The nurse is caring for a client with immunodeficiency disorder. Which nursing intervention should be included in the care plan?
Encourage the client to engage in vigorous physical activities to strengthen the immune system.
Limit the client's exposure to visitors and restrict contact with other clients in the healthcare setting.
Administer live vaccines to boost the client's immune response.
Encourage the client to eat a diet high in fresh fruits and vegetables to improve immune function.
The Correct Answer is B
Explanation: The correct answer is b. Limit the client's exposure to visitors and restrict contact with other clients in the healthcare setting. Clients with immunodeficiency disorders are at a higher risk of infections due to their weakened immune system. Restricting exposure to potential sources of infection, such as visitors and other sick clients, can help minimize the risk of acquiring infections.
Incorrect choices:
a. Engaging in vigorous physical activities may not be appropriate for clients with immunodeficiency disorders, as it can lead to an increased risk of infections and may not strengthen the immune system in these individuals.
c. Live vaccines are contraindicated for clients with immunodeficiency disorders, as they can cause severe infections in this population. Only inactivated vaccines are recommended to avoid the risk of vaccine-associated infections.
d. While a healthy diet is essential for overall well-being, there is no specific evidence to suggest that a diet high in fresh fruits and vegetables will improve immune function in clients with immunodeficiency disorders. Dietary considerations for these clients may include avoiding certain high-risk foods, but it should be discussed with the healthcare provider based on the specific immunodeficiency disorder.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Explanation: The correct answer is b. Genetic or inherited defects. Immunodeficiency disorders are primarily caused by genetic mutations or defects that result in a weakened or impaired immune system.
Incorrect choices:
a. While environmental factors can contribute to the development of secondary immunodeficiency disorders, they are not the primary cause of most immunodeficiency disorders.
c. Autoimmune reactions are not the primary cause of immunodeficiency disorders. Autoimmune disorders involve the immune system attacking the body's own tissues, not a deficiency in the immune system.
d. Excessive production of white blood cells is not the primary cause of immunodeficiency disorders. In fact, immunodeficiency disorders are characterized by a deficiency or impairment of white blood cells, which are essential components of the immune system.
Correct Answer is A
Explanation
Explanation: The correct answer is a. The procedure will assess the function of the client's immune system. A bone marrow aspiration is a diagnostic procedure that involves extracting a sample of bone marrow to evaluate the production and function of blood cells, including immune cells.
Incorrect choices:
b. A bone marrow aspiration does not involve removing lymph nodes. It is a procedure specifically focused on obtaining a bone marrow sample.
c. General anesthesia is not typically used for a bone marrow aspiration. Instead, local anesthesia is administered to numb the area around the bone marrow site.
d. A bone marrow aspiration is not a blood test to measure circulating antibodies. It is used to evaluate the bone marrow's cellular components, not circulating antibodies.
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