase fluid intake.
C) institute bleeding precautions.
D) place the client in protective isolation.

Question

Quizplus · Accepted Answer

Teach the client and significant others to institute bleeding precautions during periods of thrombocytopenia. Bleeding precautions include: soft toothbrushes and non-alcoholic rinses, no flossing, no nose-blowing or picking, administering stool softeners, not allowing women to douche or use tampons, using only electric razors, no injections, nothing in the rectum, no aspirin-containing compounds, avoiding urinary catheters, gentle suctioning if needed, removing sharp objects from the room and padding furniture, placing a pressure-reducing mattress on the bed, using care with the blood pressure cuff, and only using paper tape.

When the Nurse Records a Platelet Count of 20,000/mm³, the Most