A nurse is planning care for a child with human immunodeficiency virus (HIV). Which nursing diagnosis is the highest priority for this child?
1. Risk for Infection
2. Risk for Fluid-Volume Deficit
3. Ineffective Thermoregulation
4. Ineffective Tissue Perfusion, Peripheral
Correct Answer: 1
Rationale: A child with HIV is at risk for a myriad of bacterial, viral, fungal, and opportunistic infections because of the effect of the virus on the immune system. Risk for Fluid-Volume Deficit, Ineffective Thermoregulation, and Ineffective Tissue Perfusion, Peripheral would not be priority problems with this disease process.
You might also like to view...
A critical care nurse is caring for a client in a hypertensive crisis. Blood pressure is being reduced slowly. If the blood pressure is lowered too much too quickly, what is the patient is at risk for?
A) A myocardial infarction B) A cerebral infarction C) Renal failure D) All of the above
Support people during labour may:
a. have an effect on fetal hypoxia. b. assist the woman by encouraging her to have an epidural. c. assist the woman by preventing her from wanting an epidural. d. impede or increase progress of labour.
A neonate is born with a bilateral cleft lip that was not detected during the pregnancy. The parents are distressed about the appearance of their infant. Which nursing actions are appropriate to assist the parents to bond with their newborn? Select all that apply
1. Calling the newborn by the chosen name 2. Keeping the newborn's lower face covered with the blanket 3. Smiling and talking to the newborn in the parents' presence 4. Showing the parents before and after pictures of other children with cleft lips 5. Discussing positive features of the baby
A client is receiving a local anesthetic. What instruction is most appropriate by the nurse prior to administering the medication?
1. Never take at home. 2. Take only when drowsiness is present. 3. Report any unusual heart palpitations, lightheadedness, drowsiness, or confusion. 4. Allow family members to use as needed.