A nurse is creating a plan of care for a client who has cancer and is experiencing Immunosuppression. Which of the following Interventions should the nurse include in the plan of care?
Monitor the client's vital signs every 12 hr.
Inspect the client's mouth every 8 hr.
Provide fresh fruit with the client's meals.
Rotate health care staff caring for the client.
The Correct Answer is B
A. Monitoring vital signs every 12 hours is a standard nursing intervention but may not specifically address the needs of a client with immunosuppression.
B. Inspecting the client's mouth every 8 hours can help in early detection of mouth sores or infections, which are common in immunosuppressed individuals.
C. Providing fresh fruit with meals may not be appropriate for a client with immunosuppression, as fresh fruits can harbor pathogens that pose a risk of infection.
D. Rotating healthcare staff caring for the client helps increases the risk of introducing pathogens to the client. This increases the risk of infection in the immunosuppressed client.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Splitting behavior, where the client views people and situations as either all good or all bad, is more characteristic of borderline personality disorder rather than histrionic personality disorder.
B. Emotional lability, characterized by rapid shifts in mood, is not a primary feature of histrionic personality disorder.
C. Unexpressive affect, or a lack of emotional expression, is not a typical feature of histrionic personality disorder, which often presents with exaggerated and dramatic emotional displays.
D. Self-centered behavior, including attention-seeking and dramatic behavior to gain approval or admiration from others, is a hallmark feature of histrionic personality disorder.
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D"}
Explanation
- A Mantoux test: This is used to detect tuberculosis (TB) infection, especially if there's a suspicion of TB based on symptoms or exposure history.
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A chest x-ray: This imaging test helps assess for lung conditions, including pneumonia, tuberculosis, or other pulmonary issues that might be causing the client's symptoms.
Incorrect Choices and Explanations:
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A nasopharyngeal swab: This is used for detecting respiratory viruses, such as influenza or COVID-19, rather than evaluating TB or general lung conditions.
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A pulmonary function test: This measures lung function and is used to diagnose conditions like asthma or chronic obstructive pulmonary disease (COPD), which might not be the immediate concern in an emergency setting without specific symptoms.
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Blood cultures: These are used to identify bacterial infections in the bloodstream rather than evaluating TB or assessing lung conditions.
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