A nurse in a hospital setting is developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority?

Impaired skin integrity related to persistent deep skin abscesses

Grieving related to the poor prognosis of the condition

Risk for infection related to altered immune cell function

Anxiety related to an inherited disorder

Answer and Explanation

The Correct Answer is C

A. Impaired skin integrity related to persistent deep skin abscesses: While this is an important concern, the priority for a client with a primary immunodeficiency is to prevent and manage infections, as these are more likely to occur due to the compromised immune system.

B. Grieving related to the poor prognosis of the condition: Grieving is a valid concern, especially in a chronic or life-limiting condition, but the priority is to address the client's immediate physical health needs, such as infection prevention and management.

C. Risk for infection related to altered immune cell function: This is the priority nursing diagnosis for a client with a primary immunodeficiency. The altered immune system significantly increases the client's risk for infections, so preventing and managing infections becomes the primary focus of care.

D. Anxiety related to an inherited disorder: The immediate concern for a client with a primary immunodeficiency is the prevention and management of infections. Anxiety can be addressed as part of emotional and psychological support once the physical health needs are stabilized.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is D

Explanation

A. Wound drainage: While monitoring wound drainage is important to assess for infection or complications, airway patency is the priority in the immediate postoperative period. Ensuring the airway is clear and secure is the first priority.

B. Tissue integrity: Tissue integrity is crucial for healing, but it is secondary to ensuring the airway is patent. If the airway is compromised, tissue integrity becomes less of a concern until the airway is stable.

C. Pain severity: Managing pain is essential, but pain assessment should not take precedence over ensuring that the airway is open and functional. Airway compromise can lead to life-threatening situations and needs immediate attention.

D. Airway patency: After a laryngectomy, ensuring the airway remains patent is the highest priority. Obstruction or difficulty breathing can lead to respiratory distress, which can be life-threatening in the immediate postoperative period.

A. Dosage of the medication will be reduced during pregnancy. B. Dietary modifications occur during pregnancy when taking this medication. C. The client can breast feed when taking this medication. D. The medication should be discontinued 3 months prior to a planned

Correct Answer is D

Explanation

A. Dosage of the medication will be reduced during pregnancy: Methotrexate is not reduced in dosage during pregnancy. It is contraindicated in pregnancy due to its teratogenic effects. The medication should generally be discontinued before conception.

B. Dietary modifications occur during pregnancy when taking this medication: There are no specific dietary modifications required during pregnancy when taking methotrexate, as it is not recommended during pregnancy. The focus should be on discontinuing the medication prior to pregnancy.

C. The client can breastfeed when taking this medication: Methotrexate is excreted in breast milk and can be harmful to a breastfeeding infant. Breastfeeding should be avoided while taking this medication, and alternative treatments should be considered.

D. The medication should be discontinued 3 months prior to a planned pregnancy: Methotrexate should be discontinued before pregnancy due to its potential teratogenic effects. It should be stopped at least 3 months before trying to conceive to ensure the drug is cleared from the system and minimize risks to the fetus.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse in a hospital setting is developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is in the immediate postoperative period following a partial laryngectomy. Which of the following parameters should the nurse assess first?

Correct Answer is D

Explanation

A nurse is caring for a female client who has rheumatoid arthritis and a new prescription for methotrexate. The client tells the nurse she is planning a pregnancy. Which of the following instructions should the nurse give the client?

Correct Answer is D

Explanation

A nurse is teaching a client who has chronic obstructive pulmonary disease about ways to facilitate eating. Which of the following statements indicates a need for further teaching?

A clinic nurse is working with a client who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the client's disease?

A postoperative patient has an order for Kefzol 1g in 25 mL of D5W over 15 minutes. The medication will be infused with an IV pump. How many milliliters per hour should the IV pump be programmed for?

A nurse is assessing a client at a dermatology clinic. Which of following findings places the client at risk for developing malignant melanoma?

A nurse is caring for a client with a tracheostomy. The client's partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the client's discharge?

A nurse is caring for a client who has diagnosed with chronic gout. Which of the following medications should the nurse prepare to administer?

A nurse is caring for a client who is scheduled for a bone marrow aspiration. The client asks the nurse about the sites the provider might use for the procedure. Which of the following locations should the nurse identify as one of the sites used for this procedure?

A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select all that apply.)