A nurse is preparing to administer the first dose of cefazolin via intermittent Ivrder and refuses to take their medication. Which of the following nurse take first?

A. Obtain a serum WBC count: A WBC count will help assess for infection, as the client presents with fever, confusion, and urinary symptoms. Elevated WBC could suggest a urinary tract infection (UTI) or other infection.
B. Insert indwelling urinary catheter: An indwelling catheter is not immediately necessary unless the client is unable to void or requires continuous monitoring. Non-invasive methods like obtaining a urine sample for analysis would be a priority.
C. Make the client NPO: There is no indication that the client requires NPO status at this time. Unless surgery or another procedure is planned, this is not necessary.
D. Initiate antibiotic therapy: Given the client's symptoms (fever, confusion, urinary frequency, urgency, and dark urine), a UTI or other infection is likely. Antibiotics are needed to treat the suspected infection.
E. Obtain a consent for surgery: There is no indication that surgery is needed based on the current clinical information. The primary concern is infection, not surgical intervention.
F. Withhold metoprolol: While metoprolol may lower blood pressure, there is no indication to withhold it at this time. The client’s blood pressure is already low, and withholding this medication could worsen hypotension. Any changes in the medication regimen should be made based on further evaluation by the provider.
G. Administer acetaminophen: Acetaminophen is indicated to help reduce the client's fever (39.3°C/102.7°F). Managing the fever will help improve comfort and prevent complications like delirium.
H. Collect urine for urinalysis and culture and sensitivity: Urine analysis and culture will help confirm the presence of a UTI, identify the causative pathogen, and guide appropriate antibiotic therapy.
I. Obtain chest x-ray: A chest x-ray is not necessary unless there is a suspicion of a respiratory infection, such as pneumonia. The symptoms are more consistent with a UTI or systemic infection, so a chest x-ray is not a priority.

Potential condition: Systemic lupus erythematosus

Based on the provided information, the client is most likely experiencing Systemic Lupus Erythematosus (SLE). This is suggested by the presence of a macular rash on the cheeks, joint discomfort, fever, and elevated erythrocyte sedimentation rate (ESR).

Actions to Take

1. Anticipate administering prescribed immunosuppressant medication: This helps manage the autoimmune response and reduce inflammation.
2. Encourage client to avoid direct sunlight: Sun exposure can exacerbate lupus symptoms and trigger flares.

Parameters to Monitor

1. Vital signs every 4 hr: Monitoring vital signs helps track the client's overall condition and detect any changes that may indicate complications.
2. Erythrocyte sedimentation rate: Monitoring ESR helps assess the level of inflammation and the effectiveness of treatment.