When assessing the hemodynamic information for a newly admitted patient in shock of unknown etiology, the emergency department nurse will anticipate the administration of large volumes of Lactated Ringers (LR) when which one of the following occurs?

The mean arterial pressure (MAP) is 50 mm Hg.

Cardiac Out (CO) is 4 L/min

Stroke volume 70 ml/beat

The heart rate is 80 bpm.

Answer and Explanation

The Correct Answer is A

Mean arterial pressure (MAP) is a measure of the average pressure within the arteries during one cardiac cycle. It represents the perfusion pressure that drives blood flow to organs and tissues. In the context of shock, a MAP of 50 mm Hg is considered low and indicates inadequate tissue perfusion.
To improve tissue perfusion and restore blood pressure, the nurse would anticipate administering large volumes of intravenous fluids, such as Lactated Ringers (LR). Fluid resuscitation aims to increase intravascular volume and improve cardiac output, ultimately leading to improved tissue perfusion.
B. Cardiac Output (CO) is 4 L/min in (option A) is incorrect because Cardiac output represents the volume of blood pumped by the heart per minute. While a low cardiac output may require intervention, it does not specifically indicate the need for large volumes of fluid administration.
C. Stroke volume is 70 ml/beat in (option C) is incorrect because Stroke volume refers to the volume of blood ejected by the heart with each contraction. While stroke volume can be an important determinant of cardiac output, it alone does not indicate the need for large fluid volumes.
D. The heart rate is 80 bpm in (option D) is incorrect because: Heart rate is the number of heartbeats per minute. While the heart rate can impact cardiac output, it does not provide direct information about fluid resuscitation needs.

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Correct Answer is D

Explanation

Arterial pressure monitoring involves the insertion of an arterial catheter, typically in the radial artery, to directly measure blood pressure. Complications can arise from this invasive procedure, and one potential complication is inadequate blood flow to the hand, leading to numbness or ischemia.
A. The Allen's test is positive in (option A) is incorrect because The Allen's test is performed before arterial catheter insertion to assess the collateral circulation of the hand. A positive Allen test indicates adequate collateral circulation, which is desirable before performing the procedure. However, it does not directly indicate a complication during or after arterial pressure monitoring.
B. The mean arterial pressure (MAP) is 90 mm Hg in (option B) is incorrect because The mean arterial pressure (MAP) represents the average pressure in the arterial system during one cardiac cycle. While changes in MAP can be significant for patient management, it does not specifically indicate a complication of arterial pressure monitoring.
C. The dicrotic notch visible in the waveform in (option C) is incorrect because The dicrotic notch represents the closure of the aortic valve and is a normal finding in arterial waveforms. Its presence does not indicate a complication.

A. Administer hydrocortisone (Solu-Cortef) 100 mg IV. B. Give PRN furosemide (Lasix) 40 mg IV. C. Increase normal saline infusion to 250 mL/hr. D. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg.

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.

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When assessing the hemodynamic information for a newly admitted patient in shock of unknown etiology, the emergency department nurse will anticipate the administration of large volumes of Lactated Ringers (LR) when which one of the following occurs?

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Naxlex Comprehensive Predictor Exams

An arterial catheter is inserted in the right radial artery to monitor a patient's blood pressure. Which information obtained by the nurse indicates that a complication of arterial pressure monitoring may be occurring?

Correct Answer is D

Explanation

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

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