A nurse is caring for a client who has neutropenia due to HIV. Which of the following precautions should the nurse take while caring for this client?

Wear an N95 respirator.

Insert an indwelling urinary catheter to monitor urinary output.

Monitor the client's vital signs every 8 hr.

Use a dedicated stethoscope.

Answer and Explanation

The Correct Answer is D

A. Wearing an N95 respirator is not necessary when caring for a client with neutropenia due to HIV unless the client has respiratory symptoms or is undergoing procedures that generate aerosols.

B. Inserting an indwelling urinary catheter should be avoided unless necessary, as it can

introduce the risk of infection, which is particularly concerning in clients with neutropenia.

C. Monitoring vital signs every 8 hours may not provide sufficient frequency for detecting changes in a client with neutropenia who may be at risk for rapid deterioration.

D. Using a dedicated stethoscope helps prevent the spread of infection to other clients by avoiding cross-contamination, which is especially important when caring for a client with neutropenia who is at increased risk of infection.

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Correct Answer is A

Explanation

A. Changing clothes after working in the field helps prevent pesticide residue from being transferred to other surfaces and reduces the risk of exposure to pesticides.

B. Applying petroleum jelly to the nostrils is not an effective method for minimizing exposure to pesticides and may not provide significant protection.

C. Wiping fruits and vegetables with a dry cloth may remove some surface dirt but is unlikely to effectively remove pesticide residues, especially if they have been absorbed into the produce.

D. Taking a hot shower after finishing work may help remove pesticide residues from the skin but does not address the potential for exposure from contaminated clothing or other surfaces.

A. Failure to engraft B. Veno-occlusive disease C. Graft-versus-host disease D. Pancytopenia

Correct Answer is B

Explanation

A. Failure to engraft typically presents with symptoms such as persistent neutropenia, thrombocytopenia, and anemia, rather than skin peeling.

B. Veno-occlusive disease, also known as sinusoidal obstruction syndrome, can lead to liver dysfunction and subsequent skin manifestations such as peeling, especially on the palms and soles.

C. Graft-versus-host disease (GVHD) typically presents with symptoms such as skin rash, diarrhea, and liver dysfunction, but peeling skin is not a hallmark manifestation.

D. Pancytopenia refers to a deficiency of all types of blood cells (red blood cells, white blood cells, and platelets) and is not typically associated with skin peeling as a primary symptom.

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Nursing Test Bank

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