The nurse has reviewed the Nurses' Notes, the Vital Signs at 1000 and 1030, and the Laboratory Results at 1030.

Exhibits

Complete the following sentence by using the lists of options.

The nurse should first address the adolescent's

dropdown

followed by the adolescent's

dropdown

.

Rationale for correct choices:

• Blood pressure: The adolescent’s blood pressure dropped from 116/60 mm Hg to 88/50 mm Hg, indicating hypotension and potential septic shock. This is a life-threatening complication of meningococcal meningitis and requires immediate intervention to maintain perfusion.

• Temperature: The adolescent has a fever of 39° C (102.2° F), which contributes to metabolic stress and worsens neurologic symptoms. Once circulation is stabilized, managing hyperthermia helps decrease cerebral metabolic demand and discomfort.

Rationale for incorrect choices:

• Respiratory status: The respiratory rate and oxygen saturation are stable, with no signs of distress. This is not the most urgent priority compared to hypotension and shock risk.

• CSF results: While the findings are abnormal and confirm bacterial meningitis, they guide long-term treatment but do not pose an immediate threat like shock or hyperthermia.

• Oxygen saturation: Respirations remain 20/min with clear breath sounds and stable oxygen saturation, so there is no current evidence of respiratory compromise requiring immediate priority.

A. Pale, oily stools: Celiac disease causes malabsorption due to an immune response to gluten, leading to steatorrhea. The stools are typically pale, foul-smelling, and oily because of impaired fat absorption.

B. Redcurrant, jelly-like stools: This type of stool is characteristic of intussusception, a condition where part of the intestine telescopes into itself, causing bleeding and mucus, not celiac disease.

C. Increased hemoglobin level: Children with celiac disease often experience iron deficiency anemia due to malabsorption, which lowers hemoglobin levels. An increase in hemoglobin would not be expected.

D. Hematemesis: Vomiting blood is not a typical finding in celiac disease. It is more commonly associated with upper gastrointestinal bleeding from ulcers or esophageal varices.