ATI Med Surg B Flashcards
(1) In caring for a client with C. diff, what precautions are appropriate.
Initiate contact precautions.
Provide the client with disposable dishes and utensils for meals.
Leave blood pressure equipment in the client’s room.
Clean contaminated surfaces with bleach.
Wash hands with soap and water; alcohol based sanitizers do not kill C. diff.
A face mask is not necessary for C. diff.
(2) What method of birth control is contraindicated for a patient with a history of breast cancer.
Combination oral contraceptives.
Oral contraceptives contain estrogen, which can lead to growth of the remaining breast cancer cells.
(3) Which of the following findings indicates dehydration?
Urinary output 50mL/hr
Apical pulse rate 60/min
Creatinine 2.3mg/dL
Hematocrit 42%
Creatinine 2.3mg/dL
An elevated creatinine may indicate dehydration.
(4) Normal findings of a colostomy stoma 48 hours post op.
Dark red and dry.
Mucocutaneous separation.
Small amount of effluent discharge from the stoma.
Retraction of the stoma below the abdominal wall.
Small amount of effluent discharge from the stoma.
Discharge from the stoma is expected to begin 2 to 4 days post op. This is a sign that the colostomy is functioning and indicates return of normal bowel function.
(6) Highest priority nursing finding for an adult patient receiving 500mL/hr IV fluid.
Mental confusion.
Pink frothy sputum.
Urinary output 25mL/hr.
Weight gain.
Pink frothy sputum.
Using the ABC-priority setting framework, frothy sputum would be the highest priority.
(7) Appropriate nursing intervention for neutropenic patient.
Fresh fruits and vegetables.
Monitor platelet count daily.
Limit visitors to healthy adults.
Apply firm pressure to injection sites.
Limit visitors to healthy adults.
Minimize risk of exposure to infection.
