A nurse is caring for a client who has HIV and is neutropenic. Which of the following findings should the nurse identify as increasing the risk for the client to develop an infection?
The client is assigned to a room with negative airflow.
The client's meal tray includes ice cream with fresh fruit.
The client has artificial flowers in the room.
The client's meal tray contains hard-boiled eggs.
The Correct Answer is B
A. A room with negative airflow helps prevent the spread of airborne pathogens, which is helpful for immunocompromised clients like those with HIV, but it doesn't directly increase the risk of infection.
B. Correct. Neutropenic clients have reduced immune responses, and consume fresh fruit (which might carry bacteria. can increase the risk of infection.
C. Artificial flowers might be removed due to infection control concerns, but their presence doesn't significantly increase infection risk.
D. Hardboiled eggs are not necessarily a high-risk food for infection in neutropenic clients.
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Related Questions
Correct Answer is ["A","C","D"]
Explanation
A. The nurse should provide the client with written information about advance directives to ensure that the client fully understands their options and can make informed decisions about their healthcare wishes.
B. Not a correct option because it inaccurately states that an advance directive discontinues further care. An advance directive guides the type of care a patient wants or does not want, but it does not automatically discontinue all care.
C. The nurse should communicate the client's advance directives status to other members of the healthcare team through documentation and shift reports. The nurse should also educate the client that an advance directive is a legal document that guides healthcare decisions and must be respected by care providers.
D. The nurse can assist the client in initiating a power of attorney for health care document, which designates a trusted person to make healthcare decisions on behalf of the client if they become unable to make decisions for themselves.
Correct Answer is B
Explanation
A. Incorrect. No sounds heard after listening for 3 to 5 minutes would be considered absent bowel sounds.
B. Correct. Hyperactive bowel sounds are louder and more frequent than normal and can indicate increased bowel motility. They can also be present in early bowel obstructions due to increased peristalsis.
C. Incorrect. Soft sounds at a rate of 1/min are within the range of normal bowel sounds.
D. Incorrect. Decreased motility would result in hypoactive bowel sounds, not hyperactive.
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