Chapter 15

Infectious Mononucleosis Case Study

Answers

1. Correct Answer: C) Risk for Deficient Fluid Volume related to decreased oral intake and fever. While all other options are relevant nursing diagnoses for this client, risk for fluid volume deficit takes precedence. David’s severe sore throat is impacting his ability to swallow, putting him at a high risk for dehydration, especially considering his fever. Addressing his hydration status is paramount to prevent complications. Options A, B, and D are important to address but are not the immediate priority over a potential fluid volume deficit.
2. Correct Answer: C) Review the complete blood count (CBC) results. The CBC results are pending and will provide important information about David’s condition, such as his white blood cell count, which can help guide treatment decisions. While the other options might be appropriate actions, they are not the most important at this time. Option A addresses a symptom but not the underlying condition. Option B is not necessary.  Since infectious mononucleosis is primary transmitted via saliva, only standard precautions are needed. Option D contradicts the need to rest and avoid strenuous activity while recuperating from infectious mononucleosis.
3. Correct Answer: C) Client will consume 1200 ml of fluids by the end of shift. This addresses the nursing diagnosis of ‘risk for deficient fluid volume’ and promotes hydration.  While option B is important for managing the client’s pain, it does not directly address a priority concern. Option A is not specific or measurable enough and is not the priority at this time. Option D is not a realistic goal, as the client has an active infection.
4. Correct Answer: C) Offer the client a variety of fluids he enjoys. Providing a variety of fluids the client enjoys can encourage him to drink more and therefore increase his fluid intake.  While options A and D are appropriate interventions, they are not as directly impactful in addressing the client’s potential for inadequate fluid volume. Option B is incorrect as fluids should be consumed before feeling thirsty.  Feelings of thirst can indicate that the client is already dehydrated.
5. Correct Answer: B) I can share utensils and drinks with my family since they have already been exposed to me. Even if family members have already been exposed, sharing utensils and drinks can increase the risk of spreading the virus, especially since the virus is present in saliva. Options A, C, and D all reflect accurate understanding of infectious mononucleosis.
6. Correct Answer: C) Providing frequent rest periods and assistance with ADLs to conserve energy. The priority is to help David conserve his energy due to his significant fatigue. Rest periods and assistance with ADLs will help him manage his symptoms and prevent overexertion. While physical activity is important for recovery, pushing David to stay active when he is fatigued could worsen his symptoms and lead to further exhaustion. The focus should be on rest and gradual activity as tolerated. Pain medication can help manage discomfort, but the priority should be on addressing David’s fatigue through rest, rather than assuming that alleviating pain will immediately improve energy levels. Although deep breathing exercises are beneficial for lung expansion and relaxation, David’s primary issue is fatigue from infectious mononucleosis, not a respiratory problem. Rest and energy conservation are more critical in this situation.

Asthma Exacerbation Case Study

Answers

1. Correct Answer: A) Impaired Gas Exchange. The primary nursing diagnosis for a client with an acute asthma exacerbation who presents with shortness of breath, wheezing, and low oxygen saturation is Impaired Gas Exchange.  This diagnosis takes priority over the other options because it addresses the most immediate and life-threatening physiological need.  While the other diagnoses may be relevant, they are not the primary concern at this time.
2. Correct Answer: C) Complete a focused respiratory assessment. Although all options are important nursing interventions, completing a focused respiratory assessment to establish a baseline is the most critical action for a client experiencing an acute asthma exacerbation. The assessment will help determine the severity of her condition and guide further interventions. Administering medications, providing education, and orienting the client and family are important but can be addressed after the initial assessment.
3. Correct Answer: A) Apply the sensor to Sofia’s finger and ensure the waveform correlates with her radial pulse. It’s essential to ensure the pulse oximeter is providing accurate readings.  This is done by applying the sensor to a peripheral location (like the finger) and verifying the waveform aligns with the client’s radial pulse.  Toes, while a possible location for pulse oximetry, are not more reliable and can sometimes provide inaccurate readings due to poor circulation. While rotating the sensor site can help prevent skin breakdown, it is not necessary every 2 hours, and frequent changes can also irritate the skin. Alarm limits should be set appropriately based on the provider’s orders and the client’s condition; in Sofia’s case, her oxygen saturation should be maintained above or equal to 95%.
4. Correct Answer: C) Wheezing is no longer audible upon auscultation of her lungs. Albuterol is a bronchodilator, which means it helps open up the airways in the lungs.  The most direct indication that the albuterol has been effective is the absence of wheezing upon auscultation.  While the other options might be associated with improved respiratory status, they are not the most specific indicators of the medication’s effectiveness in this scenario.
5. Correct Answer: B) Acknowledge their concerns, reinforce the importance of following the asthma action plan, and answer any questions they have.  It is important to validate the parents’ feelings and concerns. Providing reassurance without addressing their concerns is dismissive. Reinforcing the importance of following the asthma action plan empowers the parents to participate in Sofia’s care and can help prevent future exacerbations. While a referral to the doctor might be appropriate, the nurse should first address their immediate concerns and provide support.
6. Correct Answer: A) Advise Sofia’s family to follow a daily asthma management plan that includes avoiding her known allergens and using prescribed medications as directed, with an emphasis on environmental control. The most comprehensive approach to preventing asthma exacerbations includes creating a tailored asthma management plan, which involves both avoiding known allergens (e.g., pollen, pet dander, mold) and adhering to prescribed medications (such as inhaled corticosteroids or long-acting beta-agonists) to control inflammation. This approach also emphasizes the importance of environmental control, which can significantly reduce the frequency and severity of asthma attacks. B is incorrect as complete avoidance of all outdoor activities may not be practical and could lead to a sedentary lifestyle. Managing exposure to allergens through proper precautions (e.g., wearing a mask, checking pollen levels) is more feasible. C is incorrect because oral corticosteroids are typically used for short-term exacerbations and should not be used daily unless prescribed by a healthcare provider for long-term control. D is incomplete because it only addresses the use of albuterol during symptoms and does not include broader management strategies such as allergen avoidance or long-term medication use.

Please find answers to the Learning Activity interactive elements within the element.