A nurse is contributing to the plan of care for a client who has bone marrow suppression related to chemotherapy treatments. Which of the following interventions should the nurse include in the plan?
Administer a saline enema for constipation.
Initiate contact precautions.
Encourage independence in the completion of ADLs.
Monitor oral mucosa daily.
The Correct Answer is D
A. Administer a saline enema for constipation. Administering a saline enema may be necessary for constipation, but it is not directly related to managing bone marrow suppression.
B. Initiate contact precautions. Contact precautions are typically used for infectious diseases. In clients with bone marrow suppression, neutropenic precautions are more appropriate to prevent infections.
C. Encourage independence in the completion of ADLs. While promoting independence is important, clients with bone marrow suppression may be fatigued or immunocompromised, requiring assistance to reduce infection risk and conserve energy.
D. Monitor oral mucosa daily. Monitoring oral mucosa daily is crucial because clients with bone marrow suppression are at risk for mucositis, which can lead to infection and impact nutrition and hydration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "I am not on vacation. I am here with you." This response calmly reassures the client by affirming the mother’s presence, which helps address the son’s confusion without directly challenging his perception.
B. "How can I go on vacation? I do not have any money." This response could increase confusion and does not address the son's needs effectively. It could also lead to unnecessary discussions that might not be helpful.
C. "Stop saying that. You know better. No one told you that." This response is dismissive and confrontational, which may exacerbate the son’s distress and could damage the therapeutic relationship.
D. "Just forget about that and let's talk about something else." This response avoids addressing the son’s concerns, which can make him feel dismissed and not listened to, potentially worsening his symptoms.
Correct Answer is C
Explanation
A. Wear sterile gloves. Sterile gloves are typically required for invasive procedures, not general care after chemotherapy. The key concern here is exposure to chemotherapy agents in bodily fluids.
B. Place incontinence pads in the regular trash container. Incontinence pads and other items contaminated with bodily fluids should be disposed of in a hazardous waste container, not regular trash, to prevent exposure to chemotherapy agents.
C. Wear personal protective equipment when handling blood, body fluids, and feces. Chemotherapy agents can be excreted in bodily fluids, so wearing PPE is essential to protect the healthcare worker from exposure.
D. Provide a urinal or bedpan to decrease the likelihood of soiling linens. While providing a urinal or bedpan may be practical, it does not address the key concern of handling potentially contaminated bodily fluids safely.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.