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

Answer and Explanation

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.

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Correct Answer is D

Explanation

Choice A rationale
Aortic regurgitation is a condition where the aortic valve doesn’t close tightly, causing blood to leak back into the left ventricle. This condition can lead to left heart failure but is not typically associated with right heart failure.
Choice B rationale
Mitral regurgitation is a disorder in which the mitral valve on the left side of the heart does not close properly. This condition can lead to left heart failure but is not typically associated with right heart failure.
Choice C rationale
Aortic stenosis is a narrowing of the aortic valve opening. This condition can lead to left heart failure but is not typically associated with right heart failure.
Choice D rationale
Tricuspid regurgitation is a disorder in which the heart’s tricuspid valve does not close properly, causing blood to flow backward into the right atrium. This condition can lead to right heart failure, especially when associated with pulmonary hypertension.

A. A 39-year-old patient who has right calf tenderness and swelling after a plane ride B. A 58-year-old patient taking anticoagulants for atrial fibrillation who has black stools C. A 67-year-old patient who has a gangrenous foot ulcer with a weak pedal pulse D. A 50-year-old patient who is reporting sudden sharp and severe upper back pain .

Correct Answer is D

Explanation

Choice A rationale
While calf tenderness and swelling after a plane ride could potentially indicate a deep vein thrombosis, this condition is not immediately life-threatening in most cases. The patient would need evaluation and treatment, but other patients might have more urgent needs14.
Choice B rationale
A patient taking anticoagulants for atrial fibrillation who has black stools could potentially have gastrointestinal bleeding, which would need evaluation. However, this condition might not be immediately life-threatening, and other patients might have more urgent needs14.
Choice C rationale
A patient with a gangrenous foot ulcer and a weak pedal pulse would need evaluation and treatment. However, this condition might not be immediately life-threatening, and other patients might have more urgent needs14.
Choice D rationale
A patient reporting sudden sharp and severe upper back pain could potentially have an aortic dissection, which is a life-threatening condition that requires immediate evaluation and treatment. Therefore, this patient should be assessed first14.

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Naxlex Comprehensive Predictor Exams

A 35-year-old patient presents with pulmonary hypertension and is diagnosed with right heart failure. What is the most likely cause of this condition?

Correct Answer is D

Explanation

After receiving a change-of-shift report, which patient admitted to the emergency department should the nurse assess first?

Correct Answer is D

Explanation

If a patient diagnosed with hypertension is prescribed Propranolol (Inderal), what patient history should prompt the nurse to consult with the healthcare provider before administering this drug?

How would a nurse best describe the assessment of stasis dermatitis in a patient with peripheral vascular disease (PVD)?

A woman has recently been diagnosed with Raynaud’s disease. What important information should the nurse provide to this patient?

What should a nurse inquire about from a patient with a past history of Deep Vein Thrombosis (DVT) and other vascular issues?

When caring for a client who has developed cardiac tamponade, what assessments should the nurse expect to find?

A patient has been admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI). The patient is restless, anxious, has a blood pressure of 86/40 mm Hg, and a heart rate of 132 beats/min. What is the priority problem for this patient?

A 56-year-old individual visits his primary care provider for a routine checkup.The physical examination reveals edema, an enlarged liver (hepatomegaly), and muffled heart sounds. Which of the following findings should the nurse be most concerned about?