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","B","C","E"]

Explanation

A. Chronic hypertension is a significant risk factor for the development of various cardiac diseases, including coronary artery disease, left ventricular hypertrophy, heart failure, and arrhythmias. The increased workload on the heart caused by hypertension can lead to myocardial remodeling, impaired cardiac function, and ultimately heart disease.

B. Chronic hypertension can cause damage to the kidneys over time, leading to renal insufficiency or chronic kidney disease. The elevated blood pressure damages the delicate blood vessels in the kidneys, impairing their ability to filter waste products and regulate fluid and electrolyte balance. Persistent hypertension can ultimately lead to kidney dysfunction and renal failure.

C. Hypertension is a major risk factor for the development of stroke, particularly ischemic stroke (caused by a blockage in a blood vessel supplying the brain) and hemorrhagic stroke (caused by bleeding into the brain). Chronic hypertension can damage blood vessels in the brain, leading to the formation of blood clots or weakening of vessel walls, increasing the risk of stroke.

E. Chronic hypertension is a significant risk factor for the development of atrial fibrillation, a type of irregular heart rhythm characterized by rapid and chaotic electrical activity in the upper chambers of the heart (atria). The structural changes in the heart caused by hypertension, such as left atrial enlargement and fibrosis, can predispose individuals to atrial fibrillation.

D. Familial hypercholesterolemia is a genetic disorder characterized by high levels of LDL cholesterol in the blood. While chronic hypertension itself does not directly cause familial hypercholesterolemia, hypertension and hypercholesterolemia are often comorbid conditions that contribute to cardiovascular risk. Both conditions can lead to atherosclerosis, increasing the risk of heart disease and stroke.

F. Isolated systolic hypertension refers to elevated systolic blood pressure with normal diastolic blood pressure. While isolated systolic hypertension itself is a manifestation of hypertension, it is not a direct result of end-organ damage. However, if left untreated, isolated systolic hypertension can lead to complications such as stroke, heart failure, and kidney disease, which are consequences of end-organ damage from chronic hypertension.

A. The patient has no cough reflex when suctioned. B. The patient's oxygen saturation is 90% to 93% C. The patient does not respond to voice. D. No sedative is ordered for the patient

Correct Answer is D

Explanation

D Sedatives are typically administered alongside neuromuscular blockers to ensure the patient's comfort and prevent awareness during mechanical ventilation.

A The absence of a cough reflex when suctioned is expected in a patient receiving cisatracurium (Nimbex) because it is a neuromuscular blocking agent that induces paralysis. Cisatracurium inhibits skeletal muscle movement, including the muscles involved in coughing.

B An oxygen saturation between 90% to 93% is within an acceptable range for a patient in this condition.

C The lack of response to voice may indicate that the patient is sedated or experiencing effects from the neuromuscular blocking agent. However, since the patient is receiving cisatracurium to prevent asynchronous breathing with the positive pressure ventilator, it's expected that the patient will not respond to voice due to the medication-induced paralysis.

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Naxlex Comprehensive Predictor Exams

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

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

Explanation

Which information about a patient who is receiving cisatracurium (Nimbex) to prevent asynchronous breathing with the positive pressure ventilator requires action by the nurse?

Correct Answer is D

Explanation

The nurse is caring for a client who has heart failure with an EF of 40%. The client has a BP of 170/67 with an HR of 60. He currently is in normal sinus rhythm and has an amber urine output of 45ml in the last 3 hours. Which medication would the nurse expect to give first?

A nurse is preparing a client for transfer to the ICU for placement of a pulmonary artery catheter. The nurse should explain to the client that this catheter is used to monitor which of the following conditions?

An 81-yr-old patient who has been in the intensive care unit (ICU) for a week is now stable and transfer to the progressive care unit is planned. On rounds, the nurse notices that the patient has new onset confusion. What should the nurse plan to do?

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?

Which assessment finding by the nurse caring for a patient receiving mechanical ventilation indicates the need for suctioning?

A nurse is caring for a client who is receiving positive-pressure mechanical ventilation. Which of the following interventions should the nurse implement to prevent complications? (Select all that apply.)