A patient has been admitted with a diagnosis of acute lymphoblastic leukemia. When he is receiving chemotherapy, the nurse should assess for the development of life-threatening thrombocytopenia by monitoring the patient for?

1. A

   Fever

2. B

   Diarrhea

3. C

   Headache

4. D

   Hematuria

Appeared in: NHM UP Staff Nurse - 2016

Explanation

• Chemotherapy for leukemia suppresses bone marrow, leading to thrombocytopenia (a critically low platelet count).
• The primary function of platelets is blood clotting; therefore, a low count results in an impaired ability to form clots and a high risk of bleeding.
• Hematuria (blood in the urine) is a direct sign of internal bleeding, which is a life-threatening complication of severe thrombocytopenia.
• Monitoring for hematuria is a key nursing assessment to detect bleeding early in a patient with a low platelet count.

Why Other Options Were Wrong

• Option A: Fever is a cardinal sign of infection, which is primarily associated with neutropenia (low white blood cell count), another common and serious side effect of chemotherapy, but it is not a sign of thrombocytopenia.
• Option B: Diarrhea is a common gastrointestinal side effect of chemotherapy because the drugs target rapidly dividing cells, including those lining the GI tract. It is not related to platelet function or count.
• Option C: Headache is a non-specific symptom with many potential causes. While a severe, sudden-onset headache could indicate a catastrophic intracranial hemorrhage (a rare but deadly complication of thrombocytopenia), it is not a reliable or early sign to monitor for general bleeding risk.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Assessment of Chemotherapy-Induced Thrombocytopenia to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a vital role in protecting patients with thrombocytopenia by implementing bleeding precautions, such as using soft toothbrushes, avoiding IM injections, and applying prolonged pressure to needle sites.
• Prompt identification and reporting of bleeding signs like hematuria, petechiae, or melena are critical for early intervention, which may include a platelet transfusion to prevent life-threatening hemorrhage.
• What if? If the patient's platelet count was normal but their white blood cell count was low (neutropenia), the nurse's priority assessment would shift from bleeding (hematuria) to signs of infection (fever).

How to Approach the Question

• First, identify the core pathophysiology in the question: 'thrombocytopenia'. Recall that 'thrombo-' relates to platelets and '-penia' means deficiency.
• Connect the pathophysiology to its primary clinical consequence. The function of platelets is clotting, so a deficiency (thrombocytopenia) leads to a risk of bleeding.
• Evaluate each option to see which one represents a sign of bleeding.
• Analyze the options: 'Fever' is a sign of infection. 'Diarrhea' is a GI side effect. 'Headache' is non-specific. 'Hematuria' is blood in the urine, a direct sign of bleeding.
• Conclude that hematuria is the most direct and relevant sign to monitor for the complication of thrombocytopenia.

Concept Tested & Keywords

• Concept Tested: Assessment of Chemotherapy-Induced Thrombocytopenia
• Stem keywords: acute lymphoblastic leukemia, chemotherapy, thrombocytopenia, assess
• Lead-in keywords: monitoring the patient for
• Clinical cues: Patient with leukemia on chemotherapy, a high-risk group for bone marrow suppression.

Question ID

QRSQNO0jAcRSA6IrC14XhM

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 3 p. 89-91

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