# A nurse is caring for a patient with aplastic anemia who has a platelet count of 15,000/mm³ and hemoglobin of 6.2 g/dL. Which nursing intervention should be the highest priority?

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## 문제

A nurse is caring for a patient with aplastic anemia who has a platelet count of 15,000/mm³ and hemoglobin of 6.2 g/dL. Which nursing intervention should be the highest priority?

## 보기

1. Implement bleeding precautions and monitor for signs of hemorrhage **✔ 정답**
2. Administer oxygen therapy to improve tissue oxygenation
3. Encourage increased fluid intake to prevent dehydration
4. Provide high-protein diet to support red blood cell production

**정답: 1**

## 해설

With a platelet count of 15,000/mm³, the patient is at extremely high risk for spontaneous bleeding, making bleeding precautions the highest priority. Other options address less immediate concerns like oxygenation, hydration, or nutrition.

## 심화 해설

Understanding the Clinical Scenario

The patient has aplastic anemia, a condition characterized by bone marrow failure leading to pancytopenia. The critical lab values here are a platelet count of 15,000/mm³ (severe thrombocytopenia; normal is typically 150,000–400,000/mm³) and a hemoglobin of 6.2 g/dL (severe anemia). In the hierarchy of nursing priorities, the risk for spontaneous, life-threatening hemorrhage due to profound thrombocytopenia takes precedence over the risks associated with symptomatic anemia in this moment.

Prioritization Based on Pathophysiology and Risk

The immediate danger with a platelet count of 15,000/mm³ is spontaneous bleeding, particularly intracranial hemorrhage, which can be fatal. While a hemoglobin of 6.2 g/dL indicates severely impaired oxygen-carrying capacity, the body can initiate compensatory mechanisms like increased heart rate and respiratory rate. There is no immediate compensatory mechanism to prevent bleeding from critically low platelets. Therefore, ensuring patient safety by minimizing trauma risk and monitoring for signs of hemorrhage is the most time-sensitive intervention.

Analysis of the Correct Answer: Bleeding Precautions

Implementing bleeding precautions is the highest priority. This involves a set of nursing actions designed to protect the patient from injury and detect bleeding early. Key interventions include:

- Using a soft-bristled toothbrush and avoiding flossing.

- Avoiding rectal procedures, suppositories, and enemas.

- Preventing constipation with stool softeners to avoid straining.

- Applying prolonged pressure after venipuncture or injections.

- Monitoring for petechiae, purpura, hematuria, melena, and oozing from IV sites.

- Performing neurologic checks to detect early signs of intracranial bleeding.

This aligns with the clinical reality described in the literature where thrombocytopenia is a frequent and serious hematologic adverse event, with common symptoms including abnormal bleeding and easy bruising [3]. The nurse's role is to prevent these complications from occurring or to identify them at the earliest possible stage.

Analysis of Incorrect Options

- Option 2: Administer oxygen therapy. Oxygen administration addresses the symptom of anemia (hypoxia) but does not treat the underlying cause or the more immediate lethal threat of hemorrhage. It is a supportive measure that would be implemented after ensuring the patient's safety from bleeding.

- Option 3: Encourage increased fluid intake. This intervention has no direct impact on thrombocytopenia or the immediate risk of bleeding. It is not a priority in this clinical context.

- Option 4: Provide high-protein diet. While nutrition is important for overall health, a high-protein diet will not rapidly correct bone marrow failure or stimulate red blood cell production in a clinically meaningful timeframe. This is a long-term health promotion strategy, not an acute intervention for a patient at risk of life-threatening hemorrhage. The management of aplastic anemia often involves definitive therapies like immunosuppression or hematopoietic stem cell transplantation with a conditioning regimen , not dietary changes.

Connecting to the NCLEX-RN Client Need Framework

This question falls under the category of Physiological Integrity, specifically the subcategory of Reduction of Risk Potential. The nurse must analyze laboratory values and recognize the potential complications associated with a disease process. The ability to correctly prioritize interventions based on the "ABCs" (Airway, Breathing, Circulation) and Maslow’s hierarchy, with a critical understanding that in this case, the "C" for circulation is threatened not by volume loss but by the inability to clot, is essential. The evidence-based approach to managing such a patient involves recognizing that transfusion of blood components is a key medical intervention guided by clinical practice guidelines , and the nurse's independent role is to protect the patient from harm while awaiting or facilitating such orders. The collaborative care model, as seen in specialized hematology clinics, emphasizes the importance of a multidisciplinary approach to managing complex hematologic disorders , but the nurse at the bedside must first act to ensure immediate patient safety.References (research sources)

- [3]Hematologic immune-related adverse effects of immune checkpoint inhibitors: a review.Research articleCruz Carreras MT, González Landrón F, López N, Padrón Alcántara L, Markides DM, Burk KJ, Chaftari P. (2025) · DOI: 10.1007/s00520-025-09952-2

## 임상 시나리오

Managing Severe Thrombocytopenia in Aplastic AnemiaPrioritizing Hemorrhage Prevention
For a platelet count below 20,000/mm³, the immediate priority is preventing spontaneous hemorrhage, which can be fatal. Implement bleeding precautions before addressing anemia or nutrition.

Key interventions include using a soft-bristled toothbrush, avoiding rectal procedures and IM injections, and maintaining a clutter-free environment to prevent falls. Monitor closely for petechiae, purpura, and neurological changes.

CautionDo not administer intramuscular injections or insert suppositories. Apply prolonged pressure after any venipuncture. A sudden headache or change in mental status could indicate intracranial hemorrhage and requires immediate intervention.

## 핵심 개념

- **Aplastic Anemia** — Bone marrow failure disorder resulting in pancytopenia (deficiency of red blood cells, white blood cells, and platelets).
- **Thrombocytopenia** — A platelet count below 150,000/mm³; a count below 20,000/mm³, as seen here, creates a high risk for spontaneous and potentially fatal hemorrhage.
- **Pancytopenia** — A deficiency of all three major blood cell types: erythrocytes, leukocytes, and thrombocytes.
- **Bleeding Precautions** — Nursing interventions to prevent injury and detect bleeding early in patients with low platelets, such as using a soft toothbrush and avoiding invasive procedures.

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