Free BCEN Certified Emergency Nurse (CEN) Practice Question

The correct answer is to start empiric antibiotic therapy immediately. This scenario describes a patient with probable peritoneal dialysis-associated peritonitis, a serious complication in dialysis patients. The diagnosis is supported by the presence of cloudy dialysate, abdominal pain, and fever, along with an elevated white blood cell count in the dialysate fluid. According to guidelines, empiric antibiotic therapy should be initiated as soon as peritonitis is suspected, even before culture results are available. This approach is crucial to prevent severe complications and reduce morbidity.

While obtaining cultures is important, delaying treatment to wait for results could worsen the patient's condition. Increasing dialysate exchanges may help symptomatically but does not address the underlying infection. Discontinuing peritoneal dialysis and switching to hemodialysis is a drastic step that's not necessarily the first-line approach, especially before attempting antibiotic treatment. Administering intraperitoneal heparin is not a standard initial treatment for peritoneal dialysis-associated peritonitis.

This question tests the nurse's ability to recognize peritonitis in a specific patient population and understand the urgency of initiating appropriate treatment.