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: A clear liquid diet the day before a colonoscopy ensures the bowel is free of solid residue, allowing clear visualization of the colon mucosa. Clear liquids like broth, juice, or water do not leave particulate matter, facilitating effective bowel cleansing with laxatives, critical for accurate detection of polyps or abnormalities during the procedure.

Choice B reason: Taking antibiotics the morning of a colonoscopy is not standard practice. Antibiotics are not routinely required for bowel preparation, as the procedure carries a low infection risk. They may be used in specific cases, like patients with heart valve conditions, but this is not a general instruction for colonoscopy preparation.

Choice C reason: Drinking milk is contraindicated during colonoscopy preparation. Milk is not a clear liquid and leaves residue in the bowel, obstructing visualization during the procedure. A clear liquid diet is required to ensure the colon is clean, as dairy products can interfere with effective bowel cleansing and diagnostic accuracy.

Choice D reason: Avoiding water during bowel prep is incorrect. Adequate hydration is essential during colonoscopy preparation to prevent dehydration from laxative-induced fluid loss. Drinking water supports bowel cleansing and maintains electrolyte balance, ensuring patient safety and comfort during the prep process and the procedure itself.

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.