A small amount of mercury was spilled on the floor after an old sphygmomanometer was broken. What is the priority action of the nurse?

Choice A reason: This is incorrect. The antipyretic medication will not inhibit bacterial growth within the culture tubes. Antipyretics are medications that reduce fever by affecting the hypothalamus, the part of the brain that regulates body temperature. They do not have any antibacterial effect.

Choice B reason: This is incorrect. Venous distension is not greater because of fluid retention from hyperthermia. Venous distension is the swelling of the veins due to increased pressure or volume of blood. Hyperthermia is the condition of having a body temperature above the normal range. It can cause dehydration, not fluid retention.

Choice C reason: This is incorrect. Elevated temperatures do not slow metabolic rate and improve blood oxygenation. Elevated temperatures increase metabolic rate and demand more oxygen. This can lead to tissue hypoxia, acidosis, and organ damage.

Choice D reason: This is correct. The causative organism is most prevalent during a spike in temperature. A spike in temperature is a sudden rise in body temperature that indicates an infection. Drawing a blood culture before giving an antipyretic medication can help identify the type and number of bacteria in the blood. This can guide the appropriate antibiotic therapy and monitor the response to treatment.

Choice A reason: This is an incorrect choice because asking the patient about his usual blood pressure results is not a priority action. The patient's blood pressure is elevated, but not dangerously high. The nurse should monitor the blood pressure and report any significant changes to the physician, but this is not an urgent intervention.

Choice B reason: This is an incorrect choice because applying a cool washcloth to the patient's forehead is not a priority action. The patient's temperature is normal, and there is no indication of fever or heat stroke. The nurse should ensure the patient is comfortable and hydrated, but this is not an urgent intervention.

Choice C reason: This is the correct choice because administering oxygen at 2 L/minute via nasal cannula is a priority action. The patient's pulse oximetry is low, indicating hypoxia or inadequate oxygenation of the tissues. The nurse should provide supplemental oxygen to improve the patient's oxygen saturation and prevent further complications.

Choice D reason: This is an incorrect choice because documenting the findings in the patient's medical record is not a priority action. The nurse should document the patient's vital signs and any interventions performed, but this is not an urgent intervention. The nurse should prioritize the patient's safety and well-being over documentation.