1. A 33-year-old man is admitted through the ER with a temperature of 103°F. Respiratory rate is 24 breaths per minute; pulse rate is 110 and regular. Blood pressure is 120/80. He denies any other symptoms. Which of the following would be an appropriate step for the admitting nurse to take that might be ordered by the physician?
a. Obtain a WBC and erythrocyte sedimentation rate (ESR).
b. Obtain a WBC and serum albumin.
c. Obtain a serum albumin and throat culture.
d. Obtain a chest X-ray to rule out pneumonia.
2. A nurse would know one of the most effective treatments for decreasing cerebral edema in a patient with increased intracranial pressure would be which of the following?
a. IV mannitol (Osmitrol)
b. IV furosemide (Lasix)
c. Assessment of CSF for protein
d. Force fluids
Rationale: Fever is the main symptom. WBC and ESR may be elevated if there is an underlying infectious process. WBC could be elevated if there is an infectious process, but serum albumin is generally not related to an infectious process and elevated temperature. Serum albumin level is generally not associated with an infectious process; the man has no complaints of a sore throat, which would warrant a throat culture. Initial symptoms do not indicate a diagnosis of pneumonia; more questioning would be warranted before ordering a chest X-ray.
Rationale: Osmotic diuretics like mannitol increase fluid excretion and reduce sodium reabsorption; they are often used along with corticosteroids to reduce ICP. Lasix is a loop diuretic and is generally used to relieve edema associated with congestive heart failure and acute pulmonary edema. Cerebrospinal fluid (CSF) would be drained rather than assessed to reduce ICP. Fluids would be restricted rather than forced.
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