A child has the following laboratory findings:

• Platelets: 20,000/mm³
• Hemoglobin: 10 g/dL
• WBC: 24,000/mm³
• PCT: 30

What should be given immediate nursing priority attention?

1. A

   Immediate attention to bruising and bleeding

2. B

   Suspected leukemia

3. C

   Fever monitoring

4. D

   Strict input and output monitoring

Appeared in: NORCET 10 Mains

Explanation

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• The child's platelet count is critically low at 20,000/mm3, indicating severe thrombocytopenia.
• This condition creates an immediate and life-threatening risk of spontaneous bleeding, especially intracranial hemorrhage.
• According to nursing principles of prioritizing the most immediate threat to life (safety and risk reduction), managing this bleeding risk is the top priority.
• The presence of infection (high WBC, PCT) and anemia (low Hb) are considered hemorrhagic risk factors that further increase the danger of bleeding, as confirmed in pediatric guidelines.

Why Other Options Were Wrong

• Option B: This is a medical diagnosis, not a nursing priority action. While the lab profile is suspicious, the nurse's immediate role is to manage the life-threatening symptoms resulting from the abnormal labs, not to establish a diagnosis.
• Option C: Fever monitoring is important because the high WBC and PCT strongly suggest sepsis. However, the risk of a fatal bleed from severe thrombocytopenia is a more immediate and acute threat to life than a fever.
• Option D: Monitoring intake and output is a standard nursing intervention for a sick child, especially one with sepsis, to assess hydration and renal function. However, it does not address the most immediate life-threatening problem, which is the risk of hemorrhage.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Nursing prioritization based on critical pediatric laboratory values helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Implementing bleeding precautions is a fundamental nursing competency for patients with thrombocytopenia. This includes patient education, environmental safety, and avoiding invasive procedures.
• Nurses have a critical role in recognizing and immediately communicating life-threatening lab values to the medical team using a structured format like SBAR (Situation, Background, Assessment, Recommendation).
• What if? If the platelet count was 80,000/mm3 (mild-to-moderate thrombocytopenia), the immediate bleeding risk would be lower. In that scenario, the priority would shift to managing the severe infection/sepsis indicated by the extremely high WBC and PCT, making fever monitoring and fluid balance more prominent.

How to Approach the Question

• First, identify the question type. This is a priority-setting question based on interpreting clinical data.
• Analyze each laboratory value provided and compare it to the normal range for a child. Identify which values are abnormal and, most importantly, which are critically abnormal.
• Recognize that a platelet count of 20,000/mm3 is severely low and life-threatening.
• Connect this critical value to its most immediate physiological risk, which is spontaneous, uncontrolled bleeding.
• Apply a prioritization framework, such as Maslow's hierarchy or safety/risk reduction. The risk of hemorrhage is a direct threat to physiological safety and life.
• Evaluate the other options. While managing infection (fever) and fluid balance (I&O) are important, they are not as immediately life-threatening as a major bleed. Suspecting a diagnosis is not a priority nursing action.

Concept Tested & Keywords

• Concept Tested: Nursing prioritization based on critical pediatric laboratory values.
• Stem keywords: laboratory findings, Platelets: 20,000/mm3, Hemoglobin: 10 g/dL, WBC: 24,000/mm3, PCT: 30, child
• Lead-in keywords: immediate nursing priority
• Clinical cues: A platelet count of 20,000/mm3 in a child signifies severe thrombocytopenia, which is a critical value indicating a high risk for spontaneous hemorrhage.

Question ID

Q0OmTKBimtqN7r4WHTYA_R

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 38-40

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 811-813