For a client with leukemia and thrombocytopenia, what is the priority action for the nurse?

• A. Plan rest periods throughout the day
• B. Encourage coughing, turning, and deep breathing every 2 hours
• C. Assess temperature every 4 hours
• D. Initiate bleeding precautions

Answer: (D)

In this scenario, the most important focus is preventing bleeding. Thrombocytopenia means there are very few platelets, so even minor injuries can lead to significant or life-threatening hemorrhage. Therefore, initiating bleeding precautions is the priority. This includes handling the patient gently, avoiding invasive procedures when possible, using the smallest gauge needles and applying firm pressure after any venipuncture, using an electric razor, avoiding nasal or rectal trauma, and preventing straining with stool softeners and other measures. Regularly inspect for signs of bleeding (bruising, gum or nasal bleeding, blood in urine or stool) and minimize any activity or procedures that could cause bleeding.

Rest, pulmonary hygiene, and temperature monitoring are important aspects of care, but they do not reduce the immediate life-threatening risk posed by severe thrombocytopenia as effectively as bleeding precautions do.