Virtual ATI Med-Surg Set
A nurse is administering packed red blood cells to a client. What should the nurse do if a
transfusion reaction is suspected? - ANS-Stop the infusion.
A nurse is caring for a client with skeletal traction following a fracture. How and when should
skeletal pin care be provided? - ANS-One cotton swab with chlorhexidine is designated for each
pin for pin care to be done once a shift.
A nurse is providing dietary teaching to a client newly diagnosed with constipation-predominant
irritable bowel syndrome. List two (2) teaching points the should share with the client about
dietary practices. - ANS-Eat foods high in fiber
Increase fluids
Blood compatibility:
Nursing Actions for Hemolytic transfusion reaction - ANS-Remove the blood tubing from the IV
access site. Initiate an infusion of 0.9% of sodium chloride using new tubing. Monitor VS and
fluid status. Send the blood bag and administrating set to the lab for testing.
Care of a perpherially inserted central catheter infusion system - ANS-access site for redness,
swelling, drainage, tenderness, and condition of the dressing.
Caring for pt with peritoneal dialysis: - ANS-monitor for signs of infection (bloody, cloudy or
frothy dialysate return, monitor for complications: respiratory distress, abd pain, insufficient flow,
and discolored outflow
Cushing's Disease findings (too much cortisol hormone) - ANS-fx or osteoporoesis,
mnemonic: STRESSED
S=skin fragile
T=truncal obesity with small arms
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