A nurse is planning care for a child who has neutropenia due to leukemia. Which of the following interventions should the nurse include in the plan of care?
Screen the child's visitors for active infections.
Prepare the child for a platelet transfusion.
Monitor the child for indications of active bleeding.
Initiate a low-protein diet for the child.
The Correct Answer is A
A. Screen the child's visitors for active infections. Neutropenia places the child at high risk for infection due to a severely weakened immune system. Screening visitors for signs of illness is essential to minimize exposure to infectious agents.
B. Prepare the child for a platelet transfusion. Platelet transfusions are used to treat thrombocytopenia, not neutropenia. While leukemia may cause both conditions, neutropenia specifically increases infection risk, not bleeding risk.
C. Monitor the child for indications of active bleeding. While bleeding is a concern in leukemia, it is more directly linked to low platelet levels. The priority intervention for neutropenia is infection prevention, not bleeding control.
D. Initiate a low-protein diet for the child. A low-protein diet is not appropriate for a child with leukemia. These children need adequate protein for healing, immune support, and maintaining strength during treatment.
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Related Questions
Correct Answer is A
Explanation
A. Shows perfectionism. Clients with obsessive-compulsive personality disorder (OCPD) are characterized by perfectionism, a preoccupation with orderliness, control, and rules, and a need for mental and interpersonal control, often at the expense of flexibility and efficiency.
B. Takes advantage of others. This behavior is more typical of antisocial personality disorder, not OCPD. Clients with OCPD tend to be highly conscientious, not manipulative or exploitative.
C. Irritability. While clients with OCPD may become frustrated or anxious if things are not done their way, chronic irritability is not a hallmark feature of the disorder.
D. Impulsivity. Impulsivity is more commonly associated with borderline or antisocial personality disorders. In contrast, clients with OCPD are typically rigid, cautious, and rule-bound.
Correct Answer is C
Explanation
A. 0.45% saline. This is a hypotonic solution, which may be used later in diabetic ketoacidosis (DKA) management, but it is not appropriate for initial fluid resuscitation as it does not rapidly expand intravascular volume.
B. NPH insulin. NPH is an intermediate-acting insulin and is not used for continuous infusion. In DKA, rapid insulin correction is needed, typically with a short-acting insulin like regular insulin.
C. 0.9% normal saline. This isotonic fluid is the first-line choice for fluid replacement in clients with DKA. It helps restore circulating volume and correct dehydration quickly, which is a critical initial intervention.
D. Glargine insulin. Glargine is a long-acting insulin and not suitable for IV infusion. DKA requires the use of short-acting insulin (e.g., regular insulin) administered via IV infusion to correct hyperglycemia and acidosis.
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