A nurse is caring for a client who is immunocompromised. Which of the following actions should the nurse take?
Place the client in a semiprivate room.
Have the client apply a mask when children are visiting.
Cleanse hands with an alcohol-based hand rub before client contact.
Use sterile gloves to provide perineal care.
The Correct Answer is C
When caring for an immunocompromised client, the nurse should prioritize infection prevention and control measures. One essential action is to cleanse hands with an alcohol-based hand rub before client contact. Hand hygiene is crucial in reducing the transmission of microorganisms and preventing infections. Using an alcohol-based hand rub is effective in killing many types of germs, including bacteria and viruses.
Let's now discuss why the other
Options are not the correct answers:
a. Place the client in a semiprivate room: Placing the client in a semiprivate room increases the risk of exposure to potential infections from other individuals. Immunocompromised clients have a weakened immune system, making them more susceptible to infections. Therefore, it is recommended to provide them with a private room to minimize the risk of exposure to pathogens.
b. Have the client apply a mask when children are visiting: While it is generally important to take precautions when visitors are present, having the client wear a mask when children are visiting may not be sufficient to protect the immunocompromised client. Children can carry and transmit various infectious diseases, even without displaying symptoms. Therefore, it is more appropriate for healthcare providers and visitors, including children, to adhere to strict hand hygiene and other infection control measures to minimize the risk of infection transmission.
d. Use sterile gloves to provide perineal care: The use of sterile gloves is not necessary for routine perineal care unless there is a specific indication, such as an open wound or surgical site. For routine perineal care, clean, non-sterile gloves are sufficient. Using sterile gloves unnecessarily can contribute to the development of antimicrobial resistance and increase healthcare costs without providing any additional benefits.
In summary, when caring for an immunocompromised client, the nurse should prioritize infection prevention and control. Cleansing hands with an alcohol-based hand rub before client contact is an important action to reduce the risk of infection transmission. The other
Options, such as placing the client in a semiprivate room, having the client wear a mask when children are visiting, and using sterile gloves for routine perineal care, are not the appropriate actions in this scenario.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The priority intervention for a client with a new diagnosis of terminal cancer is to discuss the client's prior coping mechanisms. This will help the nurse to understand how the client has coped with difficult situations in the past and to develop a plan of care that is tailored to the client's individual needs and preferences.
Options a, c, and d are also important interventions, but they are not the priority. Helping the client to find a local support group, developing a list of goals with the client, and teaching the client to use progressive relaxation techniques can all be helpful in supporting the client's emotional well-being, but they should be implemented after the nurse has assessed the client's coping mechanisms and developed a plan of care.
Correct Answer is B
Explanation
The correct answer is that the nurse should expect to find reduced sweat production when performing a skin assessment on an older adult client. As we age, our skin gradually loses its ability to produce sweat and oil, which can result in dry skin¹.
Options a, c and d are not expected findings when performing a skin assessment on an older adult client. Increased skin elasticity, increased production of oils and thickened outer layer of skin are not typical age- related changes.
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