A nurse is providing direction to a nursing assistant who will be caring for a client with human immunodeficiency virus (HIV) and receiving azidothymidine (AZT) antiretroviral therapy. The nurse should instruct the nursing assistant to implement which of the following actions?

Isolation gown

Contact isolation

Standard precautions

Respiratory isolation

Answer and Explanation

The Correct Answer is C

A. Isolation gown: Isolation gowns are used as part of contact precautions or airborne precautions for specific infectious diseases that require additional transmission-based precautions beyond standard precautions. However, standard precautions are generally sufficient for caring for clients with HIV receiving antiretroviral therapy.

B. Contact isolation: Contact isolation is used for patients with known or suspected infections that can be transmitted by direct or indirect contact with the patient or their environment. HIV does not require contact isolation unless there are additional infections or conditions present that warrant contact precautions.
C. Standard precautions: Standard precautions are the basic infection prevention practices that apply to all patient care, regardless of the suspected or confirmed infection status of the patient. This includes practices such as hand hygiene, the use of personal protective equipment (e.g., gloves, gown, mask, eye protection) when indicated, and safe injection practices. Standard precautions should be used for all patients, including those with HIV, to prevent the transmission of infectious agents.
D. Respiratory isolation: Respiratory isolation is used for patients with known or suspected respiratory infections that are transmitted through respiratory droplets. HIV is not transmitted through respiratory droplets and does not require respiratory isolation.

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Correct Answer is ["A","B","C","D"]

Explanation

A. Give the client a low sodium diet: SIADH causes retention of water and dilutional hyponatremia. Therefore, restricting sodium intake can help prevent further fluid retention and worsening of hyponatremia.

B. Monitor for serum electrolyte imbalances: SIADH can lead to electrolyte imbalances, particularly hyponatremia. Monitoring electrolyte levels, especially sodium, is essential for early detection and intervention.

C. Obtain daily weights: Monitoring daily weights is crucial for assessing fluid balance and detecting changes in hydration status, which is essential in clients with SIADH.

D. Educate the client on techniques to cope with thirst: Clients with SIADH often experience excessive thirst due to the body's inability to excrete excess water. Educating the client on strategies to manage thirst, such as chewing gum or sucking on ice chips, can help improve comfort.

E. Increase IV fluids: This option is incorrect because SIADH is characterized by water retention, so increasing IV fluids would exacerbate the condition and worsen hyponatremia.

A. "Increase your intake of grapefruit juice." B. "Expect to have increased generalized bruising." C. "Monitor for muscle pain." D. "Take this medication without food if nausea develops."

Correct Answer is C

Explanation

A. "Increase your intake of grapefruit juice."

Grapefruit juice can interact with many medications, including colchicine, potentially increasing the risk of adverse effects or reducing its effectiveness. Therefore, it is not recommended to increase grapefruit juice intake while taking colchicine.

B. "Expect to have increased generalized bruising." Increased bruising is not a common side effect of colchicine.

C. "Monitor for muscle pain."

Colchicine is associated with myotoxicity, which can manifest as muscle pain or weakness. Therefore, the client should be instructed to monitor for signs and symptoms of muscle pain and report them promptly to their healthcare provider.

D. "Take this medication without food if nausea develops."

While colchicine can cause gastrointestinal side effects such as nausea and vomiting, taking it without food may exacerbate these symptoms. It is generally recommended to take colchicine with food to minimize gastrointestinal upset.

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A nurse is providing direction to a nursing assistant who will be caring for a client with human immunodeficiency virus (HIV) and receiving azidothymidine (AZT) antiretroviral therapy. The nurse should instruct the nursing assistant to implement which of the following actions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has developed Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) from cancer. Which of the following nursing interventions should be included in the client's plan of care? (Select all that apply.)

Correct Answer is ["A","B","C","D"]

Explanation

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Correct Answer is C

Explanation

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