A 78-kg patient with septic shock has a pulse rate of 120 beats/min with low
central venous pressure and pulmonary artery wedge pressure. Urine output
... [Show More] has
been 30 mL/hr for the past 3 hours. Which order by the health care provider should
the nurse question?
a.
Administer furosemide (Lasix) 40 mg IV.
b.
Increase normal saline infusion to 250 mL/hr.
c.
Give hydrocortisone (Solu-Cortef) 100 mg IV.
d.
Titrate norepinephrine to keep systolic blood pressure (BP) above 90 mm Hg.
a. Administer furosemide (Lasix) 40 mg IV.
A nurse is caring for a patient whose hemodynamic monitoring indicates a blood
pressure of 92/54 mm Hg, a pulse of 64 beats/min, and an elevated pulmonary
artery wedge pressure (PAWP). Which intervention ordered by the health care
provider should the nurse question?
a.
Elevate head of bed to 30 degrees.
b.
Infuse normal saline at 250 mL/hr.
c.
Hold nitroprusside if systolic BP is less than 90 mm Hg.
d.
Titrate dobutamine to keep systolic BP is greater than 90 mm Hg.
c. Hold nitroprusside if systolic BP is less than 90 mm Hg.
The patient's elevated PAWP indicates volume excess in relation to cardiac
pumping ability, consistent with cardiogenic shock. A saline infusion at 250 mL/hrwill exacerbate the volume excess. The other actions will help to improve cardiac
output, which should lower the PAWP and may raise the BP.
A patient with massive trauma and possible spinal cord injury is admitted to the
emergency department (ED). Which assessment finding by the nurse will help
confirm a diagnosis of neurogenic shock?
a.
Inspiratory crackles
b.
Heart rate 45 beats/min
c.
Cool, clammy extremities
d.
Temperature 101.2°F (38.4°C)
b. Heart rate 45 beats/min
Neurogenic shock is characterized by hypotension and bradycardia.
An older patient with cardiogenic shock is cool and clammy. Hemodynamic
monitoring indicates a high systemic vascular resistance (SVR). Which
intervention should the nurse anticipate?
a.
Increase the rate for the dopamine infusion.
b.
Decrease the rate for the nitroglycerin infusion.
c.
Increase the rate for the sodium nitroprusside infusion.
d.
Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion.
c. Increase the rate for the sodium nitroprusside infusion.
Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload,
which will improve cardiac outputAfter receiving 2 L of normal saline, the central venous pressure for a patient who
has septic shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The
nurse will anticipate an order for
a.
furosemide .
b.
nitroglycerin
c.
norepinephrine .
d.
sodium nitroprusside
c. Norepinephrine
When fluid resuscitation is unsuccessful, vasopressor drugs are given to increase
the systemic vascular resistance (SVR) and blood pressure and improve tissue
perfusion.
A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse
128, respirations 28. The pulmonary artery wedge pressure (PAWP) is increased,
and cardiac output is low. The nurse will anticipate an order for which medication?
a.
5% albumin infusion
b.
furosemide (Lasix) IV
c.
epinephrine (Adrenalin) drip
d.
hydrocortisone (Solu-Cortef)
b. furosemide (Lasix) IV
The PAWP indicates that the patient's preload is elevated, and furosemide is
indicated to reduce the preload and improve cardiac output. Epinephrine would
further increase the heart rate and myocardial oxygen demand. 5% albumin would
also increase the PAWP. Hydrocortisone might be considered for septic or
anaphylactic shock.The emergency department (ED) nurse receives report that a seriously injured
patient involved in a motor vehicle crash is being transported to the facility with an
estimated arrival in 5 minutes. In preparation for the patient's arrival, the nurse will
obtain
a.
a dopamine infusion.
c.
lactated Ringer's solution.
b.
a hypothermia blanket.
d.
two 16-gauge IV catheters.
d. two 16-gauge IV catheters.
A patient with multiple trauma may require fluid resuscitation to prevent or treat
hypovolemic shock, so the nurse will anticipate the need for 2 large-bore IV lines
to administer normal saline.
Which finding is the best indicator that the fluid resuscitation for a 90-kg patient
with hypovolemic shock has been effective?
a.
Haemoglobin is within normal limits.
b.
Urine output is 65 mL over the past hour.
c.
Central venous pressure (CVP) is normal.
d.
Mean arterial pressure (MAP) is 72 mm Hg
b. Urine output is 65 mL over the past hour. [Show Less]