Following surgery, a patient's central venous pressure (CVP) monitor indicates high pressures. Which action will the nurse anticipate taking?

Increase the IV fluid infusion rate.

Administer IV diuretic medications.

Elevate the head of the patient's bed to 45 degrees.

Document the CVP and continue to monitor.

Answer and Explanation

The Correct Answer is B

Central venous pressure (CVP) is a measurement of the pressure in the central veins, which reflects the blood volume and right-sided cardiac function. High CVP readings may indicate fluid overload or impaired cardiac function, and intervention is necessary to address the underlying cause.
Administering IV diuretic medications can help reduce fluid volume by increasing urine output and promoting fluid elimination. By removing excess fluid, the diuretic medications can help lower the CVP and alleviate the high pressures.
The other options mentioned are not the anticipated actions for addressing high CVP:
A. Increasing the IV fluid infusion rate in (option A) is incorrect because: If the CVP is already indicating high pressures, increasing the IV fluid infusion rate would further contribute to fluid overload and exacerbate the problem. This action would not be appropriate for high CVP readings.
C. Elevating the head of the patient's bed to 45 degrees in (option C) is incorrect because Positioning the patient with the head of the bed elevated is commonly done to prevent complications such as aspiration or improve respiratory function. While it may have other benefits, it does not directly address the high CVP.
D. Documenting the CVP and continuing to monitor in (option D) is incorrect because Documenting the CVP and continuing to monitor is important for ongoing assessment and evaluation. However, in the presence of high CVP readings, intervention is necessary to address the underlying issue rather than solely documenting and monitoring.
Therefore, when a patient's CVP monitor indicates high pressures following surgery, the nurse would anticipate administering IV diuretic medications to help reduce fluid volume and lower the CVP.

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Correct Answer is A

Explanation

Tachypnoea, which refers to an increased respiratory rate, is an early symptom of hypovolemic shock. It is the body's compensatory response to inadequate tissue perfusion and decreased oxygen delivery. The increased respiratory rate is an attempt to improve oxygenation and maintain vital organ function.
B. Heart blocks in (option B) are incorrect because Heart blocks refer to disruptions in the electrical conduction system of the heart and are not specific to hypovolemic shock.
C. Vomiting in (option C) is incorrect because: Vomiting may occur in various conditions, including shock, but it is not exclusive to hypovolemic shock and can be present in other forms of shock or illnesses.
D. Bradycardia in (option D) is incorrect because Bradycardia, or a slow heart rate, is not typically an early symptom of hypovolemic shock. Instead, tachycardia (rapid heart rate) is more commonly observed as a compensatory response to maintain cardiac output.
E. Hypotension in (option E) is incorrect because Hypotension, or low blood pressure, can occur in hypovolemic shock but is generally considered a later-stage symptom. In the early stages, compensatory mechanisms may help maintain blood pressure, so hypotension may not be present initially.
F. Bradypnea in (option F) is incorrect because: Bradypnea refers to a slow respiratory rate, which is not typically an early symptom of hypovolemic shock. Tachypnoea, as mentioned earlier, is the more common early respiratory symptom.

Correct Answer is ["9000"]

Explanation

4 mL × body weight in kg × percentage of burn = total fluid volume for the first 24 hours Then, divide the total fluid volume by 2 to determine the fluid volume for the first 8 hours.

In this case, the patient weighs 90 kg and has a 50% burn injury.

4 mL × 90 kg × 50% = 18,000 mL (total fluid volume for 24 hours)

18,000 mL / 2 = 9,000 mL (fluid volume for the first 8 hours)

Therefore, the nurse would infuse the intravenous fluid resuscitation at a rate of 9,000 mL over the first 8 hours.

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Following surgery, a patient's central venous pressure (CVP) monitor indicates high pressures. Which action will the nurse anticipate taking?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The surgical ICU nurse is caring for postoperative clients at risk for hypovolemic shock. Which condition represents an early symptom of shock?

Correct Answer is A

Explanation

An emergency room nurse cares for a patient admitted with a 50% burn injury. The patient weighs 90 kg. Using the Parkland formula, calculate the rate (1st 8 hrs.) at which the nurse would infuse intravenous fluid resuscitation. (Record your answer using a whole number.)

Correct Answer is ["9000"]

Explanation

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