Your patient, post-operative from a gastrointestinal surgery, presents with a temperature of 103.6 'F, heart rate 120, blood pressure 72/42, increased white blood cell count, and respirations of 21. An IV fluid bolus is ordered STAT.
Which of the following findings indicate that the patient is progressing to septic shock? Select all that apply:
Patient requires Metoprolol (Lopresor) STAT
Patient requires Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement
Serum lactate less than 2 mmol/L
Blood pressure of 70/34 after the fluid bolus
Correct Answer : B,D
Choice A rationale
The need for Metoprolol (Lopresor) STAT does not necessarily indicate progression to septic shock. Metoprolol is a beta-blocker used to treat high blood pressure, heart failure, and angina. While it may be used in the management of sepsis to control heart rate, its use does not specifically indicate progression to septic shock.
Choice B rationale
The need for Norepinephrine to maintain a mean arterial pressure (MAP) greater than 65 mmHg despite fluid replacement is a strong indicator of septic shock. Norepinephrine is a vasopressor, a type of medication used to increase blood pressure. In septic shock, vasopressors are often required to maintain adequate blood pressure and organ perfusion despite aggressive fluid resuscitation.
Choice C rationale
A serum lactate level less than 2 mmol/L is generally not indicative of septic shock. Elevated lactate levels can indicate tissue hypoperfusion, a condition that may occur in septic shock. However, a level less than 2 mmol/L is typically considered within the normal range.
Choice D rationale
A blood pressure of 70/34 after the fluid bolus could indicate progression to septic shock. In septic shock, despite aggressive fluid resuscitation, blood pressure often remains dangerously low, which can lead to inadequate blood flow to the organs.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale: Adenosine Adenosine is a naturally occurring substance that relaxes and dilates blood vessels. It also affects the electrical activity of the heart. Adenosine is used to help restore normal heartbeats in people with certain heart rhythm disorders. However, it is not typically used for atrial fibrillation.
Choice B rationale: Diltiazem Diltiazem belongs to a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. Diltiazem also increases the supply of blood and oxygen to the heart. It is used in adults alone or in combination with other medications to treat hypertension (high blood pressure) or symptoms of angina (chest pain). Diltiazem injection is used in adults to treat certain heart rhythm disorders such as atrial fibrillation.
Choice C rationale: Atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. However, it is not typically used for atrial fibrillation.
Choice D rationale: Captopril Captopril is used in adults alone or in combination with other medications to treat high blood pressure (hypertension) and congestive heart failure.
Captopril is also used to improve survival and reduce the risk of heart failure after a heart attack in patients with a heart condition called left ventricular hypertrophy (enlargement of the walls of the left side of the heart)4. However, it is not typically used for atrial fibrillation.
Correct Answer is A
Explanation
Choice A rationale
Standing frequently can help promote blood flow in the legs, which can be beneficial for a patient with arterial insufficiency. This is because standing engages the muscles in the legs, which helps push blood back up towards the heart.
Choice B rationale
Walking without shoes is not typically recommended for patients with arterial insufficiency. This is because these patients often have reduced sensation in their feet and may not notice if they step on something sharp or if a wound develops.
Choice C rationale
Vigorous massage of the legs is not usually recommended for patients with arterial insufficiency. While gentle massage can help promote blood flow, vigorous massage could potentially damage the arteries further.
Choice D rationale
Allowing the legs to dangle dependently often is not typically recommended for patients with arterial insufficiency. This position can actually increase swelling and discomfort in the legs.
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