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

Answer and Explanation

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.

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Correct Answer is B

Explanation

B. Experiencing depression following a disaster is a common response. Survivors often experience a range of emotional responses, including depression, due to the trauma and loss associated with the event.
A. The depression is more likely related to the traumatic event rather than a pre-existing condition.
C. While survivors may struggle with feelings of guilt or disbelief, the focus should be on understanding the depression as a response to the trauma experienced.
D. Although feelings of guilt may be present, it is more pertinent to address the depression as a common mental health issue following a traumatic event.

A. Current anticoagulant use B. Blood pressure of 160/85 mm Hg C. Complete neurologic assessment D. Current treatment for client's peptic ulcer disease

Correct Answer is A

Explanation

A. Current anticoagulant use is crucial to assess before administering t-PA because combining t-PA with anticoagulants can significantly increase the risk of bleeding complications. It is essential to ensure that the client is not on medications that could interact adversely with t-PA.
B. While blood pressure is important to monitor, it is secondary to assessing anticoagulant use since high blood pressure alone does not contraindicate t-PA administration.
C. A complete neurologic assessment is important for determining the extent of the stroke but is not the immediate priority before administering t-PA.
D. While treatment for peptic ulcer disease is relevant, it is not directly related to the immediate risk factors for t-PA administration compared to anticoagulant use.

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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?

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