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 C
Explanation
In the initial 24 hours after burn injury, fluid resuscitation is a critical priority in the management of burn patients. Burn injuries can lead to significant fluid loss, both locally at the burn site and systemically due to increased capillary permeability. Fluid resuscitation aims to restore and maintain adequate intravascular volume, ensuring sufficient tissue perfusion and organ function.
The Parkland Formula is commonly used to guide fluid resuscitation in burn patients. It involves calculating the total volume of fluid needed in the first 24 hours, with a portion given in the initial hours after injury and the remainder given over the remaining hours.
A. Sterile dressing changes (option A) are incorrect because they are important in wound care management for burn patients to prevent infection. However, fluid resuscitation takes precedence within the first 24 hours.
B. Emotional support (option B) is incorrect because it is an essential aspect of burn care, as burn injuries can have a significant psychological impact. While emotional support is crucial for the patient's overall well-being, it may not be the highest priority within the first 24 hours compared to addressing the physiological needs of fluid resuscitation.
D. Range-of-motion exercises (option D) are incorrect because they are important for preventing contractures and maintaining joint mobility in burn patients. However, they are typically initiated after the initial fluid resuscitation phase and wound stabilization.
Therefore, the priority the nurse anticipates within the first 24 hours for a 31-year-old male patient with burn injuries is fluid resuscitation.
Correct Answer is A
Explanation
This pathway represents the normal sequence of electrical impulses that coordinate the contraction and relaxation of the heart chambers.
The electrical signal originates from the sinoatrial (SA) node, which is often referred to as the natural pacemaker of the heart. It is located in the right atrium and generates the electrical impulses that initiate each heartbeat. From the SA node, the electrical signal travels to the atrioventricular (AV) node, which is located at the junction between the atria and ventricles.
After passing through the AV node, the electrical impulse travels through the bundle of His (also known as the atrioventricular bundle) and divides into the right and left bundle branches. These branches continue the conduction pathway and deliver the electrical signal to the Purkinje fibers.
The Purkinje fibers spread the electrical impulse rapidly throughout the ventricles, stimulating the contraction of the ventricular muscle and allowing for efficient pumping of blood out of the heart.
Therefore, the correct sequence of the normal conduction pathway in the heart is:
A. SA node - AV node - bundle of His - bundle branches - Purkinje fibers.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today