An adolescent patient with a non-union of a comminuted fracture of the tibia is admitted with osteomyelitis.
After the healthcare provider collects bone aspirate specimens for culture and sensitivity and applies a cast to the adolescent’s lower leg, what should the nurse do next?

Choice A rationale
A potassium level of 4.4 mEq/L (4.4 mmol/L) is within the normal range. Potassium is a critical electrolyte in the body, playing key roles in cellular metabolism, protein synthesis, and electrical action potential regulation across cell membranes. Normal potassium levels typically range from 3.5 to 5.1 mmol/L1. Therefore, a potassium level of 4.4 mEq/L indicates that the patient’s potassium level is within the normal range, which is a safe condition for the administration of vancomycin.
Choice B rationale

The use of antibiotics for prophylaxis, or prevention, is a common practice in healthcare, particularly in surgical procedures such as pacemaker insertion. This is done to prevent potential infections that could occur during or after the procedure. Vancomycin is a type of antibiotic that is often used for prophylaxis against infections caused by gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA)3. Therefore, if the antibiotic is being used for prophylaxis, it would be safe to administer vancomycin.
Choice C rationale
A blood urea nitrogen (BUN) level of 17 mg/dL (6.07 mmol/L) is within the normal range. The BUN test measures the amount of urea nitrogen in the blood, which can provide important information about kidney function. Urea nitrogen is a waste product that is created in the liver when protein is metabolized. It is then transported through the blood to the kidneys, which filter out most of the urea nitrogen, leaving a small amount in the blood. Normal BUN levels typically range from 6 to 20 mg/dL4. Therefore, a BUN level of 17 mg/dL indicates that the patient’s kidney function is within the normal range, which is a safe condition for the administration of vancomycin.
Choice E rationale
The absence of known allergies in a patient is a crucial factor in determining the safety of administering any medication, including vancomycin. Allergic reactions to medications can range from mild symptoms such as rash and itching to severe and life-threatening conditions such as anaphylaxis. Therefore, if a patient has no known allergies, it would be safe to administer vancomycin.
Choice D rationale

While it’s true that the dosage of the antibiotic should be within the safe range, the specific dosage of vancomycin for the patient isn’t provided in the question. Therefore, we cannot definitively say that this condition is met based on the information given.
Choice F rationale
Although vancomycin can be administered via a peripheral IV in a large vein, it’s important to note that vancomycin has a low pH and may cause venous irritation and tissue damage in cases of extravasation. Therefore, while it’s possible to administer vancomycin this way, it’s not necessarily an indicator of safety.

Choice A rationale
Sudden onset of confusion in an older adult could be a sign of a urinary tract infection (UTI). UTIs can cause delirium and behavioral changes in older adults. Therefore, asking if the client is experiencing any pain with urination could help identify a potential UTI.
Choice B rationale
While high protein foods are generally beneficial for health, there is no direct link between increased intake of high protein foods and sudden onset of confusion. Therefore, this option is not the most appropriate action in this situation.
Choice C rationale
Reviewing the client’s current food and medication allergies is always important in healthcare settings. However, it may not directly address the sudden onset of confusion unless the client has had a recent change in diet or medication that could have triggered an allergic reaction leading to confusion.
Choice D rationale
A recent fall could potentially cause a sudden change in mental status due to a head injury or other trauma. Therefore, determining if the client has recently experienced a fall is an appropriate action.
Choice E rationale
Fever can cause confusion, especially in older adults. Therefore, providing instruction on taking the client’s temperature can help the caregiver monitor for signs of infection that could be contributing to the client’s confusion.