A community health nurse is providing education to a group of older adults about immunizations.
Which of the following immunizations should the nurse recommend?

Human papillomavirus (HPV)

Rotavirus.

Diphtheria, tetanus, and acellular pertussis (DTaP)

Herpes zoster.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Human papillomavirus (HPV) vaccination is recommended for adolescents and young adults to prevent HPV-related cancers and diseases. However, in the context of older adults, especially those who are not previously vaccinated, the priority shifts to other immunizations that are more relevant to their age group.

Choice B rationale:

Rotavirus vaccination is administered to infants to protect against rotavirus infections, which can cause severe diarrhea and dehydration. It is not a priority immunization for older adults. Older adults are at higher risk for certain diseases, and their immunization focus should be on vaccines that prevent those specific conditions.

Choice C rationale:

Diphtheria, tetanus, and acellular pertussis (DTaP) vaccination is essential for children and adults, especially for those who have not received a complete series of vaccinations. However, the question specifies older adults, and DTaP is typically administered to children. While it is crucial for healthcare providers and family members to stay up-to-date with their vaccinations, other immunizations are more pertinent for older adults.

Choice D rationale:

Herpes zoster vaccination (shingles vaccine) is recommended for adults aged 50 years and older. Herpes zoster is a painful rash caused by the reactivation of the varicella-zoster virus, which also causes chickenpox. Older adults are at higher risk of developing shingles, and vaccination can reduce the likelihood of the disease and its complications. Therefore, the nurse should recommend the herpes zoster vaccine to the group of older adults as it aligns with their age and addresses a specific health risk they face.

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Correct Answer is C

Explanation

Respiratory acidosis.

Rationale:

A. Incorrect. The client does not have respiratory alkalosis because respiratory alkalosis is characterized by a low PaCO2 (less than 35 mm Hg) and a high pH (greater than 7.45).
B. Incorrect. The client does not have metabolic alkalosis because metabolic alkalosis is characterized by a high HCO3 (greater than 26 mEq/L) and a high pH (greater than 7.45). - C. Correct. The client has respiratory acidosis because respiratory acidosis is characterized by a high PaCO2 (greater than 45 mm Hg) and a low pH (less than 7.35).
D. Incorrect. The client does not have metabolic acidosis because metabolic acidosis is characterized by a low HCO3 (less than 22 mEq/L) and a low pH (less than 7.35).

A. Providing postmortem care for a client who has recently died. B. Performing a simple dressing change on a client's foot. C. Washing hands with alcohol-based hand rub after bathing a client who has Clostridium difficile. D. Emptying an indwelling urinary catheter bag for a client while wearing clean gloves.

Correct Answer is C

Explanation

Choice A rationale:

Providing postmortem care for a client who has recently died does not require immediate intervention by the charge nurse, as it is a standard nursing responsibility to provide postmortem care with dignity and respect to the deceased client. The AP can proceed with this task independently.

Choice B rationale:

Performing a simple dressing change on a client's foot is within the scope of practice for an assistive personnel (AP) and does not require immediate intervention by the charge nurse, assuming the AP is competent and trained to perform this task.

Choice C rationale:

Washing hands with alcohol-based hand rub after bathing a client who has Clostridium difficile is not sufficient. Alcohol is not effective against C. Difficile spores.

Choice D rationale:

Clean gloves are sufficient for this task, as they do provide adequate protection against the transmission of infections.

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A community health nurse is providing education to a group of older adults about immunizations.Which of the following immunizations should the nurse recommend?

Nursing Test Bank

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Explanation

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A community health nurse is providing education to a group of older adults about immunizations.
Which of the following immunizations should the nurse recommend?