Nokea
The nurse is caring for a patient with septic shock who has had a urine output of 20 ml/hour for the past 3 hours. The pulse rate is 120 and the central venous pressure and pulmonary artery wedge pressure are low. Which of the following orders by the health care provider should the nurse question?
- A. Administer furosemide 40 mg IV
- B. Increase normal saline infusion to 150 ml/hour
- C. Administer hydrocortisone 100 mg IV
- D. Administer dopamine 5 mcg/kg/minute IV
Correct Answer: A
Rationale: Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock, who already has low central venous pressure and pulmonary artery wedge pressure, indicating hypovolemia. The other orders are appropriate to improve perfusion and manage septic shock.
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The new RN is being mentored while caring for a patient with neurogenic shock. Which of the following actions by the new RN indicates a need for further teaching?
- A. Keeping the room temperature at 75°F to prevent hypothermia
- B. Checking the heart rate every 1-2 hours
- C. Preparing to administer prescribed IV atropine
- D. Increasing the nitroprusside infusion rate for a patient with a high SVR
Correct Answer: D
Rationale: Increasing the nitroprusside infusion rate is inappropriate for neurogenic shock, as it is a vasodilator and could worsen hypotension. The other actionsâ??maintaining warm room temperature, monitoring heart rate, and preparing atropineâ??are appropriate for managing neurogenic shock, which involves bradycardia and hypothermia risk.
The nurse is caring for a patient with septic shock who has a BP of 70/46 mm Hg, pulse 136, respirations 32, temperature 40°C, and arterial oxygen saturation of 88%. Which of the following interventions should the nurse implement first?
- A. Administer acetaminophen 650 mg via nasogastric tube
- B. Give drotrecogin-?± IV
- C. Administer oxygen via non-rebreather mask
- D. Infuse normal saline 500 mL over 30 minutes
Correct Answer: C
Rationale: Administering oxygen via a non-rebreather mask is the priority to address the patient's low oxygen saturation (88%) and ensure adequate oxygenation in septic shock. Other interventions, such as fluids, drotrecogin-?±, or acetaminophen, are important but secondary to correcting hypoxemia.
Which of the following interventions should the nurse implement first when a patient in the emergency department develops anaphylactic shock?
- A. Administer normal saline 500 mL IV
- B. Insert a second IV catheter
- C. Administer epinephrine 0.3 mg intramuscularly
- D. Start a dopamine infusion at 5 mcg/kg/minute
Correct Answer: C
Rationale: Epinephrine is the first-line treatment for anaphylactic shock, as it rapidly reverses vasodilation, bronchoconstriction, and histamine effects. Fluid resuscitation, additional IV access, and vasopressors like dopamine are secondary actions after epinephrine administration.
The nurse is assessing a patient who is receiving a nitroprusside infusion to treat cardiogenic shock. Which of the following findings indicates that the medication is effective?
- A. No heart murmur is audible
- B. Skin is warm and dry
- C. Troponin level is decreased
- D. Blood pressure is 90/40 mm Hg
Correct Answer: B
Rationale: Warm, dry skin indicates improved tissue perfusion, a sign that nitroprusside, a vasodilator, is effective in reducing afterload and improving cardiac output in cardiogenic shock. Low blood pressure, absence of a heart murmur, or decreased troponin levels are not specific indicators of nitroprusside's effectiveness.
Which of the following information obtained by the nurse when caring for a patient who has cardiogenic shock indicates that the patient may be developing multiple organ dysfunction syndrome (MODS)?
- A. The patient's serum creatinine level is elevated
- B. The patient complains of intermittent chest pressure
- C. The patient has crackles throughout both lung fields
- D. The patient's extremities are cool and pulses are weak
Correct Answer: A
Rationale: An elevated serum creatinine level indicates renal failure, a sign of MODS in the context of cardiogenic shock. Crackles, chest pressure, and cool extremities are consistent with cardiogenic shock but do not specifically indicate MODS.