NCLEX practice question help

Hi everyone, can someone please provide a rational for this practice nclex question. I'm having trouble understanding why this is the right answer instead of D. I've always assumed that a blood culture should be initiated before an antibiotic therapy. The answer to this question is A.) The route of antibiotic therapy on the care pathway was changed from IV to PO. but I don't understand why a variance report needs to be made for a change in route.

Question: A febrile client is admitted to the hospital for treatment of pneumonia. In accordance with the care pathway, antibiotic therapy is prescribed. Which of the following situations requires the nurse to complete a variance report with regard to the care pathway?

A.) Route of antibiotic therapy on the care pathway was changed from IV to PO.

B.) Antibiotic therapy was initiated 2 hr after implementation of the care pathway.

C.) An allergy to penicillin required an alternative antibiotic to be prescribed.

D.) A blood culture was obtained after antibiotic therapy had been initiated.

I've never seen PO antibiotics (instead of IV) for initial treatment of a hospitalized patient with pneumonia. I still would have chosen "D", though. I'm curious too, now.

That's what I was thinking too. I think D is more likely to be right because I still don't think you need to make a variance report for a change in route of medication.

I would think that it has to do with what is best for the patient at the time and IV ABX would in theory provide a faster therapeutic drug level to help treat the pneumonia.

Ideally the blood cultures (BC) should have been drawn prior to ABX or antipyretic administration but I guess maybe the focus on the question is what you actually have orders for at the time as in...blood cultures were drawn afterwards because that's when their were orders placed to do so instead of the blood cultures being ordered but overlooked and the ABX were given prior to the BC being drawn. Make sense?

Just because it appeared in some NCLEX prep material doesn't automatically make it correct. I would just leave it alone and move on.

Hi, I'm just applying to nursing schools, but I'm reading the question above to specifically be speaking about Care "Pathway" variance and no other type and therefore only A or B would be possible answers. Just normal test taking skill and not that you don't know your stuff, I'll bet. Good luck.

NM. Totally misread the question.

Hey, the question is like most others, where you can eliminate two choices and then have to decide between the two remaining. This stem asked about a CARE PATHWAY. Therefore, the the distractors that aren't about a CARE PATHWAY don't apply.

As to the answer, I don't think you get to change CARE PATHWAYS willy-nilly. That's why there are CARE PATHWAYS.

It doesn't say how the route was changed-- if the prescriber changed it, that's a variance; if the nurse changed if from the way it was prescribed, that's certainly a variance.

So... this is less a question about the abx than it is about reading the question! Let that be a lesson to ya.

Care pathway for pneumonia specifies early antibiotics and that blood cultures are preferred (not required) before starting only if they won't cause delay in administration of antibiotic.

I understand it a little better now that you've explained it, thanks