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.
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Correct Answer is D
Explanation
Choice A rationale
Clamping a chest tube, especially without a specific physician's order or during transport, can lead to a rapid accumulation of air or fluid in the pleural space. This can cause a tension pneumothorax, a life-threatening condition where increased intrapleural pressure collapses the lung and shifts mediastinal structures, severely impairing cardiac output and respiratory function.
Choice B rationale
Disconnecting the chest tube from the drainage system during transport would expose the pleural space to atmospheric pressure. This would immediately cause a pneumothorax or worsen an existing one, as air would rush into the chest cavity, leading to lung collapse and severe respiratory distress, compromising the client's oxygenation and ventilation.
Choice C rationale
Emptying the collection chamber before transport is not a primary concern for client safety during a brief transport. The primary purpose of the collection chamber is to measure output and provide a closed system. While emptying it periodically is good practice, it doesn't directly impact the immediate safety or function of the chest tube system during transport.
Choice D rationale
Keeping the drainage system below the level of the client's chest at all times utilizes gravity to facilitate proper drainage of fluid and air from the pleural space and prevents backflow of fluid into the chest cavity. This ensures that the water seal maintains its integrity, preventing atmospheric air from entering the pleural space and maintaining negative intrapleural pressure.
Correct Answer is A
Explanation
Choice A rationale
An absolute neutrophil count (ANC) less than 1,000/mm³ indicates neutropenia, which significantly increases the risk of infection. Limiting visitors to healthy adults minimizes exposure to pathogens that could be carried by individuals who are ill or immunocompromised, thereby reducing the risk of opportunistic infections.
Choice B rationale
Taking a rectal temperature is contraindicated in neutropenic clients due to the risk of introducing bacteria from the rectum into the bloodstream, which could lead to bacteremia or sepsis. Oral or axillary temperatures are preferred methods for temperature assessment in immunocompromised individuals to prevent mucosal trauma.
Choice C rationale
Increasing raw produce in the client's diet is contraindicated in neutropenic clients. Uncooked fruits and vegetables can harbor bacteria and fungi that, while usually harmless to individuals with intact immune systems, can cause severe infections in immunocompromised patients due to compromised gut mucosal barriers.
Choice D rationale
Instructing the client to floss his teeth daily is contraindicated in severe neutropenia. Flossing can cause micro-abrasions and bleeding of the gingiva, creating entry points for oral bacteria into the bloodstream, which can lead to systemic infections in a client with a severely compromised immune system.
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