The patient weighing 147 pounds with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 30, temperature 104° F, and blood glucose 391 mg/dL. Which intervention red by the health care provider should the nurse implement first?

Give a 2000mL normal saline bolus

Start insulin drip to maintain blood glucose at 110 to 150 mg/dL.

Give acetaminophen (Tylenol) 650 mg rectally.

Give prescribed Antibiotics

Start norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg.

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is C

Explanation

In septic shock, one of the key goals of management is to restore and maintain adequate intravascular volume. However, in this case, the patient's urine output is low (30 mL/hr for the past 3 hours), suggesting inadequate renal perfusion and potential fluid overload.
Administering additional normal saline at an increased rate (250 mL/hr) without addressing the low urine output could potentially exacerbate fluid overload and further compromise the patient's condition.
A. Administer hydrocortisone (Solu-Cortef) 100 mg IV in (option A) is incorrect because: Hydrocortisone is commonly used in septic shock to help stabilize blood pressure and modulate the inflammatory response.
B. Giving PRN furosemide (Lasix) 40 mg IV in (option B) is incorrect because Furosemide, a loop diuretic, can be administered as needed to address fluid overload or to increase urine output if there is evidence of volume overload.
D. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg in (option D) is incorrect because: Norepinephrine is a vasopressor commonly used in septic shock to increase systemic vascular resistance and maintain adequate blood pressure.

A. Partial thromboplastin time 64 seconds B. Lactate 9.0 mmol/L C. Potassium 2.8 mEq/L (2.8 mmol/L) D. PaCO2 58 mm Hg

Correct Answer is B

Explanation

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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The patient weighing 147 pounds with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 30, temperature 104° F, and blood glucose 391 mg/dL. Which intervention red by the health care provider should the nurse implement first?

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Naxlex Comprehensive Predictor Exams

A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3 hours. The pulse rate is 120/minute and the central venous pressure and pulmonary artery wed pressure are low. Which order by the health care provider will the nurse question?

Correct Answer is C

Explanation

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

Correct Answer is B

Explanation

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