A nurse preparing incoming storm. Which of the following clients should the nurse recommend for discharge planning?

A child who has leukemia and an absolute neutrophil count of 200/mm3 (2.500 to 8.000/mm%)

A child who has a new diagnosis of type diabetes mellitus and is receiving IV insulin

An adolescent who has cystic fibrosis and is receiving their yearly tune-up

An infant who has respiratory syncytial virus and respiratory rate of 70/min

Answer and Explanation

The Correct Answer is B

A) "A child who has leukemia and an absolute neutrophil count of 200/mm³ (2,500 to 8,000/mm³)."
This child is at significant risk for infection due to a severely low neutrophil count, indicating severe neutropenia. Discharge planning for this child would be inappropriate at this time since they need intensive monitoring and care to manage their immunocompromised status and prevent infections.

B) "A child who has a new diagnosis of type 1 diabetes mellitus and is receiving IV insulin."
This child is appropriate for discharge planning. A new diagnosis of type 1 diabetes requires thorough teaching for the family and child about blood glucose monitoring, insulin administration, dietary adjustments, and emergency management. While the child is receiving IV insulin in the hospital, once stabilized, they can be discharged with proper education and support to manage their condition at home.

C) "An adolescent who has cystic fibrosis and is receiving their yearly tune-up."
A cystic fibrosis "tune-up" refers to a period of treatment, often including IV antibiotics and respiratory therapy, to help manage the chronic condition. Since this is part of ongoing care and not an acute issue, discharge planning is not immediately appropriate until the "tune-up" is complete, and the adolescent has stabilized.

D) "An infant who has respiratory syncytial virus (RSV) and a respiratory rate of 70/min."
This infant is at risk for respiratory distress and requires close monitoring. A respiratory rate of 70/min in an infant is elevated, and the child may need additional respiratory support. Discharge planning should not be initiated until the infant's condition improves and they are stable enough to handle care at home.

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Correct Answer is B

Explanation

A) Tell the client to leave the group if they cannot contribute.
This response is inappropriate as it does not support the client’s participation or create an open, supportive environment. Forcing the client to leave would alienate them and potentially discourage future participation. Group therapy should foster inclusiveness and understanding, not create pressure or exclusion.

B) Allow the client extra time to think of a response.
This is the most appropriate action. Some clients may need additional time to process their thoughts before speaking, especially in a group setting where they may feel anxious or hesitant. Giving the client space and time to formulate a response can encourage participation without forcing them. It allows them to engage at their own pace, promoting comfort and confidence in the group.

C) Appoint the client to lead the discussion.
While giving the client an active role might help them engage, appointing them to lead the discussion could cause undue stress or anxiety, particularly if they are already struggling to contribute. This could overwhelm the client and make them feel more isolated. Instead, a gradual approach to participation is more effective.

D) Ask other group members to limit the number of times they speak.
While this may seem like an effort to allow more time for the silent client, it may not be the best solution. Group therapy is meant to be interactive, and limiting others’ participation may make the group feel less collaborative. It is better to encourage the silent client to speak at their own pace rather than restricting the group’s natural flow of discussion.

A. The client's meal tray includes ice cream with fresh fruit. B. The client is assigned to a room with negative airflow. C. The client has artificial flowers in the room. D. The client's meal tray contains hard boiled eggs.

Correct Answer is A

Explanation

A) The client's meal tray includes ice cream with fresh fruit: Fresh fruit poses a risk to a neutropenic client because it may harbor harmful bacteria or fungi, which could lead to an infection. Neutropenic clients have a weakened immune system and are more vulnerable to infections, so it is essential to avoid raw or unwashed fruits that can carry harmful pathogens.

B) The client is assigned to a room with negative airflow: A room with negative airflow is a precautionary measure used to prevent the spread of airborne pathogens, particularly for clients with compromised immune systems. This would help reduce the risk of infection by keeping potentially harmful microorganisms from circulating into the room.

C) The client has artificial flowers in the room: While artificial flowers may not pose an immediate risk for infection, they can accumulate dust and other particles that may contribute to a less clean environment. However, they are not as significant a risk factor as the presence of fresh fruits, which can carry live microorganisms capable of causing infections in neutropenic patients.

D) The client's meal tray contains hard boiled eggs: Hard boiled eggs are generally considered safe for neutropenic clients as long as they are properly cooked and stored. Eggs are not a known source of infection in this context, especially when they are cooked and handled properly.

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