A 36-Year-Old Woman Has Increasing Nausea and Headaches 12 Hours

question 152

Multiple Choice

A 36-year-old woman has increasing nausea and headaches 12 hours after a right-sided percutaneous nephrolithotomy for staghorn calculi.  The procedure involved ultrasonic lithotripsy followed by fragment removal using a flexible nephroscope.  The patient spent a prolonged period in recovery and has been drowsy since returning to the ward.  She is receiving intermittent morphine for pain control.  She also received intravenous ceftriaxone after an episode of postoperative low-grade fever.
Other medical conditions include frequent urinary tract infections, gastroesophageal reflux disease, and angioedema.  A month ago, the patient was treated for contact dermatitis from poison ivy with a 10-day course of prednisone.
Temperature is 37.2 C (99 F) , blood pressure is 130/90 mm Hg, pulse is 64/min, respirations are 14/min, and oxygen saturation is 96% on room air.  The patient is drowsy but arousable with a short attention span.  Pupils are small but reactive to light and accommodation.  Mucous membranes are moist.  The neck is supple, and cardiovascular and lung examinations are unremarkable.  Abdominal examination reveals diminished bowel sounds.  The patient is able to move all extremities on command, and deep tendon reflexes are symmetric.  The remainder of the examination is normal.
Laboratory results are as follows:
The patient's preoperative laboratory studies were normal.  Which of the following is the most appropriate next step in management of this patient?

• A)3% saline by infusion pump
• B)500 mL bolus of normal saline followed by infusion
• C)Blood cultures and intravenous cefepime
• D)Noncontrast CT scan of head
• E)Random cortisol level and intravenous dexamethasone

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Definitions:

Supply Curves

Graphical representations showing the relationship between the price of a good and the quantity of that good that producers are willing to supply.

Price

The financial contribution expected, compelled, or made in payment for something.

Tariff

A tax imposed by a government on goods and services imported from other countries, used to control trade volumes.

Decrease in Supply

This occurs when there is a reduction in the quantity of a good or service that producers are willing and able to supply at all possible prices.