A nurse is caring for a postoperative patient receiving opioid analgesics for pain management. Which assessment would alert the nurse to contact the provider?

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: Collecting sputum specimens for acid-fast bacilli (AFB) testing over three consecutive mornings is critical for diagnosing active tuberculosis. AFB smear and culture detect Mycobacterium tuberculosis in sputum, confirming pulmonary TB. Morning samples yield higher bacterial loads, improving diagnostic sensitivity, as the bacteria accumulate overnight in the respiratory tract.

Choice B reason: Monitoring vital signs every shift is important for assessing patient stability but does not directly aid in diagnosing active tuberculosis. Fever or tachycardia may suggest infection, but these are non-specific and not confirmatory. Diagnostic tests like AFB, imaging, or serology are needed to identify Mycobacterium tuberculosis as the cause of symptoms.

Choice C reason: Ordering a complete blood count, basic metabolic panel, HIV viral load, and VDRL supports TB diagnosis. CBC may show anemia or leukocytosis, BMP assesses organ function, HIV testing identifies immunosuppression increasing TB risk, and VDRL rules out syphilis, which can mimic TB symptoms. These provide a comprehensive diagnostic workup.

Choice D reason: A chest X-ray is essential for diagnosing active pulmonary tuberculosis. It reveals characteristic findings like cavitary lesions, infiltrates, or hilar lymphadenopathy in the lungs. These radiographic signs, combined with clinical symptoms and AFB testing, confirm the presence of active TB, particularly in patients with cough and weight loss.

Choice E reason: Admitting the patient to a negative pressure room is crucial for diagnosing and managing suspected active TB. It prevents airborne transmission of Mycobacterium tuberculosis to others, ensuring safety while diagnostic tests like AFB and chest X-ray are conducted. This isolation is standard for suspected infectious TB cases.