The healthcare provider writes several prescriptions for a client diagnosed with hospital-acquired pneumonia (HAP) that include a combination of broad-spectrum antibiotics. Which intervention should the nurse implement first?

Monitor the client’s metabolic panel results during antibiotic therapy.

Schedule prescribed nebulizer treatments with respiratory therapy.

Collect blood specimens for culture prior to starting antibiotic therapy.

Review medical record for results of a chest x-ray taken on admission.

Answer and Explanation

The Correct Answer is C

Choice A reason: Monitoring the metabolic panel detects antibiotic side effects like renal toxicity, but this is ongoing. Collecting blood cultures first identifies the HAP pathogen, ensuring targeted therapy. Premature antibiotics may obscure results, leading to resistance, making cultures more urgent for effective treatment of this nosocomial infection.

Choice B reason: Nebulizer treatments aid airway clearance in HAP, but identifying the pathogen via cultures is critical before antibiotics. Ineffective therapy delays recovery, as bacteria proliferate in mucus. Cultures guide precise antibiotic selection, reducing resistance risk, making this less immediate than obtaining microbiological data.

Choice C reason: Collecting blood cultures before antibiotics identifies the HAP pathogen (e.g., MRSA) and its sensitivity, critical for tailoring therapy. Broad-spectrum antibiotics can yield false-negative cultures, complicating treatment. This ensures accurate diagnosis, optimizing outcomes in severe infections, addressing the microbiological basis of HAP management.

Choice D reason: Reviewing chest x-ray confirms HAP with infiltrates but does not guide immediate antibiotic therapy. Cultures are urgent to identify the pathogen before antibiotics, as x-rays are non-specific and already documented. Cultures ensure pathogen-specific treatment, critical for combating hospital-acquired infections effectively.

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Correct Answer is C

Explanation

Choice A reason: Administering a PRN narcotic at 9 cm dilation is inappropriate, as labor is in transition, nearing delivery. Narcotics risk fetal respiratory depression, crossing the placenta, especially with a stable fetal heart rate (120 beats/minute). Preparing for imminent delivery is critical, prioritizing a safe birth environment over pain relief.

Choice B reason: Asking the husband to leave does not address the client’s advanced labor (9 cm, 100% effaced, frequent contractions). His presence may provide support, and removal could increase distress. Setting up the delivery table is urgent, as birth is imminent, ensuring a sterile, safe environment for delivery.

Choice C reason: At 9 cm dilation, 100% effacement, and contractions every 2 minutes, the client is in transition, with delivery imminent. Setting up the delivery table ensures readiness for vaginal birth, providing a sterile field and equipment, addressing the physiological progression of labor for safe delivery of the newborn.

Choice D reason: Notifying the rapid response team is unnecessary, as the fetal heart rate (120 beats/minute) is normal (110–160), and screaming reflects labor pain. Delivery is imminent, making table setup the priority to facilitate safe birth, avoiding escalation to emergency response for a normal labor progression.

A. Administering a PRN cathartic. B. Reducing IV fluid to a keep-open rate. C. Advancing diet to full liquids. D. Insertion of a nasogastric tube.

Correct Answer is D

Explanation

Choice A reason: A cathartic is contraindicated, as pain, distension, and absent bowel sounds suggest postoperative ileus or obstruction, where peristalsis is impaired. Cathartics risk perforation. A nasogastric tube decompresses the bowel, addressing gastrointestinal stasis, preventing complications like vomiting or rupture.

Choice B reason: Reducing IV fluids does not address pain, distension, or absent bowel sounds, indicating ileus or obstruction. Fluids maintain hydration, but nasogastric tube insertion relieves bowel pressure from gas and fluid, restoring function, making fluid reduction ineffective for this postoperative complication.

Choice C reason: Advancing to liquids is inappropriate with absent bowel sounds and distension, indicating ileus, risking vomiting or aspiration. A nasogastric tube removes gastric contents, allowing bowel recovery. Oral intake worsens obstruction, making this contraindicated compared to decompression for safe recovery.

Choice D reason: Nasogastric tube insertion is critical for pain, distension, and absent bowel sounds, suggesting postoperative ileus or obstruction. It decompresses the stomach, removing gas and fluid, reducing pressure and preventing perforation. This addresses the pathophysiological basis of impaired motility, ensuring safe postoperative recovery.

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The healthcare provider writes several prescriptions for a client diagnosed with hospital-acquired pneumonia (HAP) that include a combination of broad-spectrum antibiotics. Which intervention should the nurse implement first?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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