A nurse is assisting in the care of a child.

Which of the following provider prescriptions is anticipated, nonessential, or contraindicated for the child?

For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the child. There must be at least 1 selection in every row. There does not need to be a selection in every column.

Care of a client with HIV and neutropenia requires strict infection prevention because reduced neutrophil counts severely impair the body’s ability to fight bacterial and fungal pathogens. In this immunocompromised state, exposure to contaminated food, water, or environmental sources significantly increases the risk of opportunistic infections. Dietary and environmental restrictions are implemented to minimize exposure to microorganisms commonly found in raw or unprocessed items. Nursing care focuses on identifying sources of contamination that may introduce pathogens into the client’s system.

Rationale:
A. Fresh fruit on ice cream increases infection risk because raw, unwashed produce can harbor bacteria, parasites, or fungi that are dangerous for a neutropenic client. In a client with Neutropenia, even low-level contamination can lead to severe systemic infection due to impaired immune response. This is why neutropenic precautions often include avoidance of raw fruits and vegetables unless properly cooked or sterilized.

B. Hard-boiled eggs are considered safe because they are fully cooked and do not typically harbor viable pathogens when properly prepared and stored. Protein sources like fully cooked eggs are often encouraged in neutropenic diets to maintain nutritional status without increasing infection risk. Therefore, this does not contribute to increased infection risk.

C. Artificial flowers are generally considered safe because they do not contain soil or water that can support bacterial or fungal growth. While they may collect dust if not cleaned, they are not a significant infection source compared to real plants or fresh flowers. The main concern in neutropenic precautions is avoiding live plants and stagnant water, not artificial decorations.

D. A negative airflow room does not increase infection risk for the client but is inappropriate for neutropenic (protective) isolation. Negative pressure rooms are used to prevent airborne pathogen spread from the client to others (e.g., tuberculosis). Neutropenic clients instead require positive pressure environments to protect them from external contaminants, so this is a setup issue rather than a direct infection risk factor.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system that leads to muscle weakness, fatigue, spasticity, and impaired coordination. These neurologic deficits can significantly interfere with a client’s ability to perform activities of daily living such as toileting, bathing, and dressing. Nursing care focuses on energy conservation, safety, and adaptive equipment to promote independence. Interventions should support mobility while minimizing fatigue and risk of injury.

Rationale:
A. Applying cold packs to joints is not a primary intervention for improving self-care ability in multiple sclerosis. While cooling strategies may temporarily reduce symptom exacerbation in some clients, joint cold therapy does not directly address functional limitations in toileting or mobility. It is not a key strategy for enhancing independence in daily activities.

B. Encouraging hot showers is inappropriate because heat can worsen symptoms in clients with multiple sclerosis. Increased body temperature may exacerbate fatigue, muscle weakness, and neurologic dysfunction. This phenomenon, known as heat sensitivity, can temporarily impair mobility and self-care ability.

C. Providing a raised toilet seat improves independence by reducing the effort required to sit and stand. Clients with Multiple sclerosis often experience lower extremity weakness and balance issues, making transfers difficult. Adaptive devices such as raised toilet seats enhance safety and promote self-care autonomy.

D. Planning hygiene care in the afternoon is not the most effective strategy because fatigue in multiple sclerosis is often unpredictable and may worsen later in the day. Scheduling care should be individualized based on when the client experiences peak energy levels, often in the morning. A fixed afternoon schedule may not optimize functional ability.