A nurse is caring for a client who has a new diagnosis of Clostridium difficile and is placed on contact precautions. Which of the following actions should the nurse take?
Use a portable electronic thermometer to take the client's temperature.
Wipe the stethoscope with alcohol after use.
Remove the protective gown before leaving the client's room.
Remove the protective gown before removing gloves.
The Correct Answer is C
A. Using a portable electronic thermometer is incorrect as the device must be dedicated to the client to avoid cross-contamination.
B. Wiping the stethoscope with alcohol after use is insufficient because alcohol-based sanitizers are ineffective against C. difficile spores. The stethoscope should be cleaned with bleach-based disinfectant.
C. Removing the protective gown before leaving the client's room is correct as it prevents the spread of C. difficile spores outside the isolation area.
D. Removing the protective gown before removing gloves is incorrect. Gloves should be removed first to prevent contamination when removing the gown.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Corticosteroids are not typically associated with causing thrombocytopenia. Their primary effects are on the immune system and metabolism.
B. Corticosteroids more commonly cause hypertension due to fluid retention and increased sensitivity to vasoconstrictors, rather than hypotension.
C. Corticosteroids cause immunosuppression by inhibiting the function of various immune cells and reducing the production of inflammatory cytokines. This increases the risk of infections.
D. Anemia is not a direct effect of corticosteroid use. The medication's impact on the bone marrow typically affects the white blood cell count, particularly in causing leukocytosis, rather than leading to anemia.
Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"A"}
Explanation
Sodium level: The client's sodium level is significantly elevated (157 mEq/L), indicating hyponatremia. This is a critical finding that needs to be addressed promptly to prevent serious complications such as seizures and coma.
Heart rate: While the heart rate is slightly elevated, it is not as urgent a concern as the sodium level. Once the sodium level is stabilized, the nurse can address the heart rate if it remains elevated.
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