A nurse is assisting with the plan of care for a 10-month-old infant who has HIV. Which of the following interventions should the nurse include in the plan?
Monitor the infant's lymphocyte count.
Educate the infant's guardians about exchange transfusions.
Administer granulocyte colony-stimulating factor.
Initiate droplet precautions.
The Correct Answer is A
Monitoring the infant's lymphocyte count is important in evaluating the immune function of the infant. HIV primarily affects the immune system, including lymphocytes. Monitoring the lymphocyte count helps assess the progression of the disease and the effectiveness of treatment.
Exchange transfusions are not typically used in the management of HIV. They are primarily performed in conditions like severe neonatal jaundice or blood disorders, but not for the treatment of HIV.
Granulocyte colony-stimulating factor (G-CSF) is a medication used to stimulate the production of white blood cells called granulocytes. While G-CSF can be used in certain situations, such as to counteract the side effects of certain chemotherapy drugs, it is not a standard treatment for HIV in infants.
Droplet precautions are typically implemented for infectious diseases that spread through respiratory droplets, such as influenza or respiratory syncytial virus (RSV). HIV does not spread through respiratory droplets, so initiating droplet precautions would not be necessary in the care of an infant with HIV.
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Related Questions
Correct Answer is ["A","B","C","E","G"]
Explanation
Based on the given information, the nurse should take the following actions in preparation for surgery:
- Obtain a complete blood count: This is important to assess the client's hemoglobin, hematocrit, and other blood parameters before surgery.
- Prepare the client for insertion of an 18-gauge peripheral IV prior to surgery: Adequate IV access is necessary for the administration of fluids and medications during and after surgery.
- Administer Rh, D immune globulin prior to surgery: This action is indicated if the client is Rh-negative and there is a possibility of fetal-maternal blood mixing during the termination of pregnancy. Rh, D immune globulin is given to prevent sensitization to Rh-positive blood.
- Verify consent form is signed by the client: Ensuring that the client has provided informed consent is essential before proceeding with any surgical intervention.
- Remind the client to be NPO (nothing by mouth) prior to surgery: It is important for the client to have an empty stomach to reduce the risk of aspiration during anesthesia.
The following actions are not indicated based on the given information:
- Explaining the surgical procedure to the client: Although it is important for the client to have an understanding of the procedure, this is typically done by the surgeon rather than the nurse.
- Assisting with administration of AB positive blood products if needed: There is no indication of the need for blood products based on the information provided. Blood product administration would be determined based on the client's specific condition and surgical requirements.
Correct Answer is B
Explanation
Correct answer: B
A.Family presence can provide comfort and support to the toddler, making mealtimes a more positive experience. It can also encourage the child to eat more by setting a good example. However, without first understanding the child's dietary habits and possible issues, this intervention might not address the root cause of the poor intake.
B.The nurse’sfirst actionin caring for a toddler with poor dietary intake should be toobtain the child’s dietary history. Understanding the child’s current eating habits, preferences, and any potential barriers to adequate nutrition is essential for planning appropriate interventions. Once the dietary history is obtained, the nurse can tailor further actions based on the specific needs of the child.
C.Offering nutritious snacks can help increase the child's overall calorie and nutrient intake, which is particularly important if the child has a low appetite during regular meals. Nevertheless, this step should follow the assessment of the child's dietary history to ensure that the snacks offered are appropriate and to avoid potential allergies or intolerances.
D.Positive reinforcement can encourage healthy eating behaviors and make mealtime a more enjoyable experience for the child. Praising the child can motivate them to eat more. However, this should be done after understanding the child's eating patterns and preferences to ensure that the praise is given in a context that promotes effective and lasting change.
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