How does the emergency department nurse caring for a critically ill with septic shock recognize that severe tissue hypoxia is present?

Partial thromboplastin time 64 seconds

Lactate 9.0 mmol/L

Potassium 2.8 mEq/L (2.8 mmol/L)

PaCO2 58 mm Hg

Answer and Explanation

The Correct Answer is B

Lactate is a by-product of anaerobic metabolism that accumulates when there is insufficient oxygen supply to meet cellular metabolic demands. In the context of severe tissue hypoxia, such as in septic shock, the body may resort to anaerobic metabolism, leading to increased lactate production and elevated lactate levels in the blood.
Elevated lactate levels, typically above 4.0 mmol/L, are indicative of tissue hypoxia and inadequate oxygenation at the cellular level. Higher lactate levels, such as 9.0 mmol/L, suggest more severe tissue hypoxia and increased anaerobic metabolism.
A. Partial thromboplastin time (PTT) 64 seconds in (option A) is incorrect because: PTT is a laboratory test that evaluates the intrinsic pathway of the coagulation cascade. While coagulation abnormalities may occur in septic shock, PTT alone does not specifically indicate severe tissue hypoxia.
C. Potassium 2.8 mEq/L (2.8 mmol/L) (option C) is incorrect because Low potassium levels (hypokalemia) can be a concern in septic shock, but it does not directly indicate severe tissue hypoxia.
D. PaCO2 58 mm Hg in (option D) is incorrect because: PaCO2 refers to the partial pressure of carbon dioxide in arterial blood and is a measure of the respiratory status. While an elevated PaCO2 can be a sign of respiratory acidosis, it is not specific to severe tissue hypoxia.
Therefore, in a critically ill patient with septic shock, an elevated lactate level, such as 9.0 mmol/L, indicates severe tissue hypoxia and inadequate oxygenation at the cellular level

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Correct Answer is A

Explanation

The QTc (corrected QT) interval is a measure of the time it takes for the ventricles to depolarize and repolarize during a cardiac cycle. It is corrected for heart rate (HR) to account for variations in the cardiac cycle length.
The normal range for the QTc interval varies depending on the calculation method used but generally falls within 0.36 to 0.44 seconds. In the given options, the range of 0.33 to 0.47 seconds for the QTc interval is wider than the normal range, suggesting a prolonged QTc interval, which can be indicative of a potential risk for arrhythmias, including ventricular tachycardia and torsades de pointes.
B. QT interval that varies with HR in (option B) is normal because The QT interval alone can vary with heart rate, and this is considered a normal physiological adaptation.
C. QRS interval <0.12 seconds in (option C) is normal because The QRS interval represents the time it takes for ventricular depolarization and is normally less than 0.12 seconds.
D. PR interval 0.12 to 0.24 seconds in (option D) is normal because The PR interval represents the time it takes for atrial depolarization and conduction through the AV node. The normal range is typically 0.12 to 0.20 seconds.

A. Cool, clammy skin. B. BP of 82/40 mm Hg. C. Heart rate of 48 beats/min. D. Shortness of breath.

Correct Answer is C

Explanation

Neurogenic shock is a type of distributive shock that occurs due to the loss of sympathetic nervous system tone after a spinal cord injury or other traumatic brain injuries. This loss of sympathetic tone leads to vasodilation and decreased systemic vascular resistance, resulting in inadequate perfusion to vital organs.
One of the hallmark signs of neurogenic shock is bradycardia (a heart rate less than 60 beats/min) due to the unopposed parasympathetic activity. The parasympathetic system becomes dominant when sympathetic activity is impaired. Therefore, a heart rate of 48 beats/min in this patient suggests the possibility of neurogenic shock.
A. Cool, clammy skin in (option A) is incorrect because Cool, clammy skin is a characteristic of hypovolemic shock, where reduced blood volume leads to vasoconstriction to redirect blood flow to vital organs.
B. BP of 82/40 mm Hg in (option B) is incorrect because: Hypotension is a common finding in both neurogenic shock and hypovolemic shock. A low blood pressure reading alone does not specifically indicate neurogenic shock.
D. Shortness of breath in (option D) is incorrect because Shortness of breath is not specific to neurogenic shock but can occur in various types of shock, including hypovolemic shock. It may result from inadequate oxygenation or impaired respiratory function due to the underlying condition or associated injuries.
Therefore, the heart rate of 48 beats/min suggests the possibility of neurogenic shock in addition to hypovolemic shock in this patient.

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How does the emergency department nurse caring for a critically ill with septic shock recognize that severe tissue hypoxia is present?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

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