A nurse is administering chemotherapy to a client with leukemia. Which of the following precautions should the nurse implement to ensure safety?

Choice A reason: Norepinephrine is a vasopressor used to treat septic shock from a wound infection, which causes vasodilation and hypotension. By stimulating alpha-adrenergic receptors, it increases vascular tone, raising blood pressure to improve tissue perfusion. The client’s severe hypotension (78/50 mm Hg) and tachycardia (136 bpm) indicate shock, making norepinephrine an appropriate choice to stabilize hemodynamics.

Choice B reason: Vancomycin treats infections like those caused by methicillin-resistant Staphylococcus aureus, common in wound infections. However, it does not address the client’s immediate hypotension and tachycardia, which indicate septic shock. Antibiotics are crucial for infection source control but do not rapidly correct hemodynamic instability, so this is not the primary order expected now.

Choice C reason: Furosemide, a diuretic, promotes urine output and is used in fluid overload conditions like heart failure. In septic shock with hypotension (78/50 mm Hg), it would worsen hypovolemia by reducing intravascular volume, further decreasing blood pressure and perfusion. This is contraindicated in this scenario, as fluid retention is not the primary issue.

Choice D reason: Dopamine, at 5 mcg/kg/min, primarily enhances cardiac output and renal perfusion but has less potent vasopressor effects than norepinephrine. In septic shock with profound hypotension, norepinephrine is preferred for its stronger vasoconstrictive action to restore blood pressure. Dopamine may be used but is less effective for this client’s severe hemodynamic instability.

Choice A reason: Weight loss is a common finding in hyperthyroidism due to increased metabolic rate from elevated thyroid hormone levels. Thyroxine accelerates basal metabolism, increasing calorie expenditure, leading to unintentional weight loss despite normal or increased appetite. This catabolic state affects fat and muscle, making it a key clinical sign.

Choice B reason: Bradycardia is not associated with hyperthyroidism. Excessive thyroid hormone stimulates the sympathetic nervous system, causing tachycardia to meet increased metabolic demands. Bradycardia may occur in hypothyroidism, where metabolism slows, but in hyperthyroidism, heart rate increases, often accompanied by palpitations, reflecting heightened cardiovascular activity.

Choice C reason: Cold intolerance is characteristic of hypothyroidism, not hyperthyroidism. In hyperthyroidism, increased metabolic heat production causes heat intolerance and excessive sweating. Patients feel warm due to elevated thyroid hormone levels accelerating cellular metabolism, making cold intolerance an unlikely finding in this condition.

Choice D reason: Lethargy is not typical in hyperthyroidism. Elevated thyroid hormones increase energy expenditure, leading to restlessness, nervousness, or hyperactivity. Lethargy is more common in hypothyroidism, where low hormone levels slow metabolism, causing fatigue. Hyperthyroidism patients often report insomnia or increased energy, not sluggishness or lethargy.