A 61-year-old female patient with hypovolemic shock has these vital signs: temperature 97.9°F (36.6°C): pulse 123 beats/min: blood pressure 85/48 mamite respirations 24 breaths/min; urine output 20 mL for last 2 hours: skin cool and clammy. Which prescription order for this patient does the nurse question?
Doasive Nitrogen 12m mi
Dobutamine Doubters) 5 mcg/kg/min
Plasmanate 1 unit
Bumetanide (Bumex) 1 mg IV
The Correct Answer is C
Hypovolemic shock is a life-threatening condition resulting from severe blood or fluid loss. The patient in this scenario exhibits signs of hypovolemic shock, such as low blood pressure, tachycardia, cool and clammy skin, and decreased urine output.
When assessing the prescription options, the nurse should consider the appropriateness of each intervention for hypovolemic shock. Plasmanate is a type of plasma protein fraction that is used for volume expansion in certain situations. However, in hypovolemic shock, the primary intervention is to restore intravascular volume promptly. Plasmanate alone may not be sufficient for rapid-volume resuscitation.
In hypovolemic shock, the initial management typically involves the administration of crystalloid solutions, such as Lactated Ringers or Normal Saline, to restore intravascular volume. Therefore, the prescription of Plasmanate as the primary intervention raises concerns and should be questioned by the nurse.
A. Dopamine (Intropin) 12 mcg/min in (option A) is incorrect because: Dopamine is a vasopressor medication used to increase blood pressure and cardiac output. It is a suitable option for hypovolemic shock to support blood pressure and tissue perfusion.
B. Dobutamine (Dobutrex) 5 mcg/kg/min in (option B) is incorrect because: Dobutamine is an inotropic medication that helps improve cardiac contractility and cardiac output. It can be beneficial in cases of hypovolemic shock with signs of poor cardiac function.
D. Bumetanide (Bumex) 1 mg IV in (option D) is incorrect because: Bumetanide is a loop diuretic used to promote diuresis. However, in the context of hypovolemic shock, diuretics are generally not the first-line treatment as they can further reduce intravascular volume and worsen the patient's condition.
It is essential for the nurse to consult with the healthcare provider regarding the prescription order of Plasmanate and consider alternative interventions for rapid volume resuscitation in hypovolemic shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This method, known as the 6-second method, involves counting the number of QRS complexes in a 6-second interval on the electrocardiogram (ECG) strip and then multiplying that number by 10 to calculate the heart rate per minute. The advantage of this method is that it provides a relatively quick estimate of the heart rate.
A. Printing a 1-minute ECG strip and counting the number of QRS complexes in (option A) is incorrect because it can be time-consuming and may not be practical in situations where a quick estimate is needed.
B. Calculating the number of small squares between one QRS complex and the next and dividing into 1500 in (option B) is incorrect because it is a method used to calculate heart rate, known as the "1500 method," but it is not as quick as the 6-second method and requires more time and measurement precision.
D. Counting the number of large squares in the R-R interval and dividing by 300 is another method used to calculate heart rate, known as the "300 method," but it is also less quick and less accurate for assessing heart rate in patients with regular rhythms.
It's important to note that if the heart rhythm is irregular, these methods may not provide an accurate estimate of the heart rate, and a longer monitoring period or a different approach may be necessary.
Correct Answer is C
Explanation
In septic shock, one of the key goals of management is to restore and maintain adequate intravascular volume. However, in this case, the patient's urine output is low (30 mL/hr for the past 3 hours), suggesting inadequate renal perfusion and potential fluid overload.
Administering additional normal saline at an increased rate (250 mL/hr) without addressing the low urine output could potentially exacerbate fluid overload and further compromise the patient's condition.
A. Administer hydrocortisone (Solu-Cortef) 100 mg IV in (option A) is incorrect because: Hydrocortisone is commonly used in septic shock to help stabilize blood pressure and modulate the inflammatory response.
B. Giving PRN furosemide (Lasix) 40 mg IV in (option B) is incorrect because Furosemide, a loop diuretic, can be administered as needed to address fluid overload or to increase urine output if there is evidence of volume overload.
D. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg in (option D) is incorrect because: Norepinephrine is a vasopressor commonly used in septic shock to increase systemic vascular resistance and maintain adequate blood pressure.
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