A patient with acute lymphoblastic leukemia (ALL) is admitted for chemotherapy treatment. As part of the nursing management, which of the following interventions is most critical to prevent infection in this patient?

Implementing strict hand hygiene protocols.

Administering prophylactic antibiotics regularly.

Encouraging the patient to eat a high-protein diet.

Limiting the patient’s fluid intake.

Answer and Explanation

The Correct Answer is A

Choice A Reason:

Implementing strict hand hygiene protocols is the most critical intervention to prevent infection in patients with acute lymphoblastic leukemia (ALL). Patients with ALL are highly susceptible to infections due to their compromised immune systems, which result from both the disease and the chemotherapy treatment. Hand hygiene is a fundamental practice in infection control, significantly reducing the transmission of pathogens. Ensuring that all healthcare providers, patients, and visitors adhere to strict hand hygiene protocols can greatly minimize the risk of infections.

Choice B Reason:

Administering prophylactic antibiotics regularly can help prevent infections, but it is not the most critical intervention. Overuse of antibiotics can lead to antibiotic resistance and other complications. While antibiotics are important in managing infections, they should be used judiciously and in conjunction with other infection control measures, such as hand hygiene.

Choice C Reason:

Encouraging the patient to eat a high-protein diet is beneficial for overall health and recovery, but it does not directly prevent infections. A high-protein diet can help maintain muscle mass and support the immune system, but it is not a primary infection control measure.

Choice D Reason:

Limiting the patient’s fluid intake is not relevant to preventing infections in patients with ALL. Adequate hydration is important for overall health and helps in the management of side effects from chemotherapy. Fluid restriction is not a standard intervention for infection prevention in this context.

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Correct Answer is A

Explanation

Choice A Reason:

Tilting the head to the side and pulling the earlobe up and back is the recommended method for adults to straighten the ear canal, allowing the drops to flow directly into the ear canal and reach the site of infection effectively. This method ensures that the medication is properly administered and can work effectively to treat the infection.

Choice B Reason:

Laying flat on your back and placing the drops on a cotton ball before inserting it into the ear canal is not a recommended method for administering ear drops. This method can prevent the medication from reaching the ear canal properly and may not be as effective in treating the infection. Additionally, using a cotton ball can absorb the medication, reducing its effectiveness.

Choice C Reason:

Tilting the head to the side and pulling the earlobe down and back is the correct method for administering ear drops to children under three years old. For adults, this method is not recommended as it does not straighten the ear canal properly, which can prevent the medication from reaching the site of infection effectively.

Choice D Reason:

Tilting the head forward and pulling the earlobe up and forward is not a recommended method for administering ear drops. This method does not properly straighten the ear canal and can prevent the medication from reaching the site of infection. It is important to follow the correct technique to ensure the medication is effective.

A. Administer propranolol intravenously. B. Administer dextrose 50% intravenously. C. Administer levothyroxine orally. D. Administer insulin to control hyperglycemia.

Correct Answer is A

Explanation

Choice A Reason:

Administering propranolol intravenously is the most appropriate initial intervention for managing a thyroid storm. Thyroid storm is a life-threatening condition characterized by severe hyperthyroidism, leading to symptoms such as tachycardia, hypertension, and hyperthermia. Propranolol, a non-selective beta-blocker, helps control these symptoms by reducing heart rate and blood pressure. Additionally, propranolol inhibits the peripheral conversion of T4 to T3, the more active form of thyroid hormone, thereby reducing the overall thyroid hormone activity. This makes it a critical first step in stabilizing the patient.

Choice B Reason:

Administering dextrose 50% intravenously is not the most appropriate initial intervention for thyroid storm. Dextrose 50% is typically used to treat severe hypoglycemia by rapidly increasing blood glucose levels. While maintaining adequate glucose levels is important, it does not address the primary issue of excessive thyroid hormone activity in thyroid storm.

Choice C Reason:

Administering levothyroxine orally is inappropriate in the context of thyroid storm. Levothyroxine is a synthetic form of T4 used to treat hypothyroidism, not hyperthyroidism. Administering it in a thyroid storm would exacerbate the condition by increasing the levels of thyroid hormone in the body.

Choice D Reason:

Administering insulin to control hyperglycemia is not the primary intervention for thyroid storm. While hyperglycemia can occur in thyroid storm due to increased metabolic activity, the immediate priority is to control the excessive thyroid hormone activity. Insulin administration would be secondary to stabilizing the patient’s thyroid function.

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A patient with acute lymphoblastic leukemia (ALL) is admitted for chemotherapy treatment. As part of the nursing management, which of the following interventions is most critical to prevent infection in this patient?

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