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 C

Explanation

Choice A rationale
Reducing the overall contractility of the heart muscle is not the primary reason for performing Coronary Artery Bypass Surgery (CABG)4. In fact, reducing the contractility of the heart muscle could potentially decrease the heart’s ability to pump blood effectively.
Choice B rationale
Reducing plaque buildup in the carotid artery is not the primary reason for performing CABG4. While plaque buildup in the carotid artery can lead to serious conditions such as stroke, CABG is specifically performed to bypass blocked coronary arteries, not carotid arteries.
Choice C rationale
Increasing the oxygen supply to the heart muscle is the primary reason for performing CABG4. When coronary arteries become blocked or narrowed due to plaque buildup, the heart muscle may not receive enough oxygen-rich blood. CABG is performed to create a new route, or bypass, around the blocked artery, which improves blood flow and oxygen supply to the heart muscle.
Choice D rationale
Increasing the myocardial workload is not the primary reason for performing CABG4. In fact, increasing the workload of the heart could potentially exacerbate heart disease and lead to complications such as heart failure.

A. Decreased blood pressure. B. Decreased urine output. C. Increased appetite. D. Increased fluid retention.

Correct Answer is A

Explanation

Choice A rationale
Vasotec, an Angiotensin-Converting Enzyme (ACE) inhibitor, is commonly used to treat conditions like high blood pressure and heart failure. It works by relaxing blood vessels, which allows blood to flow more easily and reduces blood pressure.
Choice B rationale
Decreased urine output is not a typical outcome of taking Vasotec. In fact, ACE inhibitors like Vasotec can sometimes increase urine output by improving kidney function.
Choice C rationale
Increased appetite is not a known effect of Vasotec. If a patient experiences a significant change in appetite while taking this medication, they should consult their healthcare provider.
Choice D rationale
Increased fluid retention is not a typical outcome of taking Vasotec. ACE inhibitors like Vasotec are often used to help reduce fluid retention in patients with conditions like heart failure.

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Naxlex Comprehensive Predictor Exams

What is the primary pathophysiological reason for performing Coronary Artery Bypass Surgery?

Correct Answer is C

Explanation

What positive outcome should a nurse anticipate in a patient taking Vasotec, an Angiotensin-Converting Enzyme (ACE) inhibitor?

Correct Answer is A

Explanation

You’re providing care to four patients. Select all the patients who are at risk for developing sepsis:

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?

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

A nurse is caring for a client on a cardiac monitor. The patient’s heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. What is the first action the nurse should take?

The nurse is caring for a client with weak pedal pulses, absent hair on bilateral legs, and a full-thickness wound on the right lateral malleolus with defined margins, including a minimal amount of serous exudate. Which of the following interventions is contraindicated?

In the context of a patient who has undergone coronary artery bypass grafting using a right radial artery graft, which observation is most crucial for the nurse to report to the healthcare provider?

A client is admitted to the telemetry unit due to an episode of substernal chest pain. Diagnostic tests reveal an elevated ST segment on the electrocardiogram (ECG) and an increased cardiac troponin level. What would be an appropriate initial nursing intervention?

A patient with Peripheral Arterial Disease (PAD) has recently undergone Percutaneous Transluminal Angioplasty (PTA) of the lower extremity. Which assessment is crucial for the nurse to perform post-procedure?