A 48-year-old female patient with septic shock presents with a BP of 70/46, pulse 136, respirations 32, temperature 104.0° F, and blood glucose of 246 mg/dl. The following have been ordered. Which order will the nurse accomplish first?
Draw an arterial blood gas (ABG).
Start insulin drip to maintain blood glucose at 150 mg/dl or lower.
Give a normal saline bolus IV of 30mL/kg.
Titrate norepinephrine (Levophed) to keep MAP greater than 65 mm Hg.
The Correct Answer is C
Septic shock is characterized by inadequate tissue perfusion and hypotension, which can lead to organ dysfunction and failure. The administration of intravenous fluids, such as a normal saline bolus, is the initial priority in the management of septic shock to restore intravascular volume and improve perfusion.
A. Draw an arterial blood gas (ABG) in (option A) is incorrect because: ABG may be ordered to assess the patient's acid-base status and oxygenation, but addressing hypotension and restoring perfusion through fluid administration takes priority.
B. Start insulin drip to maintain blood glucose at 150 mg/dl or lower in (option B) is incorrect because: Hyperglycaemia is commonly observed in critically ill patients, including those with septic shock. While controlling blood glucose is important, it is not the immediate priority compared to addressing hypotension and restoring intravascular volume.
D. Titrate norepinephrine (Levophed) to keep mean arterial pressure (MAP) greater than 65 mm Hg in (option D) is incorrect because: Norepinephrine is a vasopressor medication used to increase blood pressure and perfusion in septic shock. While it may be necessary for the management of septic shock, fluid resuscitation should be initiated first to optimize intravascular volume before starting vasopressors.
Therefore, the first order that the nurse should accomplish in this scenario is to give a normal saline bolus IV of 30 mL/kg to address the hypotension and restore intravascular volume.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
These manifestations occur as compensatory mechanisms in response to decreased blood volume and compromised tissue perfusion. The body attempts to compensate for the inadequate circulating volume by increasing heart rate (A) and respiratory rate (B) to enhance oxygen delivery.
D. The decreased systolic blood pressure (D) is a result of decreased cardiac output and vasoconstriction in an attempt to maintain perfusion to vital organs.
E. The decreased urine output (E) is a result of decreased renal perfusion due to decreased blood volume.
C. Decreased pulse rate in (option C) is incorrect because it is not typically seen in the compensatory stage of hypovolemic shock. The body tries to increase heart rate to maintain cardiac output and compensate for the decreased blood volume.
F. Bilateral crackles in (option F) is incorrect because the lung bases are more commonly associated with conditions such as pulmonary edema or fluid overload, rather than the compensatory stage of hypovolemic shock.
It's important to note that the manifestations of shock can vary depending on individual patient factors and the underlying cause of shock. Therefore, a comprehensive assessment and clinical judgment are necessary to fully evaluate the patient's condition.
Correct Answer is A
Explanation
The QTc (corrected QT) interval is a measure of the time it takes for the ventricles to depolarize and repolarize during a cardiac cycle. It is corrected for heart rate (HR) to account for variations in the cardiac cycle length.
The normal range for the QTc interval varies depending on the calculation method used but generally falls within 0.36 to 0.44 seconds. In the given options, the range of 0.33 to 0.47 seconds for the QTc interval is wider than the normal range, suggesting a prolonged QTc interval, which can be indicative of a potential risk for arrhythmias, including ventricular tachycardia and torsades de pointes.
B. QT interval that varies with HR in (option B) is normal because The QT interval alone can vary with heart rate, and this is considered a normal physiological adaptation.
C. QRS interval <0.12 seconds in (option C) is normal because The QRS interval represents the time it takes for ventricular depolarization and is normally less than 0.12 seconds.
D. PR interval 0.12 to 0.24 seconds in (option D) is normal because The PR interval represents the time it takes for atrial depolarization and conduction through the AV node. The normal range is typically 0.12 to 0.20 seconds.
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