A 65-year-old patient with a history of chronic anemia is receiving a blood transfusion. Fifteen minutes into the transfusion, the patient reports feeling chills and has a temperature of 101°F (38.3°C). What is the most appropriate initial nursing action?

Choice A Reason:

Administering IV levothyroxine is the priority intervention for a patient with myxedema coma. Myxedema coma is a severe form of hypothyroidism that requires immediate thyroid hormone replacement to correct the deficiency and stabilize the patient’s condition. Intravenous levothyroxine is preferred because it provides a rapid increase in thyroid hormone levels, which is crucial for reversing the life-threatening symptoms of myxedema coma, such as hypothermia, bradycardia, and altered mental status.

Choice B Reason:

Starting broad-spectrum antibiotics is not the primary intervention for myxedema coma. While infections can precipitate myxedema coma and should be treated if present, the immediate priority is to address the severe hypothyroidism with thyroid hormone replacement. Antibiotics may be administered if an infection is suspected or confirmed, but they do not directly address the underlying thyroid hormone deficiency.

Choice C Reason:

Administering corticosteroids immediately is important but not the highest priority. Corticosteroids are often given to patients with myxedema coma to treat potential adrenal insufficiency, which can coexist with severe hypothyroidism. However, the primary intervention remains the administration of thyroid hormone replacement to correct the hypothyroid state.

Choice D Reason:

Initiating fluid restriction is not appropriate for managing myxedema coma. Patients with myxedema coma often require careful fluid management to address potential hyponatremia and maintain hemodynamic stability. Fluid restriction is not a standard intervention for this condition and does not address the critical need for thyroid hormone replacement.

Choice A Reason:

Recommending cleaning the ear with cotton swabs daily is not appropriate for managing otitis externa. Using cotton swabs can further irritate the ear canal, potentially worsening the inflammation and increasing the risk of infection. It is generally advised to avoid inserting anything into the ear canal to prevent damage and irritation.

Choice B Reason:

Advising the patient to use over-the-counter ear drops is not the best initial intervention. While some over-the-counter ear drops may provide temporary relief, they are not as effective as prescription topical antibiotics and corticosteroids in treating the underlying infection and inflammation associated with otitis externa. Proper medical treatment is necessary to ensure effective management of the condition.

Choice C Reason:

Administering oral antibiotics is not typically the first-line treatment for uncomplicated otitis externa. Oral antibiotics are reserved for cases where the infection has spread beyond the ear canal or in patients with risk factors for severe infection. Topical antibiotics and corticosteroids are preferred for their direct action on the affected area and fewer systemic side effects.

Choice D Reason:

Administering topical antibiotics and corticosteroids is the most appropriate initial intervention for otitis externa. Topical treatments effectively target the infection and reduce inflammation, providing relief from symptoms such as pain, itching, and discharge. This approach is supported by clinical guidelines and is considered the standard of care for managing otitis externa.