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NurseDive Free Nursing Practice Question
A nurse is planning care for a client who has immunosuppression following chemotherapy. Which of the following interventions should the nurse include in the plan of care?
A. Provide the client with fresh fruit to avoid constipation.
B. Insert an indwelling catheter to monitor sediment in the urine.
C. Take the client's temperature once per shift.
D. Limit the number of health care workers entering the room.
This is because immunosuppression increases the risk of infection, and health care workers can be potential sources of pathogens. The nurse should use standard precautions, avoid invasive procedures, and restrict visitors who are ill.
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Full Explanation
This is because immunosuppression increases the risk of infection, and health care workers can be potential sources of pathogens. The nurse should use standard precautions, avoid invasive procedures, and restrict visitors who are ill.
Similar Questions
A nurse is caring for a client who has a history of exposure to TB and symptoms of night sweats and hemoptysis. Which of the following tests should the nurse realize is the most reliable to confirm the diagnosis of active pulmonary TB?
A. Mantoux test
B. Sputum culture for acid-fast bacillus
This is because sputum culture can identify the presence and type of mycobacteria that cause TB, while other tests can only indicate exposure or infection. Sputum culture results may take several weeks, so treatment should be initiated based on clinical suspicion and other tests.
C. Sputum smear
D. Chest x-ray
Full Explanation
This is because sputum culture can identify the presence and type of mycobacteria that cause TB, while other tests can only indicate exposure or infection. Sputum culture results may take several weeks, so treatment should be initiated based on clinical suspicion and other tests.
A nurse is assessing a client who has pulmonary tuberculosis. Which of the following findings should the nurse expect?
A. Lethargy
This is because pulmonary tuberculosis causes inflammation and damage to the lungs, which reduces oxygen exchange and leads to fatigue and weakness.
B. Dry cough
C. Weight gain
D. High-grade fever
Full Explanation
This is because pulmonary tuberculosis causes inflammation and damage to the lungs, which reduces oxygen exchange and leads to fatigue and weakness.
A nurse in an emergency room is caring a the client who sustained partial-thickness burns to both lower legs, chest, face, and both forearms. Which of the following is the priority action the nurse should take?
A. Insert an indwelling urinary catheter.
B. Draw blood for a complete blood cell (CBC) count.
C. Inspect the mouth for signs of inhalation injuries.
This is because inhalation injuries can compromise the airway and cause respiratory distress or failure, which can be life-threatening. The nurse should assess for signs such as soot, burns, hoarseness, or stridor.
D. Administer intravenous pain medication.
Full Explanation
This is because inhalation injuries can compromise the airway and cause respiratory distress or failure, which can be life-threatening. The nurse should assess for signs such as soot, burns, hoarseness, or stridor.