Platelets under 20,000 carry a risk of spontaneous bleeding and must be reported immediately.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is reviewing the complete blood count of a client 2 days after a vaginal birth. Which finding is an expected physiologic change of the early postpartum period?
Answer: A. A transient leukocytosis with white blood cell counts up to 25,000 to 30,000/mm3 is a normal response to the stress of labor and birth and does not by itself indicate infection. Hemoglobin and hematocrit typically fall modestly with blood loss, not rise sharply. A markedly low platelet count or a sustained drop in hematocrit suggesting hemorrhage would be abnormal.
Question 2 of 5
Which sensory change is an expected part of normal aging that the nurse should account for when communicating with an older adult?
Answer: A. Presbycusis is the gradual, high-frequency hearing loss common with aging; speaking in a lower pitch, facing the client, and reducing background noise improves communication. Sudden total hearing loss, complete blindness, and loss of all taste are not normal aging.
Question 3 of 5
The nurse reviews the CD4+ T-cell count of a client with HIV. Which result indicates the client has progressed to AIDS?
Answer: D. A diagnosis of AIDS is made when the CD4+ T-cell count falls below 200 cells/mm3 (or with an AIDS-defining opportunistic infection). Counts of 500 or above are within or near the normal range (500 to 1600), and a count of 350 indicates moderate immunosuppression but not AIDS.
Question 4 of 5
The nurse notes that the atrial rate and ventricular rate are independent of each other, with P waves marching through the QRS complexes and no consistent PR interval. Which rhythm is present?
Answer: D. Third-degree (complete) heart block is defined by complete AV dissociation: the atria and ventricles beat independently, so P waves and QRS complexes have no consistent relationship. This often produces a slow ventricular escape rhythm and frequently requires pacing. The other options retain some AV relationship.
Question 5 of 5
A nurse is teaching a client about hemolytic anemia. Which laboratory finding is most consistent with increased red blood cell destruction?
Answer: A. In hemolytic anemia, red cells are destroyed faster than they are made. Breakdown of hemoglobin raises indirect (unconjugated) bilirubin and lactate dehydrogenase (LDH), lowers haptoglobin, and increases the reticulocyte count as marrow compensates. An elevated indirect bilirubin is therefore a hallmark of hemolysis. A low reticulocyte count would suggest decreased production, not hemolysis.
Keep the streak going with more questions like these, each with a full rationale.
What is complete blood count?
Hemoglobin and hematocrit reflect oxygen-carrying capacity, the WBC count reflects infection or inflammation, and platelets reflect clotting ability. It is one of the most frequently ordered and most heavily tested panels on the NCLEX.
Key points to remember
- Hematocrit is roughly three times the hemoglobin value when hydration is normal.
- An elevated WBC suggests infection or inflammation, while a low WBC raises infection risk from immunosuppression.
- A left shift, meaning more immature neutrophils (bands), indicates an acute active infection.
- Platelets below 150,000 increase bleeding risk; below 50,000 raises serious bleeding concern.
- Low hemoglobin and hematocrit indicate anemia or active bleeding and reduce oxygen delivery.
- Neutropenia, an absolute neutrophil count under 1,000, leaves the patient highly vulnerable to infection.
Nursing priorities
- Assess for signs of bleeding, bruising, and petechiae when platelets are low.
- Initiate neutropenic precautions and protect the patient from infection when the WBC or ANC is low.
- Monitor for fatigue, pallor, tachycardia, and dyspnea when hemoglobin is low.
- Hold or question invasive or anticoagulant interventions when platelet counts are critically low.
- Trend serial values rather than reacting to a single result to detect active bleeding.
Labs & values
Patient teaching
- Avoid crowds and sick contacts and report any fever when white counts are low.
- Use a soft toothbrush and an electric razor and avoid contact sports when platelets are low.
Red flags: report now
- Platelets under 20,000 carry a risk of spontaneous bleeding and must be reported immediately.
- A new fever in a neutropenic patient is an emergency requiring prompt provider notification and cultures.
- A rapidly dropping hemoglobin signals active hemorrhage and needs urgent escalation.
References
Clinical references for this topic
