A nurse is planning care for a client who is to undergone a stem cell transplant. Which of the following actions should the nurse plan to take?

Monitor the client's vital signs once every 8 hr.

Provide the client with 1,000 mL of water to drink every 12 hr

Keep blood pressure equipment in the client's room.

Place the client in a negative airflow room.

Answer and Explanation

The Correct Answer is C

A. Monitoring vital signs every 8 hours is not sufficient for a client undergoing a stem cell transplant, who requires frequent assessment due to potential complications.
B. Providing the client with water is important, but specific fluid volumes and intervals depend on individual needs and should not be standardized.
C. Clients undergoing stem cell transplants are immunocompromised due to chemotherapy and conditioning regimens. To reduce the risk of infection, all equipment that comes into contact with the client, such as blood pressure cuffs, should be dedicated to that room only. This prevents cross-contamination from other patients.
D. Negative pressure rooms are for protecting others from airborne infections (e.g., TB). Stem cell transplant clients require positive pressure rooms to protect them from pathogens in the environment.

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Correct Answer is D

Explanation

A. Guardedsuggests uncertainty, which may understate the seriousness of stage IV disease.
B. "Good" and "very good" prognoses suggest favorable outcomes, which are less likely with stage IV ovarian cancer.
C. "Poor" prognosis indicates a bleak outlook with limited treatment options and expected decline in health.
D.Stage IV ovarian cancer indicates advanced disease with metastasis to distant organs, such as the liver or lungs. Even with aggressive treatment (surgery, radiation, chemotherapy), the overall survival rate is low, and the prognosis is considered poor. Discussing a poor prognosis allows the client to make informed decisions about treatment options, advance care planning, and supportive care.

A. A conscious adult client who reports shortness of breath, has a respiratory rate of 24/min, and capillary refill of <2 seconds B. A conscious adult client who has a dislocated right shoulder, respiratory rate of 18/min, and capillary refill of <2 seconds C. An unconscious adult client who has a sucking chest wound, respirations of 38/min, and capillary refill of <2 seconds D. An unconscious adult client who has no respirations, capillary refill is 2 seconds and paramedics have already tried to reposition airway without results

Correct Answer is C

Explanation

A. This client has respiratory distress but is conscious and stable, requiring urgent but not immediate attention compared to other critical conditions.
B. This client has a dislocated shoulder, which is painful and needs attention but is not life-threatening compared to other conditions.
C. This client is unconscious with a sucking chest wound and high respiratory rate, indicating severe respiratory compromise and needing immediate intervention to prevent further deterioration.
D. This client is also unconscious with no respirations despite attempted airway management, indicating a need for immediate resuscitative efforts, potentially including CPR.

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A nurse is planning care for a client who is to undergone a stem cell transplant. Which of the following actions should the nurse plan to take?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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