A nurse is creating a plan of care for a client who has cancer and is experiencing Immunosuppression. Which of the following Interventions should the nurse include in the plan of care?
Monitor the client's vital signs every 12 hr.
Inspect the client's mouth every 8 hr.
Provide fresh fruit with the client's meals.
Rotate health care staff caring for the client.
The Correct Answer is B
A. Monitoring vital signs every 12 hours is a standard nursing intervention but may not specifically address the needs of a client with immunosuppression.
B. Inspecting the client's mouth every 8 hours can help in early detection of mouth sores or infections, which are common in immunosuppressed individuals.
C. Providing fresh fruit with meals may not be appropriate for a client with immunosuppression, as fresh fruits can harbor pathogens that pose a risk of infection.
D. Rotating healthcare staff caring for the client helps increases the risk of introducing pathogens to the client. This increases the risk of infection in the immunosuppressed client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
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Correct Answer is A
Explanation
A. Uneven shoulder and pelvic heights are classic signs of scoliosis, visible during a physical examination where one shoulder or hip may appear higher than the other.
B. Mild pain in the hip region is not a specific indicator of scoliosis.
C. Exaggerated curvature of the sacrum is not a specific indicator of scoliosis.
D. Limited range-of-motion of the hips is not a specific indicator of scoliosis
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
Mastitis is a breast infection that can occur in breastfeeding women. It causes inflammation, pain, redness, and sometimes fever and pus in the affected breast. One of the risk factors for mastitis is nipple trauma, such as cracks or fissures, that can allow bacteria to enter the breast tissue.
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