UPUMS Nsg.Officer-2024: A woman who is receiving cancer chemotherapy exhibits all of the following. Which is most indicative of bone…

UPUMS Nsg.Officer-2024

Medical Surgical Nursing

Medium

Appeared in: UPUMS Nsg.Officer-2024

Explanation

Petechiae are small, pinpoint, red or purple spots on the skin that result from minor bleeding from broken capillaries.
Their appearance is a classic sign of thrombocytopenia, which is a dangerously low platelet count.
Since platelets are produced in the bone marrow, a low count (and the resulting petechiae) is a direct and primary indicator that the bone marrow's function is suppressed by chemotherapy.

Option A: Stomatitis (inflammation of the mouth) is caused by chemotherapy's damage to the rapidly dividing cells of the mucous membranes in the GI tract, not the bone marrow.
Option B: Constipation is a gastrointestinal side effect related to decreased motility. It is often caused by the chemotherapy drugs themselves or by other supportive medications (like anti-nausea drugs or pain relievers), not by bone marrow depression.
Option C: Alopecia (hair loss) occurs because chemotherapy damages the rapidly dividing cells in hair follicles. This is an effect on the integumentary system, not the bone marrow.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Chemotherapy-induced bone marrow depression (myelosuppression) and its clinical manifestations as background academic context rather than a clinical decision trigger.
A nurse's primary role is to monitor for signs of myelosuppression. This includes assessing the skin for petechiae, ecchymosis (bruising), and any active bleeding (e.g., gums, nosebleeds).
When a patient has thrombocytopenia, the nurse must implement bleeding precautions. This includes using a soft toothbrush, avoiding razors (using an electric shaver instead), preventing falls, and avoiding invasive procedures like intramuscular injections when possible.
What if? If the patient presented with a fever of 101°F (38.3°C) instead of petechiae, the most indicative problem would be neutropenia (low white blood cells), another critical consequence of bone marrow depression. This would be considered a medical emergency (neutropenic fever) requiring immediate intervention.

How to Approach the Question

First, identify the key concept in the question stem: 'bone marrow depression'.
Recall the primary function of bone marrow, which is to produce the three main types of blood cells: red blood cells, white blood cells, and platelets.
Think about the clinical signs that would result from a deficiency in each of these cell lines: anemia/fatigue (low RBCs), infection/fever (low WBCs), and bleeding/bruising (low platelets).
Evaluate each of the four options to determine which one is a direct result of one of these deficiencies.
Recognize that stomatitis, constipation, and alopecia are side effects related to chemotherapy's impact on other rapidly dividing cells (mucosa, hair follicles) or systems (GI motility).
Conclude that petechiae, a sign of bleeding due to low platelets (thrombocytopenia), is the only option that directly indicates bone marrow depression.

Concept Tested & Keywords

Concept Tested: Chemotherapy-induced bone marrow depression (myelosuppression) and its clinical manifestations.
Stem keywords: cancer chemotherapy, bone marrow depression
Lead-in keywords: most indicative
Negative lead-in flag: false

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