The nurse is caring for a client with immunodeficiency disorder. Which nursing intervention should be included in the care plan?
Encourage the client to engage in vigorous physical activities to strengthen the immune system.
Limit the client's exposure to visitors and restrict contact with other clients in the healthcare setting.
Administer live vaccines to boost the client's immune response.
Encourage the client to eat a diet high in fresh fruits and vegetables to improve immune function.
The Correct Answer is B
Explanation: The correct answer is b. Limit the client's exposure to visitors and restrict contact with other clients in the healthcare setting. Clients with immunodeficiency disorders are at a higher risk of infections due to their weakened immune system. Restricting exposure to potential sources of infection, such as visitors and other sick clients, can help minimize the risk of acquiring infections.
Incorrect choices:
a. Engaging in vigorous physical activities may not be appropriate for clients with immunodeficiency disorders, as it can lead to an increased risk of infections and may not strengthen the immune system in these individuals.
c. Live vaccines are contraindicated for clients with immunodeficiency disorders, as they can cause severe infections in this population. Only inactivated vaccines are recommended to avoid the risk of vaccine-associated infections.
d. While a healthy diet is essential for overall well-being, there is no specific evidence to suggest that a diet high in fresh fruits and vegetables will improve immune function in clients with immunodeficiency disorders. Dietary considerations for these clients may include avoiding certain high-risk foods, but it should be discussed with the healthcare provider based on the specific immunodeficiency disorder.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Explanation: The correct answer is c. Limit visitors to family members only. Clients with immunodeficiency disorders are at increased risk of infections, and limiting visitors to family members only can help reduce the risk of exposure to infectious agents. It is essential to create a controlled and safe environment for these clients.
Incorrect choices:
a. Encouraging the client to interact with other clients in the unit can increase the risk of exposure to infections and is not appropriate for someone with immunodeficiency.
b. Live vaccines contain weakened pathogens and are contraindicated for clients with immunodeficiency disorders, as they can cause serious infections in this population.
d. Providing the client with a private room with negative pressure is not necessary for every client with immunodeficiency disorder. Negative pressure rooms are used for clients with specific airborne infectious diseases, and the decision to use such rooms is based on the specific circumstances of each client.
Correct Answer is D
Explanation
Explanation: The correct answer is d. Maintain strict hand hygiene and utilize protective equipment when providing care. Children with severe combined immunodeficiency (SCID) have a severely compromised immune system, making them highly susceptible to infections. Strict hand hygiene and the use of protective equipment, such as gloves and masks, are essential in preventing the transmission of infections to the child.
Incorrect choices:
a. Placing the child on contact precautions may not be sufficient to protect them from infections due to their high susceptibility. Additional precautions, such as strict hand hygiene and protective equipment, should be implemented.
b. Encouraging the child to play with other children may increase the risk of exposure to infections. Children with SCID should be protected from contact with potential sources of infection.
c. Live attenuated vaccines are contraindicated for children with SCID, as they can cause severe infections. Only inactivated vaccines are recommended to avoid the risk of vaccine-associated infections.
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