The physician prescribes levofloxacin 300 mg IV every 6 hours for a client diagnosed with sepsis.

The client weighs 43.5 kg. The nursing drug guide recommends a maximum of 5 - 7.5 mg/kg/dose.

What is the maximum safe dose for this client in mg/dose? Round answer to the nearest hundredth.

This case involves a client showing signs of a suspected pulmonary embolism, including pleuritic pain and hypoxia. Managing this medical emergency requires prioritizing diagnostic imaging, maintaining oxygenation, ensuring vascular access for stabilization, and monitoring cardiac and respiratory status to prevent collapse.

Choice A rationale

Computed tomography pulmonary angiography is the gold standard for diagnosing a pulmonary embolism. It allows for direct visualization of the pulmonary vasculature to identify blockages, which is essential for initiating the appropriate life-saving anticoagulation or thrombolytic therapy.

Choice B rationale

Placing a client with dyspnea and hypoxia in a flat supine position is contraindicated. This position increases the work of breathing and reduces lung expansion. The nurse should instead use a high-Fowler position to optimize ventilation-perfusion matching.

Choice C rationale

Obtaining venous access is a critical priority for any client with suspected pulmonary embolism. It ensures that emergency medications, such as intravenous heparin or fluids for hemodynamic support, can be administered immediately if the client's condition rapidly deteriorates or worsens.

Choice D rationale

Drawing laboratory tests like CBC and coagulation studies provides essential baseline data. CBC helps rule out infection or anemia, while coagulation studies like PT, PTT, and INR are required before starting systemic anticoagulants to ensure safe dosing.

Choice E rationale

Continuous cardiac monitoring is vital because a pulmonary embolism can cause acute right ventricular strain and lead to arrhythmias or sudden cardiac arrest. Early detection of heart rate changes or rhythm disturbances allows for rapid clinical intervention.

Choice F rationale

Given the client's current SpO2 of 90 percent, which is below the normal range of 95 to 100 percent, continuous monitoring is necessary. This ensures the nurse can titrate oxygen therapy and immediately identify further respiratory decline.

Choice G rationale

Nurses cannot independently increase medication dosages. Adjusting apixaban from 5 mg to 10 mg requires a specific provider order. Furthermore, in an acute suspected PE, parenteral anticoagulation like heparin is typically preferred over oral medications for faster effect.

Choice H rationale

Applying oxygen via nasal cannula or mask is an immediate priority to treat the client's hypoxia. Supplemental oxygen helps maintain cellular oxygenation and reduce the workload on the heart while further diagnostic testing and definitive treatments are arranged..

Analyzing arterial blood gas results requires understanding the relationship between hydrogen ion concentration, carbon dioxide levels, and bicarbonate. Knowledge of respiratory physiology is essential to determine if the primary imbalance stems from gas exchange failure or metabolic dysfunction in the body.

Choice A rationale

Metabolic acidosis is defined by a low pH and a low bicarbonate level below 22 mEq/L. In this case, the bicarbonate is 26 mEq/L, which is within the normal range of 22 to 28 mEq/L, ruling it out.

Choice B rationale

Respiratory alkalosis occurs when the pH is above 7.45 and the PaCO2 is below 35 mm Hg. This client has a low pH of 7.22 and a high PaCO2 of 68 mm Hg, which indicates an acidotic state.

Choice C rationale

Metabolic alkalosis is characterized by a high pH above 7.45 and an elevated bicarbonate level. This client presents with a low pH and a normal bicarbonate level, which does not fit the criteria for a metabolic alkalotic imbalance.

Choice D rationale

The pH of 7.22 is below 7.35, indicating acidosis. The PaCO2 of 68 mm Hg is above the normal 35 to 45 mm Hg range, confirming a respiratory cause. A respiratory rate of 7/min causes CO2 retention.