A nurse is providing teaching to a client who has neutropenia.
Which of the following information should the nurse include in the teaching?
Perform mild exercise, such as gardening.
Avoid crowds.
Eat plenty of fresh fruits and vegetables.
Take temperature weekly.
The Correct Answer is B
Choice A rationale
Gardening involves exposure to soil-borne microorganisms, fungi, and dust, which pose a significant infection risk for neutropenic clients whose compromised immune systems, characterized by a neutrophil count typically below 1.5 × 10^9/L (normal range 2.5–7.5 × 10^9/L), cannot effectively combat these environmental pathogens.
Choice B rationale
Avoiding crowds minimizes exposure to airborne pathogens, including viruses and bacteria, which are easily transmitted in close proximity. Neutropenic individuals have a severely impaired innate immune response due to a deficiency in neutrophils, making them highly susceptible to even common community-acquired infections. This reduces the pathogen load they encounter.
Choice C rationale
Fresh fruits and vegetables can harbor bacteria, molds, and pesticides on their surfaces, even after washing. For a neutropenic client, ingesting these microorganisms can lead to severe gastrointestinal infections or systemic sepsis due to the inability of their diminished neutrophil count to mount an adequate immune defense.
Choice D rationale
Taking temperature weekly is insufficient for monitoring neutropenia. A daily or even more frequent temperature assessment is crucial because fever (oral temperature >38.0°C or 100.4°F) is often the first and sometimes only sign of infection in neutropenic clients, necessitating immediate intervention given their immunocompromised state.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
The client's platelet count is $170,000/\text{mm}^3$, which falls within the normal range of $150,000-400,000/\text{mm}^3$. Therefore, there is no increased risk for bleeding based on this lab value. A significantly decreased platelet count, known as thrombocytopenia, would typically be below $100,000/\text{mm}^3$ to indicate a substantial bleeding risk.
Choice B rationale
The client's hemoglobin ($12.1 \text{ g/dL}$) and hematocrit ($36.5\%$) are within or very close to normal ranges (hemoglobin: $12-16 \text{ g/dL}$ for women, hematocrit: $37-47\%$ for women). An erythropoiesis-stimulating agent is typically indicated for significant anemia, usually when hemoglobin levels are substantially lower, to stimulate red blood cell production.
Choice C rationale
The client's albumin level is $4.5 \text{ g/dL}$, which is within the normal range of $3.5-5.0 \text{ g/dL}$. Albumin is a plasma protein essential for maintaining oncotic pressure and transporting various substances. A diet with increased protein would be indicated for hypoalbuminemia, a condition of low albumin, which is not present here.
Choice D rationale
The client's white blood cell (WBC) count is $1,400/\text{mm}^3$. The normal range for WBCs is $4,500-11,000/\text{mm}^3$. This significantly low WBC count, known as leukopenia, indicates bone marrow suppression, a common side effect of chemotherapy like cisplatin. This severe reduction in leukocytes, particularly neutrophils, greatly compromises the immune system, leading to a high susceptibility to infections.
Correct Answer is A
Explanation
Choice A rationale
Atrial fibrillation causes an irregular and often rapid heart rate, leading to inefficient ventricular filling and reduced cardiac output. This dysrhythmia often results in a pulse deficit, where the apical heart rate is higher than the peripheral radial pulse rate due to some beats not generating a palpable peripheral pulse.
Choice B rationale
Differences in blood pressure between upper limbs can indicate conditions such as aortic dissection, subclavian steal syndrome, or peripheral arterial disease. While important, this finding is not directly indicative of atrial fibrillation, which primarily affects cardiac rhythm and output, not typically causing inter-limb blood pressure discrepancies. Normal blood pressure is typically <120/80 mmHg.
Choice C rationale
Differences in upper and lower lung sounds may suggest conditions like pneumonia, pleural effusion, or atelectasis, which affect lung expansion and air movement. While shortness of breath is a symptom of pericarditis and potential complications, varying lung sounds are not a direct sign of atrial fibrillation.
Choice D rationale
Differences between oral and axillary temperatures can occur due to variations in measurement techniques or local environmental factors, but these are not specific indicators of atrial fibrillation. Atrial fibrillation is a cardiac rhythm disturbance, and temperature discrepancies do not reflect its presence. Normal oral temperature is 36.5°C to 37.5°C (97.7°F to 99.5°F).
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