The pathophysiology of venous thrombosis is often explained by Virchow's triad, which includes hypercoagulability, endothelial injury, and venous stasis. Based on Virchow's triad and your knowledge of risk factors for thrombosis, which of the following pediatric patients has the greatest risk of hospital-acquired venous thromboembolism?

Correct Answer: C

Rationale: The correct answer is C because the ex-28 week premature infant requiring NICU-level care for necrotizing enterocolitis has the greatest risk of hospital-acquired venous thromboembolism. Premature infants have inherent hypercoagulability due to immature coagulation factors and increased risk of endothelial injury from central lines or catheters. Necrotizing enterocolitis further increases the risk of venous stasis due to decreased gut perfusion. Choice A: The 3-day-old full-term infant admitted for hyperbilirubinemia is less likely to have significant risk factors for thrombosis compared to a premature infant with necrotizing enterocolitis. Choice B: The 6-month-old male admitted for respiratory syncytial virus is less likely to have prolonged immobilization or other significant risk factors compared to a premature infant in the NICU. Choice D: The 7-year-old male with acute lymphoblastic leukemia has a higher risk of thromb

Correct Answer: D

Rationale: The correct answer is D: Place the client on safety precautions. A platelet count of 58,000/mm3 is considered low (normal range is 150,000-450,000/mm3). This places the client at risk for bleeding. Safety precautions involve preventing injuries that could lead to bleeding, such as falls, bumps, or cuts. This is crucial to prevent complications like spontaneous bleeding. Encouraging high-protein foods (choice A) is important for overall health but not directly related to managing low platelet count. Neutropenic precautions (choice B) are for clients with low white blood cell counts, not low platelet counts. Limiting visitors (choice C) to healthy adults is important for infection control but not directly related to preventing bleeding in a client with low platelet count.

Correct Answer: C

Rationale: The correct answer is C: Excessive alcohol consumption. Alcohol can lead to various hematologic health problems such as anemia, bleeding disorders, and impaired immune function. Excessive alcohol intake can disrupt the production of red blood cells and platelets, leading to an increased risk of hematologic issues. Family history of military excellence (A) and family history of allergies (D) are not directly related to hematologic health problems. A diet low in iron and protein (B) can contribute to hematologic issues, but it is not as direct a risk factor as excessive alcohol consumption.

Correct Answer: A

Rationale: The correct answer is A. Subcutaneous injection of heparin is avoided because it can lead to hematomas due to its anticoagulant properties. Heparin is not stored in mast cells (B), but it is synthesized in mast cells. Heparin binds to plasma antithrombin III and inhibits activated thrombin (C). Protamine sulfate can be used to counteract heparin overdose by binding to heparin and neutralizing its anticoagulant effects (D). Therefore, the statement that subcutaneous injection of heparin is avoided due to hematoma formation is the false statement among the options provided.

Correct Answer: C

Rationale: The correct answer is C: Trypanosoma brucei gambiense. This is the most likely causative organism because the patient's presentation of fever and posterior cervical lymphadenopathy is consistent with African trypanosomiasis, also known as sleeping sickness, which is caused by T. brucei gambiense. This parasite is transmitted by the tsetse fly in sub-Saharan Africa. The other choices (A, B, D) are not the correct causative organism for African trypanosomiasis and do not match the clinical presentation described in the question. Trypanosoma cruzi causes Chagas disease, Trypanosoma brucei rhodesiense causes a more acute form of African trypanosomiasis, and Leishmania donovani causes visceral leishmaniasis, which typically presents with splenomegaly and hepatomegaly rather than posterior cervical lymphadenopathy.