A nurse is caring for an older adult client who has a WBC count of 2,000/mm after three rounds of chemotherapy. Which of the following actions should the nurse take?
Humidify the client's room.
Replace the water in flower vases with fresh water daily.
Clean dentures in a denture cup.
Serve cooked fruit with meals.
The Correct Answer is D
Choice A reason: Humidifying the client's room can help maintain mucous membrane integrity and prevent respiratory infections, which is crucial for a client with a low WBC count.
Choice B reason: Replacing the water in flower vases daily can prevent the growth of bacteria, reducing the risk of infection for an immunocompromised client.
Choice C reason: Cleaning dentures in a denture cup is a standard infection control practice that helps maintain oral hygiene and prevent infections.
Choice D reason: Serving cooked fruit with meals reduces the risk of transmitting infections that can be associated with raw fruits, which is important for a client with neutropenia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Renal function is not typically reestablished during the oliguric phase of acute kidney injury; this phase is characterized by a significant reduction in urine output due to renal tubule damage.
Choice B reason: BUN and creatinine levels usually increase during the oliguric phase because the kidneys' ability to filter and excrete these waste products is compromised.
Choice C reason: The oliguric phase is defined by a urine output of less than 400 mL per 24 hours, which is a result of decreased kidney function and damage to the renal tubules.
Choice D reason: The GFR does not recover during the oliguric phase; instead, it is typically low due to reduced kidney function. Recovery of GFR occurs later in the recovery phase of acute kidney injury.
Correct Answer is A
Explanation
Choice A reason: Neurological checks are essential after spinal surgery to monitor for any changes or deterioration in the patient's neurological status. The frequency of these checks can vary based on the patient's condition, but a common standard is to perform them every 4 hours or sooner. However, in some cases, especially immediately post operation, checks may be required more frequently, such as every 2 hours, to ensure any complications are identified and managed promptly.
Choice B reason: While mobilization is an important aspect of postsurgical care to prevent complications such as deep vein thrombosis, positioning a patient in a chair every 2 hours may not be appropriate immediately following spinal surgery. The patient's mobility and pain level must be assessed, and activities should be gradually increased as tolerated.
Choice C reason: Inspecting the spinal dressing is important to identify signs of infection or complications. However, clear drainage is not typically expected and could indicate cerebrospinal fluid leakage, which requires immediate medical attention.
Choice D reason: The term "criminal checks" is not relevant to nursing care and seems to be a typographical error. The nurse's focus should be on clinical assessments and interventions related to the patient's health status.
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