The nurse is caring for a client who had an appendectomy 4 hours ago. Which finding requires immediate action by the nurse?

Choice A reason: The humoral immune response is mediated by B cells that produce antibodies against specific antigens. However, this response is not the main problem in AIDS, because B cells are not directly affected by the human immunodeficiency virus (HIV) that causes AIDS. Therefore, this choice is incorrect.

Choice B reason: The cellular immune response is mediated by T lymphocytes that activate other immune cells, such as macrophages, to destroy infected or abnormal cells. This response is the main problem in AIDS, because HIV infects and destroys CD4+ T cells, which are essential for coordinating the cellular immunity. As a result, the client becomes susceptible to opportunistic infections, such as Pneumocystis jiroveci pneumonia. Therefore, this choice is correct.

Choice C reason: Bone marrow suppression of white blood cells can cause immunodeficiency, but it is not the primary cause of AIDS. Bone marrow suppression can occur as a side effect of some drugs or treatments, such as chemotherapy or radiation therapy, but it is not directly caused by HIV. Therefore, this choice is incorrect.

Choice D reason: Exposure to multiple environmental infectious agents can challenge the immune system, but it does not necessarily cause it to fail. The immune system can adapt and respond to different pathogens, unless it is compromised by an underlying condition, such as AIDS. Therefore, this choice is incorrect.

Choice A reason: Obtaining a soft diet for the client is not the best initial nursing action for a client with chemotherapy-induced mucositis who is describing soreness of the tongue and oral issues. A soft diet can help reduce the irritation and discomfort of the oral mucosa, but it does not address the underlying cause of the inflammation and infection. The nurse should first assess the client's oral hygiene and provide appropriate interventions to prevent further complications.

Choice B reason: Encouraging frequent mouth care is the best initial nursing action for a client with chemotherapy-induced mucositis who is describing soreness of the tongue and oral issues. Frequent mouth care can help prevent or reduce the severity of mucositis by removing plaque, bacteria, and debris from the oral cavity, and by moisturizing and soothing the oral tissues. The nurse should instruct the client to use a soft toothbrush, a mild toothpaste, and a saline or bicarbonate rinse at least four times a day, and to avoid alcohol, tobacco, spicy, acidic, or hot foods and beverages.

Choice C reason: Cleansing the tongue and mouth with swabs is not the best initial nursing action for a client with chemotherapy-induced mucositis who is describing soreness of the tongue and oral issues. Swabs can be abrasive and damaging to the oral mucosa, especially if they are dry or contain alcohol or hydrogen peroxide. Swabs can also increase the risk of bleeding, infection, and ulceration of the oral tissues. The nurse should use a soft toothbrush or a gentle sponge to clean the tongue and mouth.

Choice D reason: Administering a topical analgesic per protocol is not the best initial nursing action for a client with chemotherapy-induced mucositis who is describing soreness of the tongue and oral issues. A topical analgesic can provide temporary relief of pain and discomfort, but it does not address the underlying cause of the inflammation and infection. The nurse should first assess the client's oral hygiene and provide appropriate interventions to prevent further complications. The nurse should also monitor the client's response to the analgesic and report any adverse effects or inadequate pain control.