The nurse is admitting a client from the post-anesthesia unit to the postoperative surgical care unit. Which prescription should the nurse implement first?
Complete blood cell count (CBC) in AM.
Straight catheterization if unable to void.
Advance from clear liquids as tolerated.
Cefazolin 1 gram intravenously every 6 hours.
The Correct Answer is B
A. A complete blood cell count (CBC) is important for monitoring but is not an immediate priority during the admission process.
B. Straight catheterization if unable to void is a priority intervention to prevent bladder distention and complications following surgery.
C. Advancing from clear liquids as tolerated can be important for nutrition but does not address immediate postoperative concerns regarding urinary function.
D. Administering Cefazolin is important for preventing infection but should be prioritized after ensuring the client can void or addressing any issues with urinary retention.
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Related Questions
Correct Answer is B
Explanation
A. Continue to provide life support until a thorough search for a guardian is completed: While continuing life support is essential, the delay involved in waiting for a guardian to be located could jeopardize the patient's life. Immediate surgery is necessary to save the client, and life support is unlikely to be sufficient on its own.
B. Carry on with surgical preparation of the client without a signed informed consent: In cases of medical emergencies where the patient is unable to provide consent (such as being unresponsive), the healthcare team can proceed with necessary life-saving procedures without waiting for formal written consent. The principle of implied consent applies in this scenario, where it is assumed the patient would consent to life-saving treatment if they were able to do so.
C. Ask the client's friend to sign the informed consent since the client is unresponsive: The friend does not have the legal authority to provide informed consent unless they are a legal guardian or have been granted specific decision-making powers. Consent should not be obtained from a non-guardian in this situation.
D. Notify the unit manager that an emergency court order is needed to allow surgery: While emergency court orders can sometimes be used in certain legal situations, they are unnecessary when the immediate need for life-saving surgery overrides the formalities of obtaining a signed consent. The focus should be on proceeding with treatment to preserve life.
Correct Answer is B
Explanation
A. While close living quarters may contribute to disease spread, it is not the most direct source of contamination related to diarrhea.
B. Drinking water contaminated by sewage is a significant concern during disasters, often leading to gastrointestinal illnesses such as diarrhea due to pathogens.
C. Nosocomial transmission is less likely in a disaster medical area if proper infection control measures are in place.
D. Food contamination from floodwaters is a possibility, but drinking contaminated water poses a more immediate and severe risk for diarrhea.
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