A nurse is planning care for a child with human immunodeficiency virus (HIV). Which nursing diagnosis is the highest priority for this child?
Ineffective tissue perfusion
Risk for infection
Risk for fluid volume deficit
Ineffective thermoregulation
The Correct Answer is B
a) Ineffective tissue perfusion: Though this might be a concern, the highest priority for an HIV-positive child is the risk of acquiring infections due to compromised immunity.
b) Risk for infection: HIV weakens the immune system, significantly increasing the risk of contracting infections. Preventing infections is the primary focus.
c) Risk for fluid volume deficit: While important, it's not the highest priority compared to the risk of infection due to HIV.
d) Ineffective thermoregulation: Not typically the primary concern for an HIV-positive child compared to the increased risk of infections due to the compromised immune system.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
a) Acute diarrhea, dehydration: Not typically associated with Hirschsprung disease, which involves constipation.
b) Failure to pass meconium, abdominal distension: Characteristic signs of Hirschsprung disease due to the absence of ganglion cells in the distal colon, leading to constipation and distension.
c) Gelatinous stools, pain: Uncommon features of Hirschsprung disease.
d) Projectile vomiting, altered electrolytes: These symptoms are not typically seen in Hirschsprung disease; they might indicate other conditions affecting the gastrointestinal tract.
Correct Answer is B
Explanation
a) Obtaining a sweat chloride test: Likely already part of routine monitoring for cystic fibrosis.
b) Reproductive ability: Adolescents with cystic fibrosis may need education regarding how their condition can affect fertility.
c) The effect of pancreatic enzymes on sex hormones: Not a commonly discussed aspect in cystic fibrosis care.
d) Increased need for weight reduction diet: Weight maintenance or specific diets to promote weight gain are more commonly addressed in cystic fibrosis care.
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