A 78-kg patient in septic shock has a pulse rate of 120 beats/min with low central venous pressure and pulmonary artery wedge pressure. After initial fluid volume resuscitation, the patient's urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question?
Give hydrocortisone (Solu-Cortef) 100 mg IV.
Administer furosemide (Lasix) 40 mg IV.
Increase normal saline infusion to 250 ml/hr.
Use norepinephrine to keep systolic BP above 90 mm Hg.
The Correct Answer is B
B. Administering furosemide, a loop diuretic, to a patient in septic shock with low urine output could exacerbate hypovolemia and worsen organ perfusion. It could further reduce preload, exacerbating hypotension, and impairing cardiac output. Loop diuretics are typically contraindicated in hypovolemic shock.
A. Corticosteroids such as hydrocortisone can help improve vascular tone and responsiveness to vasopressors. Given the patient's clinical presentation and lack of response to initial fluid resuscitation, administering hydrocortisone is appropriate.
C. Increasing the fluid infusion rate can help restore intravascular volume and improve organ perfusion. However, caution should be exercised to avoid fluid overload and pulmonary edema.
D .Norepinephrine is a vasopressor commonly used to increase systemic vascular resistance and improve blood pressure in septic shock. It helps maintain perfusion pressure to vital organs, thereby supporting organ function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B This maneuver, called the Valsalva maneuver, can sometimes help to restore normal heart rhythm in cases of SVT. It involves blowing forcefully into a syringe or performing a similar action that increases intra-abdominal pressure, which can stimulate the vagus nerve and help to slow down the heart rate.
A Defibrillation is a treatment used for life-threatening cardiac arrhythmias, particularly ventricular fibrillation or pulseless ventricular tachycardia. It involves delivering a therapeutic dose of electrical energy to the heart with a device called a defibrillator.
C Drawing troponin levels may be appropriate if there is suspicion of myocardial infarction as the cause of chest palpitations or if there are other symptoms suggestive of acute coronary syndrome. However, in the context of SVT presenting with chest palpitations and a racing heart, the priority is to address the arrhythmia first
D Amiodarone is an antiarrhythmic medication used to treat various types of cardiac arrhythmias, including ventricular and supraventricular arrhythmias. While it can be effective in certain cases of SVT, it is not typically the first-line treatment or the immediate next step in managing SVT in the emergency department.
Correct Answer is C
Explanation
C. its use in hypovolemic shock is generally not appropriate because the primary treatment for hypovolemic shock is fluid resuscitation to address the volume loss.
A. Dopamine is often used in neurogenic shock to increase systemic vascular resistance and improve blood pressure. Therefore, dopamine is an appropriate choice for the management of hypotension due to neurogenic shock.
B. Dopamine is commonly used in septic shock to improve cardiac output and systemic vascular resistance. It helps to support blood pressure and perfusion in septic shock patients.
D. It is indicated for cardiogenic shock as it increases cardiac contractility.
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