# Stage 4 — Generate solutions. Which actions appropriately address Mr. B's suspected colorectal incisional SSI? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=373405&lang=en > language: en > subject: System-Specific Assessments > category: ROR ## Question Stage 4 — Generate solutions. Which actions appropriately address Mr. B's suspected colorectal incisional SSI? Select all that apply. 1 Repeat a focused wound and systemic assessment, mark the erythema border, evaluate for sepsis or deeper abdominal complication, and promptly notify the surgical team. 2 Use Standard Precautions while a clean dressing contains the drainage; add Contact Precautions if drainage becomes major or uncontained, following infection-prevention guidance. 3 Support opening and drainage as ordered, obtain an aseptic wound specimen, and consider blood cultures from the fever, systemic assessment, and bacteremia risk without delaying urgent therapy if instability develops. 4 Begin cefepime alone because it provides complete gram-negative and anaerobic coverage for every postoperative colorectal infection, regardless of severity, allergies, or local data. 5 Use empiric therapy matched to severity, gastrointestinal operative site, MRSA risk, allergies, and the local antibiogram, then narrow or stop agents as source control, cultures, and clinical response permit. 6 Restart prophylactic antibiotics for 30 days and require an insulin infusion to keep glucose below 80 mg/dL because both are universal CDC measures once an SSI is suspected. ## Explanation Appropriate actions: 1, 2, 3, and 5 Perform a focused severity and depth assessment and notify surgery (choice 1). Select precautions from whether drainage is contained rather than applying Contact Precautions automatically (choice 2). Combine ordered source control with an aseptic wound specimen and indication-based blood cultures, without delaying urgent treatment in instability (choice 3). Select empiric treatment from severity, colorectal site, MRSA risk, allergies, and local data, then narrow promptly (choice 5). Cefepime alone lacks anaerobic coverage (choice 4). Prolonged prophylaxis and a glucose target below 80 mg/dL are unsafe and unsupported (choice 6). ## In-depth explanation Wrong — choice 4 Cefepime covers many gram-negative organisms but not anaerobes. A colorectal-site infection requires anaerobic consideration, so cefepime alone is not complete empiric coverage. Wrong — choice 6 Antibiotics used to treat an established infection are not restarted prophylaxis, and prophylaxis is not continued for 30 days. CDC's perioperative SSI-prevention glucose target is below 200 mg/dL; forcing glucose below 80 mg/dL creates hypoglycemia risk. Nuance Blood cultures are not mandatory for every superficial SSI. They are considered when systemic features or bacteremia risk make them useful. Likewise, Contact Precautions depend on whether wound drainage is major or uncontained. ## Clinical scenario Scenario (Stage 4 — Generate solutions) The client remains hemodynamically stable while the surgical team evaluates the incision and the nurse prepares immediate bedside actions. ## Key concepts - **Drainage-dependent precautions** — Standard Precautions for minor or limited contained drainage, with Contact Precautions added for major or uncontained drainage until it stops or can be contained. - **Indication-based blood cultures** — Blood cultures selected from systemic severity, high fever, hypotension, bacteremia concern, or special risk rather than ordered automatically for every superficial wound infection. - **Antimicrobial de-escalation** — Stopping unnecessary agents or narrowing spectrum, route, and duration as source control, microbiology, infection depth, organ function, and clinical response become clear. ## Related questions - [A nurse on a medical-surgical unit reviews the morning labs for a 67-year-old male client …](https://mymerci.kr/pages/nclex_q.php?qn_id=361711&lang=en) - [A 6-year-old client is on the pediatric surgical unit on postoperative day 1 following ton…](https://mymerci.kr/pages/nclex_q.php?qn_id=361812&lang=en) - [A 45-year-old female client with severe iron-deficiency anemia is receiving the first unit…](https://mymerci.kr/pages/nclex_q.php?qn_id=361898&lang=en) - [A 72-year-old male client is receiving a continuous IV heparin infusion for a left lower-e…](https://mymerci.kr/pages/nclex_q.php?qn_id=362064&lang=en) - [A nurse is monitoring an adult client 4 hours after an open abdominal hysterectomy. 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