A 78-kg patient in septic shock has a pulse rate of 120 beats/min with low central venous pressure and pulmonary artery wedge pressure. After initial fluid volume resuscitation, the patient's urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question?

Give hydrocortisone (Solu-Cortef) 100 mg IV.

Administer furosemide (Lasix) 40 mg IV.

Increase normal saline infusion to 250 ml/hr.

Use norepinephrine to keep systolic BP above 90 mm Hg.

Answer and Explanation

The Correct Answer is B

B. Administering furosemide, a loop diuretic, to a patient in septic shock with low urine output could exacerbate hypovolemia and worsen organ perfusion. It could further reduce preload, exacerbating hypotension, and impairing cardiac output. Loop diuretics are typically contraindicated in hypovolemic shock.

A. Corticosteroids such as hydrocortisone can help improve vascular tone and responsiveness to vasopressors. Given the patient's clinical presentation and lack of response to initial fluid resuscitation, administering hydrocortisone is appropriate.

C. Increasing the fluid infusion rate can help restore intravascular volume and improve organ perfusion. However, caution should be exercised to avoid fluid overload and pulmonary edema.

D .Norepinephrine is a vasopressor commonly used to increase systemic vascular resistance and improve blood pressure in septic shock. It helps maintain perfusion pressure to vital organs, thereby supporting organ function.

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Correct Answer is D

Explanation

D. Oral hygiene is crucial in reducing the risk of VAP as it helps to reduce the bacterial load in the oral cavity, which can be aspirated into the lower respiratory tract. Using a suction toothbrush to mechanically remove dental plaque and bacteria from the teeth and oral mucosa can help to prevent VAP.

A. Elevating the head of the bed to between 30 and 45 degrees (semi-recumbent position) is recommended to prevent aspiration of oral or gastric contents, which can contribute to the development of VAP. This position helps to promote drainage of secretions and reduces the risk of reflux.

B. While maintaining appropriate humidity levels in the ventilator tubing helps to prevent drying of the respiratory mucosa and promote secretion clearance, it does not directly reduce the risk of VAP. Other interventions are more directly related to VAP prevention.

C. Regular turning and repositioning of the client help to prevent pooling of secretions, improve ventilation-perfusion matching, and reduce the risk of pressure ulcers. Turning the client every 2 hours is often recommended to optimize lung expansion and secretion clearance, thereby reducing the risk of VAP.

A. Give hydrocortisone (Solu-Cortef) 100 mg IV. B. Administer furosemide (Lasix) 40 mg IV. C. Increase normal saline infusion to 250 ml/hr. D. Use norepinephrine to keep systolic BP above 90 mm Hg.

Correct Answer is B

Explanation

C. Increasing the fluid infusion rate can help restore intravascular volume and improve organ perfusion. However, caution should be exercised to avoid fluid overload and pulmonary edema.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator- associated pneumonia?

Correct Answer is D

Explanation

Correct Answer is B

Explanation

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