A nurse is caring for a client immediately following a lumbar puncture. Which of the following actions should the nurse take?

Choice A reason: Epinephrine is primarily used in emergency situations for its vasoconstrictive and bronchodilatory effects, particularly in cases of anaphylaxis or cardiac arrest. It is not typically used to manage symptoms associated with brainstem contusions or to regulate urinary output.

Choice B reason: Furosemide is a loop diuretic commonly prescribed to reduce fluid retention in conditions such as heart failure or renal disease. Given that the client has already produced a large volume of urine (4,000 mL in 24 hours, which is above the normal range of 800 to 2,000 milliliters per day), administering furosemide would not be appropriate as it would likely exacerbate the excessive urinary output.

Choice C reason: Nitroprusside is a potent vasodilator used to treat acute hypertensive crises. It has no role in the management of thirst or regulation of urinary output and is not indicated for the treatment of brainstem contusions.

Choice D reason: Desmopressin is a synthetic analogue of the naturally occurring antidiuretic hormone vasopressin. It is used to treat conditions characterized by excessive urination, such as diabetes insipidus, and to manage polyuria and polydipsia (excessive thirst) following head trauma or surgery in the pituitary region. In the context of a brainstem contusion with a reported high urinary output, desmopressin would be the appropriate medication to prescribe to reduce urine volume and address the client's thirst.

Choice A reason: Serosanguineous drainage, which is a mixture of blood and a clear yellow liquid known as serum, is generally expected after surgery. While the amount of 150 mL may seem significant, it is not uncommon in the first hour postoperatively, especially after abdominal surgery. The nurse should continue to monitor the drainage and report if the volume increases significantly or if the drainage becomes bright red, indicating active bleeding.

Choice B reason: Greenish-yellow drainage is typically bile, which can be present in NG tube drainage after abdominal surgery. This type of drainage is not unusual and does not necessarily need to be reported unless accompanied by other concerning symptoms or changes in the patient's condition.

Choice C reason: 100 mL of red drainage is concerning and should be reported to the provider immediately. Red drainage suggests active bleeding, and in the context of the first postoperative hour, it could indicate a complication such as hemorrhage. Prompt assessment and intervention are required to address this potential emergency situation.

Choice D reason: Brown drainage may be old blood or could be related to the contents of the gastrointestinal tract. While 200 mL is a larger volume, brown drainage is not typically as concerning as bright red drainage. However, the nurse should monitor for changes in the color and consistency of the drainage, as well as the patient's vital signs and overall status.