A nurse is creating home instructions for a client who has immunodeficiency. Which of the following statements by the client indicates an understanding of the teaching?
I might experience harmless white patches in my mouth.
I will expect to have a mild, occasional fever.
I will avoid people who have just received a live vaccine.
I will limit the use of skin cream to once a week.
The Correct Answer is C
Choice A reason:
The statement “I might experience harmless white patches in my mouth” could indicate the presence of oral thrush, a common fungal infection in immunocompromised individuals. However, this statement does not directly reflect an understanding of preventive measures or home care instructions for someone with immunodeficiency.
Choice B reason:
Expecting to have a mild, occasional fever is not a typical understanding of immunodeficiency care. While fevers can occur, they should not be considered normal or expected. Any fever in an immunocompromised person should be promptly evaluated by a healthcare provider as it could indicate an infection.
Choice C reason:
Avoiding people who have just received a live vaccine is a crucial preventive measure for individuals with immunodeficiency. Live vaccines contain a weakened form of the virus or bacteria, which can pose a risk to immunocompromised individuals. This statement shows an understanding of the need to avoid potential sources of infection.
Choice D reason:
Limiting the use of skin cream to once a week is not a standard recommendation for immunodeficiency care. Skin care is important, but the frequency of using skin cream should be based on individual needs and the type of cream used. This statement does not reflect a specific understanding of immunodeficiency management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Administering the medication over 1 minute is crucial for phenytoin IV administration. Phenytoin should be administered slowly to prevent severe cardiovascular reactions, including hypotension and arrhythmias. The recommended rate is not to exceed 50 mg per minute.
Choice B reason: Diluting the medication with sterile water before injecting is not recommended for phenytoin. Phenytoin should be administered undiluted or diluted with normal saline if necessary. Using sterile water can cause the medication to precipitate.
Choice C reason: Slowing the injection if the medication crystallizes is not an appropriate action. If phenytoin crystallizes, it should not be administered. The nurse should ensure the solution is clear before administration and discard any crystallized medication.
Choice D reason: Following the injection with sterile water is not necessary. Phenytoin does not require a flush with sterile water after administration. Instead, normal saline can be used to flush the IV line before and after administration to ensure the line is clear.
Correct Answer is D
Explanation
Choice A reason: The procedure will be cancelled if the urinalysis indicates the presence of red blood cells
This statement is incorrect. The presence of red blood cells in the urine does not necessarily cancel an intravenous pyelogram (IVP). The test is often used to diagnose conditions that might cause blood in the urine, such as kidney stones or tumors. Therefore, this statement does not accurately reflect the procedure’s protocol.
Choice B reason: You will be able to resume your regular diet as soon as the test is complete
This statement is correct. After an IVP, clients can typically resume their regular diet unless otherwise instructed by their healthcare provider. However, this is not the most critical piece of information for the client to understand about the procedure.
Choice C reason: High-frequency sound waves will be used to identify renal system structures
This statement is incorrect. An IVP uses X-rays and a contrast dye to visualize the urinary tract, not high-frequency sound waves. High-frequency sound waves are used in ultrasound imaging, which is a different diagnostic procedure.
Choice D reason: After the procedure, you will be encouraged to drink plenty of fluids
This statement is correct and important. After an IVP, clients are encouraged to drink plenty of fluids to help flush the contrast dye out of their system and reduce the risk of kidney damage. This is a crucial part of post-procedure care and should be emphasized to the client.
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