A client who is febrile is admitted to the hospital for treatment of pneumonia. In accordance with the care pathway, antibiotic therapy is prescribed. Which of the following situations requires the nurse to complete a variance report with regard to the care pathway?
An allergy to penicillin required an alternative antibiotic to be prescribed.
Antibiotic therapy was initiated 2 hr after implementation of the care pathway.
The route of antibiotic therapy on the care pathway was changed from IV to PO.
A blood culture was obtained after antibiotic therapy had been initiated.
The Correct Answer is D
The correct answer is: d.
Choice A reason: An allergy to penicillin requiring an alternative antibiotic to be prescribed is a common and expected variation in care. Allergies are patient-specific factors that must be accommodated within the care pathway. The need for an alternative antibiotic does not typically constitute a variance that requires reporting, as adjustments for allergies are part of personalized care planning.
Choice B reason: Initiating antibiotic therapy 2 hours after implementation of the care pathway may not require a variance report if it falls within the acceptable time frame for antibiotic administration. The timing of antibiotic therapy can be critical, but slight deviations are often accounted for within the care pathway guidelines. However, if the care pathway specifies a narrower time frame for initiation, then this could be a reportable variance.
Choice C reason: Changing the route of antibiotic therapy from IV to PO (oral) is a clinical decision that may be based on the patient's condition, progress, and ability to tolerate oral medications. This switch is a part of antimicrobial stewardship and is often encouraged when clinically appropriate to reduce IV line use and potential complications. It is a standard practice and does not typically require a variance report unless the change contradicts a specific protocol in the care pathway.
Choice D reason: Obtaining a blood culture after the initiation of antibiotic therapy is a significant variance from the standard care pathway. Blood cultures should be obtained before starting antibiotics to accurately identify the causative organisms and their antibiotic sensitivities. Starting antibiotics before obtaining blood cultures can reduce the likelihood of growing the bacteria in the culture, potentially leading to misdiagnosis and inappropriate treatment. This is a deviation from the standard of care that requires a variance report.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: This is the correct choice because an evidence-based nursing journal is a reliable and credible source of information that is based on research and best practices. A nurse can use an evidence-based nursing journal to find current and accurate data on the prevalence of Tay-Sachs disease, as well as the causes, symptoms, diagnosis, treatment, and prevention of the disease.
Choice B reason: This is not the correct choice because the client's health care provider is not a resource that the nurse should use to obtain information about the prevalence of Tay-Sachs disease. The nurse should respect the client's autonomy and privacy and not contact the client's health care provider without the client's consent. The nurse should also avoid relying on the health care provider's opinion or knowledge, which may not be up to date or consistent with the evidence.
Choice C reason: This is not the correct choice because the facility's case manager is not a resource that the nurse should use to obtain information about the prevalence of Tay-Sachs disease. The case manager's role is to coordinate the client's care and services, not to provide information or education on specific diseases. The case manager may not have the expertise or the access to the relevant information that the nurse needs.
Choice D reason: This is not the correct choice because a collaborative, user-edited website is not a resource that the nurse should use to obtain information about the prevalence of Tay-Sachs disease. A collaborative, user-edited website, such as Wikipedia, is not a reliable or credible source of information, as anyone can edit or add content without verification or peer review. The information on such a website may be outdated, inaccurate, biased, or incomplete.
Correct Answer is C
Explanation
Choice A reason: Using condoms during treatment for chlamydia is important for preventing transmission, but this is not the priority nursing action. The most critical step for the nurse is fulfilling the legal and public health obligation to report the infection to the health department, as chlamydia is a reportable sexually transmitted infection.
Choice B reason: This is not the correct choice because this action is not appropriate for clients who have chlamydia. Chlamydia is caused by bacteria, not viruses, so antiviral creams are ineffective and unnecessary. The nurse should administer the prescribed antibiotics and monitor the client for any adverse reactions or complications.
Choice C reason:Reporting the infection to the local health department is correct. Chlamydia is a reportable disease in all states, and this step ensures proper public health tracking, partner notification, and prevention of further spread. This is a nurse’s responsibility in accordance with infection control and community health regulations.
Choice D reason: This is not the correct choice because this action is not indicated for clients who have chlamydia. Contact precautions are used to prevent the transmission of infections that are spread by direct or indirect contact with the client or their environment. Chlamydia is not spread by contact, but by sexual intercourse. The nurse should use standard precautions, which include hand hygiene and wearing gloves, when caring for the client.
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