The nurse reviews the following orders for a patient admitted with infective endocarditis and fever. The nurse gives the highest priority to which order?

Obtain blood cultures from two sites

Schedule a transesophageal echocardiogram

Administer ceftriaxone 1g IVPB Q 12 hours

Give acetaminophen 650mg PO Q 6 hours PRN for fever

Answer and Explanation

The Correct Answer is A

A. Obtain blood cultures from two sites: Obtaining blood cultures before initiating antibiotics is the highest priority because it ensures accurate identification of the causative organism. Administering antibiotics prior to culture collection can result in false-negative cultures, delaying targeted therapy and potentially worsening the infection.

B. Schedule a transesophageal echocardiogram: Echocardiography is important for assessing valvular damage or vegetations in infective endocarditis, but it does not take precedence over obtaining cultures, which are critical for guiding immediate antimicrobial therapy.

C. Administer ceftriaxone 1g IVPB Q 12 hours: Timely administration of antibiotics is essential, but it should follow culture collection. Administering antibiotics before cultures could compromise diagnostic accuracy, affecting subsequent treatment decisions.

D. Give acetaminophen 650mg PO Q 6 hours PRN for fever: Antipyretics relieve symptoms but do not treat the underlying infection. While important for comfort, managing fever is secondary to establishing the causative pathogen and initiating appropriate antimicrobial therapy.

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Correct Answer is C

Explanation

A. P wave: The P wave represents atrial depolarization. Synchronizing a cardioversion shock to the P wave is not standard practice, as delivering a shock during atrial depolarization could precipitate ventricular arrhythmias rather than correcting a tachyarrhythmia.

B. T wave: The T wave represents ventricular repolarization. Delivering a shock on the T wave (the vulnerable period) can induce ventricular fibrillation, which is dangerous and avoided during synchronized cardioversion.

C. R wave of the QRS: Synchronized cardioversion delivers the electrical shock on the R wave of the QRS complex, during ventricular depolarization. This timing avoids the vulnerable period of repolarization (T wave) and allows the shock to terminate tachyarrhythmias safely while minimizing the risk of inducing ventricular fibrillation.

D. PR interval: The PR interval represents the conduction time from the atria to the ventricles. Synchronizing the shock to this interval is not effective for treating arrhythmias and does not provide the safety mechanism inherent in R wave synchronization.

A. Ensure the pressure bag around the flush solution is inflated to 300 mm Hg. B. Flush the line before administering antibiotics. C. Instruct the patient to bear down when readings are obtained. D. Position the patient in Trendelenburg to obtain readings.

Correct Answer is A

Explanation

A. Ensure the pressure bag around the flush solution is inflated to 300 mm Hg: The flush solution pressure bag must be maintained at approximately 300 mm Hg to ensure continuous perfusion of the arterial line, prevent clot formation, and maintain accurate arterial pressure waveform readings. Proper inflation is essential for line patency and reliable hemodynamic monitoring.

B. Flush the line before administering antibiotics: Flushing the arterial line for medication administration is not standard practice because arterial lines are primarily for monitoring and blood sampling. Administering medications through an arterial line can be dangerous unless specifically ordered, and antibiotics are usually given via a venous route.

C. Instruct the patient to bear down when readings are obtained: Bearing down (Valsalva maneuver) can artificially alter arterial pressure readings and is not appropriate during hemodynamic monitoring. Accurate measurements require the patient to be relaxed and in a neutral position.

D. Position the patient in Trendelenburg to obtain readings: Trendelenburg positioning is not necessary for arterial line readings and may actually affect hemodynamic values. The patient should be positioned comfortably, with the transducer leveled to the phlebostatic axis for accurate pressure measurement.

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The nurse reviews the following orders for a patient admitted with infective endocarditis and fever. The nurse gives the highest priority to which order?

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