A 55-year-old male client is admitted with a diagnosis of acute hepatitis B with fever. Which of the following orders should the nurse question?

A. The drug should be discontinued immediately after blood pressure increases: Stopping norepinephrine abruptly can cause a sudden drop in blood pressure. Vasoactive drugs must be adjusted gradually to maintain stable perfusion as the client responds. Sudden withdrawal places the client at risk for rapid hemodynamic deterioration.

B. The drug dose should be tapered down once vital signs improve: Vasoactive drugs like norepinephrine require gradual titration based on the client’s hemodynamic response to avoid abrupt shifts in perfusion. As blood pressure and cardiac stability improve, doses are slowly reduced while monitoring for recurrent hypotension.

C. The client should have arterial blood gases drawn every 10 minutes during treatment: Frequent ABGs are unnecessary and impractical unless the client is experiencing severe respiratory instability. Hemodynamic monitoring, vital signs, and urine output provide more precise ongoing indicators of perfusion during vasoactive therapy.

D. The infusion rate should be titrated according to client's subjective sensation of adequate perfusion: Clients in shock cannot reliably assess their own perfusion status due to impaired cognition, altered mental status, or stress. Vasoactive medications must be titrated based on objective data such as MAP, blood pressure, and urine output.

A. Cardiac monitor shows a pulse rate of 204: A markedly elevated heart rate is expected during the early burn-shock phase due to pain, stress, and circulating catecholamines. Although it indicates a hypermetabolic and hypovolemic state, it is not as specific for inadequate fluid resuscitation as reduced urine output, so it is not the most urgent finding.

B. Serous exudate is leaking from the burns: Plasma leakage from damaged capillaries is normal in the first 24–48 hours after a major burn. While this contributes to hypovolemia, its presence alone does not indicate a worsening condition and does not require immediate provider notification compared with signs of renal hypoperfusion.

C. Urine output is 20 mL for the past 2 hours: This extremely low output is a key indicator of inadequate renal perfusion during the resuscitation period. Clients with major burns should maintain 30–50 mL/hr to ensure the kidneys are receiving adequate circulation, making this the most critical finding to report promptly.

D. Blood pressure is 94/50 per arterial line: Borderline hypotension commonly occurs during early burn shock because of fluid shifts into the interstitial space. Although concerning, it is less reliable than urine output for assessing end-organ perfusion.