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.

Answer and Explanation

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.

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Correct Answer is ["A","C","D","E"]

Explanation

A. Hypotension may result from decreased cardiac output due to hypoxemia and acidosis or as a compensatory response to hypoxia-induced vasodilation. Therefore, monitoring for hypotension is important in ARF.

C. Hypoxemia can impair cerebral perfusion and neuronal function, leading to alterations in mental status ranging from confusion to coma. Decreased level of consciousness is a concerning sign of inadequate oxygenation and should be closely monitored in patients with ARF.

D. Dyspnea, or difficulty breathing, is a hallmark symptom of respiratory failure. In ARF, the respiratory system's inability to adequately oxygenate or ventilate leads to increased work of breathing and feelings of breathlessness. Patients with ARF often experience severe dyspnea as they struggle to maintain adequate gas exchange.

E. Headache is not typically considered a primary manifestation of ARF. However, it may occur as a secondary symptom due to factors such as hypoxemia, hypercapnia, or acidosis. Patients with ARF may experience headache as a result of cerebral vasodilation in response to hypoxia or as a symptom of underlying conditions contributing to respiratory failure.

B. Nausea is not a typical manifestation of ARF itself. However, it may occur as a secondary symptom due to factors such as hypoxia, acidosis, or medications administered for the management of ARF. While nausea may be present, it is not a direct result of respiratory failure.

A. The rapid response team will begin with defibrillation and then progress to cardiopulmonary resuscitation if needed B. It would be best if you waited outside, as you won't want to see cardiopulmonary resuscitation performed on your loved one C. As long as the team is doing cardiopulmonary resuscitation, your loved on has a normal blood flow throughout their body D. The rapid response team cannot defibrillate your loved on because they are in systole; they are continuing cardiopulmonary resuscitation.

Correct Answer is D

Explanation

D. Asystole represents the absence of electrical activity in the heart and is not amenable to defibrillation. Therefore, the RRT would continue cardiopulmonary resuscitation (CPR) with chest compressions and may administer medications or other interventions as indicated. This statement provides accurate information to the family about the patient's condition and the actions being taken by the RRT.

A. Defibrillation is not indicated for asystole. Asystole represents a flatline on the cardiac monitor, indicating the absence of electrical activity in the heart. Defibrillation is only effective for certain types of cardiac rhythms, such as ventricular fibrillation or pulseless ventricular tachycardia. Therefore, the RRT would not use defibrillation for a patient in asystole.

B. It does not provide the family with information about the patient's condition or the actions being taken by the RRT. Moreover, excluding the family from the patient's care may cause additional distress and prevent them from being present to support their loved one during a critical situation.

C. Cardiopulmonary resuscitation (CPR) is performed to maintain blood flow and oxygenation to vital organs during cardiac arrest. However, it does not restore normal blood flow or circulation. The goal of CPR is to provide temporary support until advanced interventions can be initiated or until return of spontaneous circulation (ROSC) is achieved.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has an acute respiratory failure (ARF). The nurse should monitor the client for which of the following manifestations of this condition? (Select all that apply.)

Correct Answer is ["A","C","D","E"]

Explanation

The rapid response team (RRT) is caring for a client with asystole. Which nursing statement made to the client's family about the actions of the RRT is appropriate?

Correct Answer is D

Explanation

Which is(are) potential result(s) of end-organ damage from chronic hypertension? (Select all that apply.)

A nurse is caring for a client who has pericarditis and reports feeling a new onset of palpitations and shortness of breath. Which of the following assessments should indicate to the nurse that the client may have developed atrial fibrillation?

A patient who has been involved in a motor vehicle crash arrives in the emergency department (ED) with cool, clammy skin; tachycardia; and hypotension. Which intervention prescribed by the health care provider should the nurse implement first?

Which of the following is NOT an appropriate indication for the use of dopamine in critical care?

A nurse is caring for a client who has a cardiopulmonary arrest. The nurse anticipates the emergency response team will administer which of the following medications if the client's restored rhythm is symptomatic bradycardia?

A nurse in an urgent care center is assessing a client who reports a sudden onset of irregular palpitations, fatigue, and dizziness. The nurse finds a rapid and irregular heart rate with a significant pulse deficit. Which of the following dysrhythmias should the nurse expect to find on the ECG?

A nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury?

Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which data indicate that the nurse should consult with the health care provider before starting the norepinephrine?