The nurse is giving discharge instructions to a patient on the medical-surgical unit. Which patient should be taught about the possibility of an overwhelming infection?
Post chemotherapy
Diagnosed with sickle cell anemia
Diagnosed with multiple myeloma
Post-splenectomy patient
The Correct Answer is D
A. While patients receiving chemotherapy are at risk for infections due to immunosuppression, the risk of overwhelming infection, particularly from encapsulated bacteria, is higher in post-splenectomy patients due to impaired immune function without the spleen.
B. Patients with sickle cell anemia are at increased risk of infections, particularly from encapsulated bacteria, due to functional asplenia or hyposplenism, but the risk of overwhelming infection is highest in post-splenectomy patients.
C. Patients with multiple myeloma are immunocompromised and at increased risk of infections, but they do not have the same risk of overwhelming infection as post- splenectomy patients.
D. Post-splenectomy patients are at highest risk of overwhelming infection due to impaired immune function resulting from the absence of the spleen, which plays a crucial role in immune surveillance and defense against encapsulated bacteria.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D","E"]
Explanation
First, Hodgkin lymphoma (HL) is commonly characterized by painless lymphadenopathy and is not painful, as stated above. Secondly, HL is often characterized by a low-grade fever rather than a high fever. Third, the presence of Bence-Jones cells in a laboratory test is not associated with Hodgkin lymphoma but indicates multiple myeloma, a different type of cancer. Fourth, Hodgkin disease is indeed a form of cancer; it is a malignancy of the lymphatic system. The nurse's statement that it is "not really cancer" is incorrect and misleading. Fifth, palliative radiation therapy is typically used to relieve symptoms in advanced stages of cancer or non-curative scenarios. However, for stage 1 Hodgkin lymphoma, the treatment usually involves chemotherapy and/or radiation therapy with curative intent, not palliative. Joe's nurse should provide accurate information about the nature of Hodgkin's disease and its treatment options, which are based on the stage and specific characteristics of the lymphoma.
Correct Answer is B
Explanation
A. In the oliguric phase of acute kidney injury, fluid intake may need to be restricted rather than encouraged to prevent fluid overload.
B. Hourly intake and output monitoring is crucial for managing fluid balance and assessing the progression of kidney injury. Close monitoring can help prevent fluid overload, which is a risk due to the reduced urine output. It also aids in the timely adjustment of fluid administration and the detection of any changes in the client's condition that may necessitate intervention.
C. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are contraindicated in acute kidney injury as they can further impair renal function.
D. In the oliguric phase, protein intake may need to be restricted to reduce the workload on the kidneys and minimize azotemia. A high-protein diet can increase the burden on already compromised kidneys due to the increased production of urea, a byproduct of protein metabolism that requires excretion by the kidneys.
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