A nurse is providing care to a client who is immunocompromised.

Which of the following should the nurse identify as a possible source of infection?

Explanation

A.8 oz chopped hard-boiled egg

Eggs are considered a complete protein source, meaning they contain all essential amino acids that the body needs. They are an excellent source of high-quality protein and provide essential nutrients. Chopped hard-boiled eggs, in particular, can be easily added to salads, sandwiches, or consumed on their own.

8 oz brown rice in (option B) is incorrect because brown rice is a healthy carbohydrate source, it is not a significant source of protein.

8 oz fruit yogurt in (option C) is incorrect because fruit yogurt may contain some protein, but the protein content is generally lower compared to other sources such as eggs.

8 oz raw spinach in (option D) is incorrect because spinach is a nutrient-rich vegetable, it is not a significant source of protein.

Explanation

D. Maintain the client in high-Flower’s position

Crackles in the bases of the lungs, shortness of breath, and an increased respiratory rate are signs of pulmonary congestion, which is commonly seen in heart failure. Maintaining the client in a high-Fowler's position, with the head of the bed elevated to a 45-60-degree angle, helps reduce venous return to the heart, decreases fluid accumulation in the lungs, and improves breathing comfort for the client.

The other options are not appropriate actions for the client's condition:

Instructing the client to cough every 4 hours in (option A) is not the priority action in this situation. Coughing may not effectively address the underlying cause of pulmonary congestion and may not provide immediate relief for the client.

Encouraging the client to ambulate to loosen secretions in (option B) is not the priority action in this situation. While ambulation can be beneficial for overall health, the client's symptoms of pulmonary congestion require immediate attention to improve respiratory status.

Increasing the client's intake of oral fluids in (option C) is not the priority action in this situation. While maintaining adequate hydration is important, excessive fluid intake can worsen the symptoms of heart failure and contribute to further fluid accumulation in the lungs.

Therefore, the nurse should maintain the client in high-Fowler's position (option D) to promote optimal lung function and improve breathing comfort. It is important to promptly notify the healthcare provider of the client's condition for further assessment and intervention.