A nurse is planning care for a client who is receiving chemotherapy and has neutropenia. Which of the following interventions should the nurse include in the plan?
Restrict visits from young children to 2 hr per day.
Avoid including raw fruits in the client's diet.
Measure the client's temperature every 8 hr.
Use disposable gloves from a box outside the client's room.
The Correct Answer is B
A. While restricting visits from young children may help reduce infection risk, it is not a sufficient or specific intervention for neutropenic precautions.
B. Avoiding raw fruits is critical because they can harbor bacteria and increase the risk of infection in neutropenic clients. Cooked fruits are safer options.
C. Measuring temperature should occur more frequently than every 8 hours, ideally every 4 hours or more, to quickly identify fever, a sign of infection.
D. Disposable gloves should be used from within the client's room to maintain strict infection control measures; using gloves from outside could introduce contaminants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Arterial blood gases (ABGs) are typically used to assess respiratory function and acid-base balance, which are not primary concerns with valproic acid use.
B. Serum liver enzyme levels are critical to monitor due to the risk of hepatotoxicity associated with valproic acid therapy, making this test essential for safe management.
C. A chest X-ray is generally used to assess respiratory conditions, not relevant for monitoring the effects of valproic acid.
D. Urine culture and sensitivity are used to diagnose urinary tract infections and are not relevant to the monitoring of valproic acid therapy.
Correct Answer is B
Explanation
A. Triglycerides within the normal range do not indicate a need for additional nutrients.
B. A low albumin level of 2.8 g/dL indicates poor protein status and may suggest that the client requires additional protein in their enteral feeding to help with healing and overall nutrition.
C. A creatinine level of 1.1 mg/dL is within normal limits and does not indicate a need for additional nutrients.
D. Alkaline phosphatase at 118 units/L is within the normal range and does not suggest a deficiency requiring additional nutrients.
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