A 33-Year-Old Woman Comes to the Emergency Department Complaining of 2

question 790

Multiple Choice

A 33-year-old woman comes to the emergency department complaining of 2 days of urinary frequency, fever, and nausea.  She has no other medical problems and takes no medications.  She is sexually active with her husband, has had 2 uncomplicated pregnancies, and uses condoms for contraception.  The patient has regular menstrual periods.  Her temperature is 39 C (102 F) , blood pressure is 112/60 mm Hg, pulse is 110/min, and respirations are 16/min.  Examination shows left costovertebral angle tenderness but is otherwise unremarkable.  Laboratory testing shows a white blood cell count of 17,000/µL with 8% bands.  Urinalysis shows positive nitrite, many white blood cells, and >100 bacteria/hpf.  A pregnancy test is negative.  Appropriate cultures are obtained and the patient is started on empiric intravenous antibiotics.  Which of the following is the most appropriate indication for CT scan of the abdomen and pelvis in this patient?

• A)No clinical improvement within first 72 hours
• B)Obtain now to rule out hydronephrosis
• C)Obtain routinely in 48 hours
• D)Positive blood cultures
• E)Positive urine culture for Klebsiella pneumoniae

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Definitions:

Implementation Through Change

The process of putting plans, strategies, or policies into action within an organization through the management and execution of change.

Organizational Vision

a strategic declaration of an organization’s long-term objectives, intended direction, or desired future state, which guides its internal decision-making.

Participative Decision Making

A decision-making process whereby employees at all levels are involved in contributing to the development of decisions.

Performance Standards

Specific criteria and benchmarks set to measure the efficiency, effectiveness, and quality of work performed or services provided.