The nurse has reviewed the Nurses' Notes, the Vital Signs at 1000 and 1030, and the Laboratory Results at 1030. Exhibits For each potential provider prescription, click to specify if the prescription is expected or unexpected for the adolescent. There must be at least 1 selection in every row. There does not need to be a selection in every column.

• Keep adolescent flat in bed for 24 hr post lumbar puncture: Extended flat bed rest is not recommended after lumbar puncture, as it does not prevent spinal headache and can increase discomfort. Instead, the adolescent may be kept supine only briefly for observation. • Place the adolescent on a cooling blanket: While the adolescent has a fever of 39° C (102.2° F), a cooling blanket can cause the body to shiver, which can increase metabolic rate and raise the core temperature. A safer method is the administration of antipyretic medications like acetaminophen. • Administer IV acyclovir: IV acyclovir is indicated for viral meningitis, particularly caused by herpes simplex virus. This adolescent’s presentation, CSF findings (low glucose, high protein, high WBC), and purpuric rash point toward bacterial meningitis, not viral etiology, making acyclovir inappropriate here. • Place the adolescent on seizure precautions: The adolescent has developed seizure activity with tonic-clonic features, cyanosis, and pooling secretions. Seizure precautions are essential to protect from aspiration and injury, with measures such as padded side rails, suction readiness, and airway support. • Administer IV cefotaxime: Cefotaxime is a broad-spectrum antibiotic effective against common bacterial meningitis pathogens. Given the cloudy CSF, elevated WBC, low glucose, and rapid deterioration, immediate administration of IV antibiotics is the standard, lifesaving intervention. • Insert a peripheral IV catheter: IV access is necessary to administer fluids, antibiotics, and emergency medications. The adolescent is also showing signs of sepsis and hypotension (BP 88/50 mmHg), so fluid resuscitation and supportive therapy via IV are vital.