In caring for a client who is receiving meropenem IV for nosocomial pneumonia, which assessment finding is most important for the nurse to report to the health care provider?

Choice A reason: Keeping the bed in the lowest position and initiating seizure and fall precautions is not an immediate action for the nurse to take. Seizure and fall precautions are measures that prevent injury or harm to the client in case of a seizure or a fall. Seizure and fall precautions include lowering the bed, padding the side rails, removing any objects that may cause injury, and having suction and oxygen equipment ready. However, these precautions are not specific to the client's condition and do not address the underlying cause.

Choice B reason: Placing an indwelling urinary catheter and measuring strict intake and output is not an urgent action for the nurse to take. An indwelling urinary catheter is a tube that drains urine from the bladder into a collection bag. Measuring intake and output is a way of monitoring fluid balance and kidney function. However, these interventions are not essential for the client's condition and may increase the risk of infection or trauma.

Choice C reason: Maintaining elevated positioning of the dependent joints on affected side is not a relevant action for the nurse to take. Dependent joints are joints that are below the level of the heart, such as the ankles or wrists. Elevating dependent joints can help reduce swelling or pain by improving blood flow and drainage. However, this intervention is not related to the client's condition and does not improve neurological function.

Choice D reason: This is the correct answer because starting two large bore IV catheters and reviewing inclusion criteria for IV fibrinolytic therapy is a critical action for the nurse to take. IV catheters are devices that allow access to the bloodstream for fluid or medication administration. Fibrinolytic therapy is a treatment that dissolves blood clots that may block blood flow to vital organs, such as the brain or heart. The client's symptoms suggest a possible stroke, which is a medical emergency that occurs when blood flow to a part of the brain is interrupted, causing brain tissue damage or death. The nurse should start two large bore IV catheters in case one fails or becomes occluded, and review inclusion criteria for IV fibrinolytic therapy, such as onset of symptoms, blood pressure, blood glucose, coagulation status, and history of bleeding or trauma, to determine if the client is eligible for this potentially life-saving treatment.

Choice A reason: Notifying the healthcare provider is an important action, but not the first one. The nurse should prioritize interventions that address the client's immediate needs, such as oxygenation and circulation.

Choice B reason: Preparing a continuous heparin infusion per protocol is an appropriate action for preventing further clot formation and reducing the risk of recurrent pulmonary embolism, but it is not the first action. The nurse should first stabilize the client's condition before administering anticoagulant therapy.

Choice C reason: This is the correct answer because providing supplemental oxygen is the first action that the nurse should take to improve the client's oxygenation and reduce hypoxia. Pulmonary embolism can cause impaired gas exchange and respiratory distress, which can lead to cardiac arrest and death if not treated promptly.

Choice D reason: Bringing the emergency crash cart to the bedside is a prudent action, but not the first one. The nurse should prepare for possible cardiopulmonary resuscitation (CPR) in case of cardiac arrest, but should first attempt to prevent it by providing oxygen and other supportive measures.