The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 196, R-R interval regular, P-R interval not measurable, QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as;

Cool, clammy skin, tachycardia, and hypotension are signs of shock, indicating inadequate tissue perfusion and oxygenation. The immediate priority is to ensure adequate oxygen delivery to the tissues. Providing oxygen at 100% via a non-rebreather mask helps increase the patient's oxygen saturation and improve tissue oxygenation.
While all the options mentioned are important in the management of a patient in shock, oxygenation takes priority as it directly addresses compromised tissue perfusion and oxygenation.
A. Inserting two large-bore IV catheters in (option A) is incorrect because: Establishing intravenous access is crucial for fluid resuscitation and administration of medications, but it can be done after ensuring adequate oxygenation.
C. Drawing blood to type and crossmatch for transfusions in (option C) is incorrect because Blood typing and crossmatching are important for potential blood transfusions but should not be the first action in this critical situation.
D. Initiating continuous electrocardiogram (ECG) monitoring in (option D) is incorrect because Continuous ECG monitoring is important for assessing cardiac rhythm and detecting any dysrhythmias, but ensuring oxygenation should be the initial priority.
Therefore, in a patient presenting with cool, clammy skin, tachycardia, and hypotension, the nurse should first provide oxygen at 100% via a non-rebreather mask to address inadequate tissue perfusion and oxygenation.

In septic shock, prompt administration of antibiotics is crucial in order to target the underlying infection and prevent further progression of the septic process. Antibiotics help to eradicate the causative organisms and reduce the bacterial load, which can help improve patient outcomes.
While all the options mentioned are important interventions in the management of septic shock, initiating antibiotic therapy is considered a priority in order to address the underlying infection and prevent sepsis-related complications.
A. Giving a 2000 mL normal saline bolus in (option A) is incorrect because: Fluid resuscitation is important in septic shock to restore intravascular volume, but antibiotic therapy takes precedence as it directly targets the underlying infection.
B. Starting an insulin drip to maintain blood glucose at 110 to 150 mg/dL in (option B) is incorrect because Glycemic control is important in septic shock, but it is not the first priority compared to addressing the infection.
C. Giving acetaminophen (Tylenol) 650 mg rectally in (option C) is incorrect because Antipyretic medications can help reduce fever, but they do not address the underlying infection or stabilize the patient's condition.
E. Starting norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg in (option E) is incorrect because: Vasopressor support may be necessary in septic shock to maintain adequate blood pressure, but initiating antibiotics takes priority in order to address the underlying infection.
Therefore, in a patient with septic shock presenting with the given signs and symptoms, the nurse should first implement the intervention of giving the prescribed antibiotics to target the underlying infection.