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1. Question
A client with a history of upper gastrointestinal bleeding has a platelet count of 300,000 mm3 (300 × 109/L). The nurse should take which action after seeing the laboratory results?
Correct
Option D is the correct answer:
Rationale: A normal platelet count ranges from 150,000 to 400,000 mm3 (150 to 400 × 109/L). The nurse should place the report containing the normal laboratory value in the client’s medical record. A platelet count of 300,000 mm3 (300 × 109/L) is not an elevated count. The count also is not low; therefore, bleeding precautions are not needed.
Test-Taking Strategy: Focus on the subject, a platelet count of 300,000 mm3 (300 × 109/L). Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate options indicating to report the abnormally low count and placing the client on bleeding precautions first. From the remaining options, recalling the normal range for this laboratory test will direct you to the correct option.
Incorrect
Option D is the correct answer:
Rationale: A normal platelet count ranges from 150,000 to 400,000 mm3 (150 to 400 × 109/L). The nurse should place the report containing the normal laboratory value in the client’s medical record. A platelet count of 300,000 mm3 (300 × 109/L) is not an elevated count. The count also is not low; therefore, bleeding precautions are not needed.
Test-Taking Strategy: Focus on the subject, a platelet count of 300,000 mm3 (300 × 109/L). Remember that options that are comparable or alike are not likely to be correct. With this in mind, eliminate options indicating to report the abnormally low count and placing the client on bleeding precautions first. From the remaining options, recalling the normal range for this laboratory test will direct you to the correct option.
Upper gastrointestinal bleed (UGIB) causes significant morbidity and mortality the world over. The two main causes have been due to increasing nonsteroidal anti-inflammatory drug use along with the high prevalence of Helicobacter pylori infection in patients with peptic ulcer and bleeding from gastroesophageal varices due to portal hypertension. Other causes of esophageal tears, gastrointestinal malignancy, and arteriovenous malformations also contribute to the morbidity and motality.
Rapid assessment, resuscitation, and early endoscopy form the basis of early management of patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early Upper gastrointestinal endoscopy (UGIE) (within 24 h of presentation) confirms the diagnosis and allows for targeted endoscopic treatment, which results in reduced morbidity, hospital stay, the risk of recurrent bleeding, and need for surgery.
Despite successful endoscopic therapy, re-bleeding remains a risk and a second attempt at endoscopic therapy is recommended in most. Arteriography with embolization can serve as an extremely useful therapeutic option. Thanks to excellent medical and endoscopic control, surgery for UGIB is rarely required nowadays.
