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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Free Nursing Study Resources

Correct Answer is D

Explanation

D. Atrial fibrillation can lead to irregular and often rapid heart rates, resulting in discrepancies between the apical (heart) and radial (peripheral) pulses. In atrial fibrillation, the atria fibrillate instead of contracting effectively, leading to irregular and sometimes asynchronous ventricular contractions. This irregularity may result in a pulse deficit, where the number of apical beats exceeds the number of radial pulses felt at the wrist.

A. Different blood pressures in the upper limbs may indicate conditions such as aortic dissection or arterial stenosis, but they are not typically associated with atrial fibrillation. Atrial fibrillation primarily affects the heart rhythm rather than blood pressure distribution.

B. Differences in upper and lower lung sounds may indicate conditions such as pneumonia or pleural effusion, but they are not specific to atrial fibrillation. Atrial fibrillation primarily affects the heart's electrical activity rather than respiratory findings.

C. Differences between oral and axillary temperatures may indicate localized variations in temperature, such as infection or inflammation, but they are not specific to atrial fibrillation. Atrial fibrillation primarily affects cardiac rhythm rather than body temperature regulation.

A. Left ventricular failure B. Fluid overload C. Hypovolemia D. Intracardiac shunt

Correct Answer is C

Explanation

C. Hypovolemia, or low blood volume, can lead to decreased venous return to the heart and reduced filling pressures. Consequently, CVP may decrease in hypovolemic states. Low CVP may indicate inadequate preload and reduced cardiac output, which are characteristic of hypovolemia.

A. Left ventricular failure typically results in elevated filling pressures rather than low CVP. In left ventricular failure, blood backs up into the pulmonary circulation, leading to increased pulmonary venous pressure and potentially elevated pulmonary capillary wedge pressure (PCWP), which is a surrogate marker for left atrial pressure. This elevated pressure is reflected in the CVP as well, resulting in increased CVP rather than low CVP.

B. Fluid overload typically results in elevated filling pressures and increased CVP rather than low CVP. Excess fluid volume increases venous return to the heart, leading to increased pressure within the central veins and elevated CVP.

D. Intracardiac shunts may cause alterations in cardiac pressures, but they typically do not result in consistently low CVP. Depending on the type and severity of the shunt, the direction and magnitude of pressure changes may vary. However, in the absence of other pathophysiological factors, intracardiac shunts are less likely to cause consistently low CVP.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has pericarditis and reports feeling a new onset of palpitations and shortness of breath. Which of the following assessments should indicate to the nurse that the client may have developed atrial fibrillation?

Correct Answer is D

Explanation

A nurse is evaluating the central venous pressure (CVP) of a client who has sustained multiple traumas. Which of the following interpretations of a low CVP pressure should the nurse make?

Correct Answer is C

Explanation

A nurse is caring for a client who is postoperative and whose respirations are shallow and 9/min. Which of the following acid-based imbalances should the nurse identify the client as being at risk for developing initially?

Which statement by the nurse when explaining the purpose of positive end-expiratory pressure (PEEP) to the patient's caregiver is accurate?

A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload?

Mr Jones came to the ER complaining of chest palpitations. He states his heart feels like it is "racing". The nurse found the following rhythm on the monitor. What is the next step would the nurse expect to take first?

A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. What procedure should the nurse anticipate assisting with to determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure?

A nurse is conducting a primary survey of a client who has sustained life-threatening injuries due to a motor-vehicle crash. Identify the sequence of actions the nurse should take. (Move the actions into the box on the right, placing them in the selected order of performance. Use all the steps.)