A client with thrombocytopenia secondary to leukemia develops epistaxis. The nurse should instruct the client to:

Correct Answer: B

Rationale: The nurse should instruct the client to sit upright, leaning slightly forward when experiencing epistaxis (nosebleed). This position helps prevent blood from dripping down the back of the throat, reducing the risk of aspiration. In the case of a client with thrombocytopenia secondary to leukemia, the blood may have difficulty clotting due to low platelet counts. Therefore, it is important to minimize bleeding as much as possible. Lying supine with the neck extended may increase the risk of blood flowing down the throat, while blowing the nose or putting lateral pressure on it may aggravate the bleeding. Holding the nose while bending forward at the waist may also increase blood flow towards the head. Sitting upright, leaning slightly forward is the safest position to prevent complications associated with epistaxis in this case.

Correct Answer: C

Rationale: Anemia is a condition characterized by a decrease in the concentration of red blood cells in the blood. This can result from various factors such as decreased production of red blood cells, increased destruction of red blood cells, or blood loss. Hemoglobin levels are often used to diagnose anemia, but the key feature of anemia is the decrease in the number of red blood cells, leading to reduced oxygen-carrying capacity in the blood. This in turn can lead to symptoms such as fatigue, weakness, and shortness of breath.

Correct Answer: C

Rationale: Leukemia is a type of cancer that affects the blood and bone marrow, leading to an overproduction of abnormal white blood cells. The symptoms of leukemia can include fatigue, weakness, weight loss, frequent infections, fever, bruising or bleeding easily, and bone pain. Given the vague presenting symptoms and the potential involvement of multiple bodily systems, leukemia is a condition that should be suspected and investigated further. Anemia, rheumatic arthritis, and systematic lupus erythematosus can also present with some similar symptoms, but for the given scenario, leukemia is the most probable condition to suspect.

Correct Answer: D

Rationale: Calcium is the mineral necessary for chemical clotting. When there is a cut or injury that causes bleeding, the body's clotting process is initiated to stop the bleeding. Calcium ions play a crucial role in several steps of the clotting cascade, helping to activate various clotting factors and promoting the formation of a stable blood clot. Without sufficient calcium, the blood would not be able to clot properly, leading to potential complications with excessive bleeding.

Correct Answer: C

Rationale: The best evidence that the teaching has been effective is when the patient uses an electric razor instead of his safety razor. This action demonstrates understanding and application of the teaching to prevent bleeding in a practical way. By choosing the electric razor, the patient is actively taking steps to minimize the risk of injury and bleeding due to thrombocytopenia. This concrete behavior indicates that the patient has internalized the instructions provided by the nurse and is implementing them to protect his health.