A nurse is caring for a client who has HIV.
Which of the following laboratory values is the nurse’s priority?

CD4-T-cell count 180 cells/mm³.

Positive Western blot test.

Platelets 150,000/mm³.

WBC 5,000/mm³.

Answer and Explanation

The Correct Answer is A

Choice A rationale

A CD4-T-cell count of 180 cells/mm³ indicates severe immunosuppression in a client with HIV, making them highly susceptible to opportunistic infections. This is a critical value that requires immediate attention to prevent life-threatening complications.

Choice B rationale

A positive Western blot test confirms the presence of HIV antibodies but does not indicate the current immune status or the urgency of the client’s condition.

Choice C rationale

Platelets at 150,000/mm³ are within the normal range and do not indicate an immediate threat to the client’s health.

Choice D rationale

A WBC count of 5,000/mm³ is within the normal range and does not indicate an immediate threat to the client’s health.

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Correct Answer is D

Explanation

Choice A rationale

Diphenhydramine does not expand blood volume. It is an antihistamine used to prevent allergic reactions.

Choice B rationale

Diphenhydramine does not enhance clotting factors. It is used to manage allergic reactions.

Choice C rationale

While diphenhydramine can help manage fever and chills, its primary purpose before a blood transfusion is to prevent allergic reactions.

Choice D rationale

Administering diphenhydramine before a blood transfusion helps prevent urticaria and other allergic reactions by blocking histamine release. .

A. I need to drink room temperature beverages. B. I can take a prescribed analgesic to help manage the pain. C. I need to be careful not to spread this to my family. D. The chemotherapy affected my immune system.

Correct Answer is C

Explanation

Drinking room temperature beverages can help minimize irritation in the mouth and throat, which is beneficial for clients with stomatitis. Cold or hot beverages can exacerbate the condition by causing discomfort and pain.

Choice B rationale

Taking a prescribed analgesic can help manage the pain associated with stomatitis. Pain management is crucial for maintaining the client’s comfort and ability to eat and drink.

Choice C rationale

Stomatitis is not contagious and cannot be spread to family members. This statement indicates a need for further teaching as it reflects a misunderstanding of the condition.

Choice D rationale

Chemotherapy can affect the immune system, making the client more susceptible to infections and conditions like stomatitis. This statement is accurate and does not indicate a need for further teaching.

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A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse’s priority?

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Naxlex Comprehensive Predictor Exams

What is the purpose of administering diphenhydramine before a blood transfusion?

Correct Answer is D

Explanation

A client diagnosed with bowel cancer has recently received a course of chemotherapy and has now developed stomatitis. The nurse provides instructions to the client regarding the condition and determines the need for further teaching if the client makes which statement?

Correct Answer is C

Explanation

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A nurse is caring for a client who has HIV.
Which of the following laboratory values is the nurse’s priority?