A nurse is caring for a client who has multiple sclerosis and is experiencing progressive multifocal leukoencephalopathy (PML). Which of the following medications should the nurse recognize is associated with the development of PML?

Choice A Reason:

Metoprolol is incorrect. Metoprolol is a beta-blocker medication commonly used to treat conditions such as hypertension, angina, and heart failure. However, in the context of neurogenic shock following a spinal cord injury, the use of beta-blockers such as metoprolol is generally contraindicated. Beta-blockers antagonize the effects of sympathetic activation, leading to a reduction in heart rate and myocardial contractility, which can exacerbate hypotension and bradycardia, the hallmarks of neurogenic shock. Therefore, the nurse would not anticipate a prescription for metoprolol in the management of neurogenic shock.

Choice B Reason:

Lactated Ringers intravenous fluid is correct. Fluid resuscitation with isotonic crystalloid solutions such as lactated Ringers is essential to restore intravascular volume and improve perfusion.

Choice C Reason:

Furosemide is incorrect. Furosemide is a loop diuretic medication commonly used to treat conditions such as heart failure, edema, and hypertension by promoting diuresis and reducing fluid volume. However, in the context of neurogenic shock, the use of diuretics such as furosemide is generally not indicated unless there is concurrent volume overload. Neurogenic shock is characterized by hypotension due to vasodilation and decreased systemic vascular resistance, often leading to relative hypovolemia rather than volume overload. Therefore, administering furosemide could further decrease intravascular volume, exacerbating hypotension and compromising perfusion. As a result, the nurse would not anticipate a prescription for furosemide in the management of neurogenic shock.:

Choice D Reason:

Dopamine is correct. Dopamine is a vasopressor medication that acts to increase vascular tone and blood pressure by stimulating alpha-adrenergic receptors. It is commonly used in the management of neurogenic shock to augment blood pressure.

Choice E Reason:

Epinephrine is correct. Epinephrine is a potent vasopressor that acts on both alpha and beta-adrenergic receptors, leading to vasoconstriction and increased cardiac output. It is used in the treatment of refractory hypotension in neurogenic shock.

Choice A Reason:

Typical pneumonia is correct. Streptococcus pneumoniae is a common bacterial pathogen that causes typical pneumonia, also known as community-acquired pneumonia (CAP). Typical pneumonia is characterized by an acute onset of symptoms such as fever, productive cough with purulent sputum, chest pain, and difficulty breathing. Streptococcus pneumoniae is one of the most common causes of typical pneumonia, especially in community settings.

Choice B Reason:

Chemical pneumonitis is incorrect. chemical pneumonitis, refers to inflammation of the lung tissue caused by inhalation or aspiration of toxic chemicals, gases, or gastric contents. It is not caused by Streptococcus pneumoniae.

Choice C Reason:

Atypical pneumonia is incorrect. Atypical pneumonia, refers to pneumonia caused by atypical pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Atypical pneumonia typically presents with milder symptoms compared to typical pneumonia and may not respond to traditional antibiotics used for typical bacterial pneumonia.

Choice D Reason:

Aspiration pneumonia. Aspiration pneumonia, occurs when foreign material, such as food, saliva, or gastric contents, is aspirated into the lungs, leading to inflammation and infection. While Streptococcus pneumoniae can cause pneumonia in the context of aspiration, it is more commonly associated with typical pneumonia acquired through inhalation of respiratory droplets containing the bacteria.