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While Bathing a Patient with Cancer, a Nurse Assessed Several

Question 30

Multiple Choice

While bathing a patient with cancer, a nurse assessed several large new bruises on the patient's upper arms and thighs.What is the best understanding of the possible causes and the correct nurse's actions for these findings?


A) The patient must have fallen last night walking to the bathroom.Teach the patient to use the call bell when assistance is needed.
B) The patient may have disseminated intravascular coagulation.The size, shape, location, color, and tenderness must be reported and recorded fully.
C) An intravascular fluid overload is occurring because of the chemotherapy.Place the patient on strict input/output (I/O) status and limit fluids.
D) The patient must have had a drug-induced seizure, which caused arm and leg thrashing and the bruises.Report and record the findings, and pad the side rails.

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