A nurse is caring for a client who developed a wound infection. Despite aggressive fluid resuscitation, the client has a blood pressure of 78/50 mm Hg and a heart rate of 136 beats per minute. The nurse contacts the provider. Which of the following orders does the nurse expect to receive from the provider?
Start intravenous norepinephrine 0.1 mcg/kg/min
Administer intravenous vancomycin 1 g every 12 hours
Administer intravenous furosemide 40 mg
Start intravenous dopamine 5 mcg/kg/min
The Correct Answer is A
Choice A reason: Norepinephrine is a vasopressor used to treat septic shock from a wound infection, which causes vasodilation and hypotension. By stimulating alpha-adrenergic receptors, it increases vascular tone, raising blood pressure to improve tissue perfusion. The client’s severe hypotension (78/50 mm Hg) and tachycardia (136 bpm) indicate shock, making norepinephrine an appropriate choice to stabilize hemodynamics.
Choice B reason: Vancomycin treats infections like those caused by methicillin-resistant Staphylococcus aureus, common in wound infections. However, it does not address the client’s immediate hypotension and tachycardia, which indicate septic shock. Antibiotics are crucial for infection source control but do not rapidly correct hemodynamic instability, so this is not the primary order expected now.
Choice C reason: Furosemide, a diuretic, promotes urine output and is used in fluid overload conditions like heart failure. In septic shock with hypotension (78/50 mm Hg), it would worsen hypovolemia by reducing intravascular volume, further decreasing blood pressure and perfusion. This is contraindicated in this scenario, as fluid retention is not the primary issue.
Choice D reason: Dopamine, at 5 mcg/kg/min, primarily enhances cardiac output and renal perfusion but has less potent vasopressor effects than norepinephrine. In septic shock with profound hypotension, norepinephrine is preferred for its stronger vasoconstrictive action to restore blood pressure. Dopamine may be used but is less effective for this client’s severe hemodynamic instability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Elevated troponin is a strong indicator of myocardial infarction, reflecting massive cardiac cell destruction. Troponins are proteins released from damaged cardiomyocytes during ischemia. Their high specificity for cardiac muscle makes them a key biomarker for diagnosing acute myocardial infarction, as levels rise within hours of cell death.
Choice B reason: Decreased hemoglobin indicates anemia or blood loss but is not specific to massive cell destruction in myocardial infarction. It may occur secondary to chronic conditions or bleeding but does not directly reflect acute cardiac tissue damage, unlike troponin, which is a precise marker of cardiomyocyte necrosis.
Choice C reason: Elevated creatinine reflects renal dysfunction, not massive cell destruction in myocardial infarction. It indicates impaired kidney filtration, often due to hypoperfusion or chronic disease. While shock from infarction may cause secondary renal injury, creatinine is not a direct marker of cardiac cell death, unlike troponin.
Choice D reason: Decreased sodium (hyponatremia) may occur in heart failure or fluid overload but is not a marker of massive cell destruction. It reflects electrolyte imbalance, not tissue necrosis. In myocardial infarction, sodium levels are typically unaffected unless complicated by other conditions, making it irrelevant to acute cardiac damage.
Correct Answer is A
Explanation
Choice A reason: Esophageal varices are a major complication of cirrhosis and portal hypertension. Increased portal vein pressure from liver scarring causes collateral vessel formation, including varices in the esophagus. These fragile vessels can rupture, leading to life-threatening gastrointestinal bleeding, requiring urgent monitoring and interventions like band ligation or beta-blockers to reduce risk.
Choice B reason: Pulmonary edema is not directly associated with cirrhosis or portal hypertension. It occurs in heart failure or fluid overload, which may be secondary to other conditions but not a primary complication of liver disease. Cirrhosis complications focus on portal system effects, like varices, rather than pulmonary fluid accumulation.
Choice C reason: Hypoglycemia may occur in end-stage cirrhosis due to impaired gluconeogenesis in the liver, but it is not the primary complication of portal hypertension. Esophageal varices pose a more immediate, life-threatening risk due to potential massive bleeding, making them a higher monitoring priority than metabolic disturbances like hypoglycemia.
Choice D reason: Hypernatremia is not a common complication of cirrhosis or portal hypertension. Cirrhosis may lead to hyponatremia due to impaired water excretion and fluid retention from low albumin and aldosterone dysregulation. Monitoring for varices is more critical, as they pose a direct risk of catastrophic bleeding compared to electrolyte imbalances.
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