A nurse is caring for a client in septic shock. The client is still hypotensive and lethargic following a 2,500 mL fluid bolus of lactated Ringer (LR) solution. Which of the following interventions does the nurse anticipate next?
Epinephrine intramuscular (IM) injection
Norepinephrine intravenous (IV) infusion
Dobutamine intravenous (IV) infusion
Dexamethasone intravenous (IV) injection
The Correct Answer is B
A. Epinephrine IM injection is not appropriate in this scenario, as it is typically reserved for treating anaphylactic shock. It is not used for septic shock where hypotension persists after fluid resuscitation.
B. Norepinephrine IV infusion is the correct choice. It is the first-line vasopressor in septic shock management when a fluid bolus does not adequately raise blood pressure. Norepinephrine works by constricting blood vessels, thereby increasing vascular resistance and blood pressure.
C. Dobutamine IV infusion might be considered if there is evidence of myocardial dysfunction or if additional inotropic support is necessary. However, it is not the immediate next step following fluid resuscitation when addressing persistent hypotension in septic shock.
D. Dexamethasone IV injection is not indicated for treating septic shock directly. It may be used in other contexts, such as treating adrenal insufficiency or reducing inflammation, but it does not play a role in immediate blood pressure management in septic shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Corticosteroids are not typically associated with causing thrombocytopenia. Their primary effects are on the immune system and metabolism.
B. Corticosteroids more commonly cause hypertension due to fluid retention and increased sensitivity to vasoconstrictors, rather than hypotension.
C. Corticosteroids cause immunosuppression by inhibiting the function of various immune cells and reducing the production of inflammatory cytokines. This increases the risk of infections.
D. Anemia is not a direct effect of corticosteroid use. The medication's impact on the bone marrow typically affects the white blood cell count, particularly in causing leukocytosis, rather than leading to anemia.
Correct Answer is C
Explanation
A. Obtaining pulmonary function tests can help assess the extent of respiratory involvement but is not the immediate priority in an emergency situation like anaphylaxis.
B. Assessing blood pressure is important to monitor for signs of shock, but administering epinephrine takes precedence in treating anaphylaxis.
C. Administering epinephrine is the first-line treatment for anaphylaxis. Epinephrine rapidly reverses the symptoms of anaphylaxis, such as airway constriction and low blood pressure, making it the highest priority intervention.
D. Assessing the client's level of consciousness is important but should occur after the administration of epinephrine, which is critical in reversing the anaphylactic reaction.
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