Nursing care of a child who is immunosuppressed due to leukemia or chemotherapeutic agents should include:
(choose one best answer)
Have them share a room with a child with active mumps
Restrict oral fluids
Strict isolation
Use good handwashing
The Correct Answer is D
Choice A reason: This choice is incorrect because having them share a room with a child with active mumps may expose them to infection and worsen their condition. A child who is immunosuppressed due to leukemia or chemotherapeutic agents has a weakened immune system and is more susceptible to infections from bacteria, viruses, fungi, or parasites. Therefore, they should be placed in a private room or cohorted with another immunosuppressed child.
Choice B reason: This choice is incorrect because restricting oral fluids may cause dehydration and electrolyte imbalance in the child who is immunosuppressed due to leukemia or chemotherapeutic agents. A child who is immunosuppressed due to leukemia or chemotherapeutic agents may have increased fluid losses from vomiting, diarrhea, fever, or sweating. Therefore, they should be encouraged to drink adequate fluids to maintain hydration and electrolyte balance.
Choice C reason: This choice is incorrect because strict isolation may cause psychological distress and social isolation in the child who is immunosuppressed due to leukemia or chemotherapeutic agents. A child who is immunosuppressed due to leukemia or chemotherapeutic agents may benefit from protective isolation, which involves using standard precautions and additional measures such as wearing gloves, gowns, masks, or eye protection when in contact with the child or their body fluids. However, strict isolation, which involves limiting visitors and activities, may harm the child's emotional and developmental well-being.
Choice D reason: This choice is correct because using good handwashing is essential nursing care for a child who is immunosuppressed due to leukemia or chemotherapeutic agents. Handwashing is the most effective way to prevent the transmission of microorganisms that can cause infections. The nurse should wash their hands before and after touching the child or their belongings, and teach the child and their family members to do the same. The nurse should also use alcohol-based hand rubs when water and soap are not available.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This choice is incorrect because tying colorful latex balloons to the side of
the crib may pose a risk of choking or suffocation for the infant who is in a cast for DDH. Latex balloons are made of rubber that can break easily and form small pieces that can block the airway or lungs if swallowed or inhaled by
the infant. Therefore, avoiding latex products such as balloons, gloves, or bandages is important to prevent accidents or injuries.
Choice B reason: This choice is incorrect because following the doctor's instructions regarding activities and treatment plans is not a specific strategy to promote the infant's growth and development. Following
the doctor's instructions regarding activities and treatment plans is a general responsibility of the nurse that applies to any client who has any condition or procedure. It may help to ensure the safety and effectiveness of the care, but it does not address the developmental needs of the infant who is in a cast for DDH.
Choice C reason: This choice is correct because providing a small electronic toy is a specific strategy to promote
the infant's growth and development. Providing a small electronic toy can help stimulate the infant's senses, cognition, and motor skills by offering visual, auditory, or tactile feedback. It may also help to reduce boredom, frustration, or depression by providing entertainment, diversion, or comfort. Therefore, providing a small electronic toy can help to enhance the developmental outcomes of the infant who is in a cast for DDH.
Choice D reason: This choice is incorrect because changing the infant's diaper as soon as soiling occurs is not a specific strategy to promote the infant's growth and development. Changing the infant's diaper as soon as soiling occurs is a general hygiene measure that applies to any infant who wears a diaper. It may help to prevent skin irritation, infection, or odor by keeping the diaper area clean and dry, but it does not address the developmental needs of the infant who is in a cast for DDH.
Correct Answer is C
Explanation
Choice A: Oliguria is a condition of reduced urine output, which can indicate dehydration, kidney failure, or urinary tract obstruction. It is not associated with a CNS infection, which affects the brain and spinal cord.
Choice B: A negative Brudzinski sign is a normal finding that indicates no meningeal irritation. It is elicited by flexing the neck of a supine patient and observing no involuntary flexion of the hips and knees. A positive Brudzinski sign, on the other hand, is a sign of meningitis, which is a type of CNS infection.
Choice C: A bulging fontanel is an abnormal finding that indicates increased intracranial pressure, which can be caused by a CNS infection, such as meningitis or encephalitis. A fontanel is a soft spot on the skull of an infant that allows for brain growth and development.
Choice D: Jaundice is a condition of yellowing of the skin and eyes, which can indicate liver disease, hemolytic anemia, or neonatal hyperbilirubinemia. It is not associated with a CNS infection, which affects the brain and spinal cord.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today