Nursing care of a child who is immunosuppressed due to leukemia or chemotherapeutic agents should include:
(choose one best answer)
Have them share a room with a child with active mumps
Restrict oral fluids
Strict isolation
Use good handwashing
The Correct Answer is D
Choice A reason: This choice is incorrect because having them share a room with a child with active mumps may expose them to infection and worsen their condition. A child who is immunosuppressed due to leukemia or chemotherapeutic agents has a weakened immune system and is more susceptible to infections from bacteria, viruses, fungi, or parasites. Therefore, they should be placed in a private room or cohorted with another immunosuppressed child.
Choice B reason: This choice is incorrect because restricting oral fluids may cause dehydration and electrolyte imbalance in the child who is immunosuppressed due to leukemia or chemotherapeutic agents. A child who is immunosuppressed due to leukemia or chemotherapeutic agents may have increased fluid losses from vomiting, diarrhea, fever, or sweating. Therefore, they should be encouraged to drink adequate fluids to maintain hydration and electrolyte balance.
Choice C reason: This choice is incorrect because strict isolation may cause psychological distress and social isolation in the child who is immunosuppressed due to leukemia or chemotherapeutic agents. A child who is immunosuppressed due to leukemia or chemotherapeutic agents may benefit from protective isolation, which involves using standard precautions and additional measures such as wearing gloves, gowns, masks, or eye protection when in contact with the child or their body fluids. However, strict isolation, which involves limiting visitors and activities, may harm the child's emotional and developmental well-being.
Choice D reason: This choice is correct because using good handwashing is essential nursing care for a child who is immunosuppressed due to leukemia or chemotherapeutic agents. Handwashing is the most effective way to prevent the transmission of microorganisms that can cause infections. The nurse should wash their hands before and after touching the child or their belongings, and teach the child and their family members to do the same. The nurse should also use alcohol-based hand rubs when water and soap are not available.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A: This response is appropriate, as it indicates urgency and concern for the infant's condition. Projectile vomiting immediately after eating can be a sign of pyloric stenosis, which is a condition that causes the narrowing of the pylorus, which is the opening between the stomach and the small intestine. Pyloric stenosis can prevent food from passing through and cause dehydration, electrolyte imbalance, or weight loss. The infant needs to be evaluated by a provider as soon as possible and may need surgery to correct the problem.
Choice B: This response is not appropriate, as it does not address the underlying cause of the infant's condition. Oral rehydration solution can help replace fluids and electrolytes lost through vomiting, but it does not treat pyloric stenosis or prevent further vomiting. Oral rehydration solution may also be vomited out by the infant if given too soon or too much.
Choice C: This response is not appropriate, as it does not address the underlying cause of the infant's condition. Burping the baby more frequently during feedings can help release air bubbles and prevent gas or colic, but it does not treat pyloric stenosis or prevent further vomiting. Burping may also trigger vomiting by increasing pressure on the stomach.
Choice D: This response is not appropriate, as it does not address the underlying cause of the infant's condition. Switching to a different formula can help if the infant has an allergy or intolerance to certain ingredients in their current formula, but it does not treat pyloric stenosis or prevent further vomiting. Switching formulas may also cause diarrhea or constipation by changing the infant's bowel flora.
Correct Answer is D
Explanation
Choice A reason: This choice is incorrect because a regular diet, no added salt may not be sufficient to prevent fluid retention and hypertension in a child who has acute glomerulonephritis. Acute glomerulonephritis is an inflammation of the glomeruli, which are the tiny blood vessels that filter blood in the kidneys. It may cause symptoms such as hematuria, proteinuria, oliguria, edema, or hypertension. Therefore, avoiding salt alone may not reduce sodium and water intake and excretion.
Choice B reason: This choice is incorrect because a low-protein, low-potassium diet may not be necessary for a child who has acute glomerulonephritis. A low-protein, low-potassium diet may be indicated for a child who has chronic kidney disease or end-stage renal disease, which can cause uremia, hyperkalemia, or metabolic acidosis. However, in acute glomerulonephritis, the kidney function usually recovers within weeks or months, and the protein and potassium levels are not significantly affected.
Choice C reason: This choice is incorrect because a low-carbohydrate, low-protein diet may not be appropriate for a child who has acute glomerulonephritis. A low-carbohydrate, low-protein diet may be used for a child who has diabetes mellitus or ketosis-prone epilepsy, which can cause hyperglycemia or ketone production. However, in acute glomerulonephritis, carbohydrate metabolism is not impaired, and the protein intake should be adequate to prevent malnutrition and promote healing.
Choice D reason: This choice is correct because a low-sodium, fluid-restricted diet is an appropriate diet for a child who has acute glomerulonephritis. A low-sodium, fluid-restricted diet helps to reduce the fluid retention and hypertension by limiting the sodium and water intake and excretion. The sodium intake should be less than 2 g per day, and the fluid intake should be equal to the urine output plus 500 mL per day.
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