*NURSING > ATI MEDICAL SURGICAL > ATI Medical Surgical Nursing, Inflammation and the Immune Response (All)
ATI Medical Surgical Nursing, Inflammation and the Immune Response
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1. A client has a reduction in immune function. What is the nurse’s priority action for this client? a. Determine whether it is temporary or permanent. b. Take the client’s vital signs every 4... hours. c. Teach family members to receive the flu shot yearly. d. Wash hands before entering the room. ANS: D The nurse should take precautions to prevent infection in the client who has a reduction in immune function. It does not matter whether it is temporary or permanent. Teaching the family what to do after the client is discharged from the hospital would not be the primary action. Taking vital signs would be an important action but would not prevent infection, which is the priority. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology) MSC: Integrated Process: Nursing Process (Implementation) [Show More]
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