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A client with hypovolemic shock who did not respond to fluid resuscitation is started on norepinephrine. What is the desired outcome?

A.

Urine output of less than 0.5mL/kg

B.

Improved mental status, decreased lactate level

C.

A mean arterial pressure (MAP) of 65

D.

A pain level of 4 or less on a scale of 0-10

Answer and Explanation

The Correct Answer is C

A. Urine output of less than 0.5 mL/kg

Norepinephrine is a vasopressor used to improve perfusion. A urine output of less than 0.5 mL/kg suggests ongoing hypoperfusion and inadequate organ perfusion, which is an undesirable outcome.

B. Improved mental status, decreased lactate level

These are positive indicators of improved perfusion and oxygen delivery, but they are not the primary target for norepinephrine therapy.

C. A mean arterial pressure (MAP) of 65

A MAP of at least 65 mmHg is the target for vasopressor therapy, as it ensures adequate perfusion of vital organs.

D. A pain level of 4 or less on a scale of 0-10

While pain management is important, norepinephrine’s primary role is not pain control but rather maintaining adequate perfusion.


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Related Questions

Correct Answer is B

Explanation

A. Assessment of neurologic status
While neurological assessment is important, it is not the priority in this situation. The immediate priority is managing the chest wound and airway to ensure oxygenation and prevent further complications.

B. Obtain IV access with two large bore lines and blood for lab studies
IV access is important for fluid resuscitation and medication administration but is not the immediate priority compared to securing the airway and ensuring ventilation.

C. Placement of a naso-gastric tube to decompress the stomach
Although the naso-gastric tube may be necessary to decompress the stomach later, it is not the priority in the initial management of a client with a gunshot wound to the chest.

D. Placement of an indwelling catheter (Foley) to measure urine output
While measuring urine output is important for monitoring renal function and fluid balance, it is not the priority in this emergency situation.

Correct Answer is B

Explanation

A. is expected to be decreased for three to five days.
In the initial stages following severe burn injury, there is often oliguria (low urine output), but this is typically followed by diuresis (increased urine output) after the first 24-48 hours, not a decrease over 3-5 days.

B. will be reduced in the first 24-48 hours and will then increase.
In the first 24-48 hours following a severe burn injury, the body may undergo a state of hypovolemia and oliguria. As fluid resuscitation begins, urine output typically increases.

C. output will be greatest in the first 24 hours after the burn injury.
Although urine output may increase with proper fluid resuscitation, it is not usually greatest in the first 24 hours; the increase typically happens after the initial resuscitation period.

D. will be elevated due to the amount of intravenous fluids administered during the initial phases of treatment.
While fluid resuscitation leads to an increase in urine output after the first 24-48 hours, it is not expected to be elevated right away. The kidneys may initially respond with oliguria.

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