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

Explanation

A. Dobutamine is a positive inotropic agent that increases myocardial contractility, leading to improved cardiac output. Enhanced cardiac output can result in improved renal perfusion and increased urine output, which is a positive indicator of improved cardiac function in clients with heart failure.

B. Decreased blood glucose level is not typically associated with the effectiveness of dobutamine. Dobutamine primarily affects cardiac contractility and does not directly influence blood glucose levels.

C. Decreased blood pressure would not typically indicate the effectiveness of dobutamine. While dobutamine can increase cardiac output, it does not necessarily lead to a decrease in blood pressure.

D. Increased heart rate may occur as a compensatory mechanism in response to increased cardiac output due to dobutamine administration. However, increased heart rate alone may not reliably indicate the effectiveness of dobutamine.

A. The patient has occasional audible expiratory wheezes. B. The patient's respiratory rate is 32 breaths/min C. The patient was last suctioned 6 hours ago. D. The patient's oxygen saturation drops to 93%.

Correct Answer is D

Explanation

D. A drop in oxygen saturation may indicate inadequate oxygenation, which could be due to airway obstruction or retained secretions.

A. While audible expiratory wheezes may indicate airway obstruction or secretions, they do not necessarily indicate the need for suctioning in a patient receiving mechanical ventilation.

B. An elevated respiratory rate may suggest increased work of breathing, which could be due to retained secretions or airway obstruction. However, an elevated respiratory rate alone may not always indicate the need for suctioning.

C. The timing of the last suctioning episode is an important consideration when determining the need for suctioning. However, it should not be the sole indicator for when to suction.

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Naxlex Comprehensive Predictor Exams

A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective?

Correct Answer is A

Explanation

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

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

Which action should the nurse take first when the low pressure alarm sounds for a patient who has an arterial line in the left radial artery?

A client tells the nurse that he is concerned because his provider told him he has a heart murmur. The nurse should explain to the client that a murmur

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?

The nurse is caring for a patient receiving a continuous norepinephrine IV infusion. Which finding indicates that the infusion rate may need to be adjusted?

A patient with respiratory failure has a respiratory rate of 26 breaths/min and an oxygen saturation (SpO2) of 80%. The patient is increasingly pale and restless but follows commands. Which intervention will the nurse anticipate?

A nurse is caring for a client in a critical care unit who suffered a knife wound to the chest. The nurse suspects the client is developing cardiac tamponade. Which of the following assessment findings should the nurse identify as supporting this suspicion?