After fluid resuscitation, a patient in septic shock has a decreasing blood pressure and cardiac output. The nurse anticipates the administration of which medication?

Sodium nitroprusside

Norepinephrine

Regular insulin

Nitroglycerin

Answer and Explanation

The Correct Answer is B

A. Sodium nitroprusside: Sodium nitroprusside is a potent arterial and venous vasodilator used primarily in hypertensive emergencies and acute heart failure. In septic shock, systemic vascular resistance is already profoundly decreased due to inflammatory-mediated vasodilation. Administering a vasodilator would further lower blood pressure and worsen hypoperfusion.

B. Norepinephrine: Norepinephrine is the first-line vasopressor for septic shock when hypotension persists after adequate fluid resuscitation. It stimulates alpha-1 adrenergic receptors to increase systemic vascular resistance and beta-1 receptors to enhance myocardial contractility. This improves mean arterial pressure and supports organ perfusion in distributive shock states.

C. Regular insulin: Regular insulin is used to manage hyperglycemia, which is common in critically ill patients due to stress-induced insulin resistance. While glucose control is important, insulin does not address the primary hemodynamic instability of septic shock. It has no direct effect on vascular tone or cardiac output in this context.

D. Nitroglycerin: Nitroglycerin is a venous vasodilator that reduces preload and myocardial oxygen demand, typically used in acute coronary syndromes or heart failure. In septic shock with declining blood pressure and cardiac output, reducing preload would further compromise perfusion. Vasopressor support, not vasodilation, is indicated.

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Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}

Explanation

Rationale for Correct Answers:

Supraventricular tachycardia: The telemetry strip shows a rapid, regular rhythm originating above the ventricles, consistent with supraventricular tachycardia (SVT), and the heart rate is above 150 beats per minute. SVT can cause palpitations, dizziness, or hypotension if sustained, making accurate identification critical for timely intervention.

Administering adenosine: Adenosine is the first-line pharmacologic treatment for stable SVT. It transiently blocks AV nodal conduction, which can terminate the reentrant tachycardia and restore normal sinus rhythm. Administration requires rapid IV push with immediate saline flush and continuous monitoring due to potential transient bradycardia or brief asystole.

Rationale for Incorrect Answers

Atrial fibrillation: This rhythm is irregularly irregular with no identifiable P waves. SVT is regular and very rapid.

Sinus tachycardia: This has a normal P wave before every QRS complex and is typically caused by pain, fever, dehydration, or anxiety. It is not treated with adenosine.

Defibrillation: This is used for life-threatening rhythms such as ventricular fibrillation or pulseless ventricular tachycardia, not stable SVT.

Administering diltiazem: This is commonly used to control ventricular rate in atrial fibrillation, not as first-line treatment for SVT.

A. Administer an injection of epinephrine stat. B. Administer oxygen 4 liters via nasal cannula. C. Administer albuterol 2 puffs stat. D. Have the patient in high Fowler's position in the bed.

Correct Answer is A

Explanation

A. Administer an injection of epinephrine stat: The patient’s symptoms are classic signs of anaphylaxis, a severe IgE-mediated hypersensitivity reaction. Epinephrine is the first-line treatment because it stimulates alpha-1 receptors (causing vasoconstriction to reduce edema and hypotension) and beta-2 receptors (producing bronchodilation). Immediate intramuscular administration prevents airway obstruction and cardiovascular collapse.

B. Administer oxygen 4 liters via nasal cannula: Supplemental oxygen supports oxygenation during respiratory distress but does not reverse the underlying pathophysiology of anaphylaxis. It does not address airway edema, bronchospasm, or vasodilation. Oxygen is an important adjunct after epinephrine, but it is not the priority intervention in a rapidly progressing allergic reaction.

C. Administer albuterol 2 puffs stat: Albuterol is a beta-2 agonist that provides bronchodilation and may help relieve bronchospasm. However, it does not reduce laryngeal edema or counteract systemic vasodilation and hypotension. In anaphylaxis, albuterol is considered secondary therapy and should not delay epinephrine administration.

D. Have the patient in high Fowler's position in the bed: Positioning may help ease breathing effort by optimizing lung expansion. However, it does not treat airway edema, bronchoconstriction, or the systemic vasodilatory effects of anaphylaxis. Supportive measures such as positioning are important but must follow immediate administration of epinephrine.

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After fluid resuscitation, a patient in septic shock has a decreasing blood pressure and cardiac output. The nurse anticipates the administration of which medication?

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Naxlex Comprehensive Predictor Exams

Based on the information in the electronic health record, complete the following sentences using the drop-down lists. The nurse reads the telemetry strip and interprets the client's cardiac rhythm asdropdown. Based on the cardiac rhythm and client assessment, the nurse anticipatesdropdown

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}

Explanation

Correct Answer is A

Explanation

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