Norepinephrine (Levophed) has been ordered for the patient in hypovolemic shock. Before administering the drug, the nurse ensures that the

patient's heart rate is less than 100.

patient has received IV fluid replacement boluses.

patient's urine output is within normal range.

patient is not receiving other sympathomimetic drugs.

Answer and Explanation

The Correct Answer is B

Rationale:

A. There is no strict requirement for the patient’s heart rate to be below 100 before starting norepinephrine. Tachycardia is a normal compensatory mechanism in hypovolemic shock, as the body attempts to maintain cardiac output in the setting of decreased circulating volume. Administering norepinephrine will increase vascular resistance, which may further elevate heart rate temporarily. Focusing solely on heart rate without addressing volume status would not correct the underlying problem.

B. This is the most critical step. Hypovolemic shock is caused by a significant loss of circulating blood or fluid, resulting in low preload (the volume of blood returning to the heart), decreased stroke volume, and hypotension. Vasopressors like norepinephrine act primarily to constrict blood vessels and raise systemic vascular resistance, which increases blood pressure. However, if the intravascular volume is severely depleted, vasoconstriction alone cannot restore adequate cardiac output or tissue perfusion. Administering norepinephrine before fluid resuscitation can worsen organ ischemia, particularly in the kidneys, heart, and gastrointestinal tract, because there is not enough circulating volume to perfuse tissues despite the increased vascular tone. Therefore, ensuring adequate fluid replacement through IV boluses is a prerequisite to safely and effectively using norepinephrine in hypovolemic shock.

C. Urine output is an important indicator of renal perfusion and organ function. While monitoring it is essential in shock management, it is not a requirement before starting norepinephrine. Urine output may already be low in hypovolemic shock due to reduced renal perfusion, and fluid resuscitation is aimed at improving it. Norepinephrine can help maintain blood pressure and organ perfusion, but it cannot correct volume depletion alone.

D. Concurrent use of other sympathomimetics can increase the risk of excessive vasoconstriction, arrhythmias, or hypertension. While this is important to consider, the priority in hypovolemic shock is restoring circulating volume, not avoiding drug interactions, because volume replacement is the cornerstone of treatment.

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Correct Answer is C

Explanation

Rationale:
A. Hypertension is not expected in hypovolemic shock. Early in shock, compensatory mechanisms may maintain blood pressure, but as fluid loss continues, hypotension typically develops due to decreased circulating volume and reduced cardiac output.

B. Flushing of the skin is usually associated with distributive shock (e.g., septic or neurogenic) where vasodilation occurs. In hypovolemic shock, the skin is more often pale, cool, and clammy due to peripheral vasoconstriction as the body shunts blood to vital organs.

C. Oliguria (decreased urine output) is an expected finding in hypovolemic shock. Reduced circulating volume decreases renal perfusion, activating the renin-angiotensin-aldosterone system, which conserves water and sodium. This leads to concentrated urine and oliguria, reflecting decreased kidney perfusion and an early sign of organ hypoperfusion.

D. Bradypnea is not typical in hypovolemic shock. Patients often exhibit tachypnea as a compensatory response to maintain oxygen delivery to tissues. Bradypnea would indicate central nervous system depression or respiratory failure rather than hypovolemia.

A. Heart rate 160 beats/min. B. Cyanotic skin. C. Blood pressure 115/74. D. Hypoglycemia.

Correct Answer is A

Explanation

Rationale:
A. In the compensatory (early) stage of shock, the body activates mechanisms to maintain perfusion to vital organs. Sympathetic nervous system stimulation increases heart rate (tachycardia) to maintain cardiac output despite decreased circulating volume. A heart rate of 160 beats/min reflects this compensatory response.
B. Cyanotic or mottled skin occurs in the progressive or decompensated stage of shock when tissue perfusion is significantly impaired. In the compensatory stage, skin may appear cool and pale due to vasoconstriction, but frank cyanosis is not yet present.
C. Blood pressure in the compensatory stage is usually maintained within normal limits due to vasoconstriction and increased heart rate. A BP of 115/74 is normal and does not indicate compensatory shock on its own. Hypotension develops later in the progressive stage.
D. Hypoglycemia is not a characteristic finding of the compensatory stage of shock. Early shock may actually lead to hyperglycemia due to stress hormone release (catecholamines and cortisol), which increases gluconeogenesis and glycogenolysis.

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Norepinephrine (Levophed) has been ordered for the patient in hypovolemic shock. Before administering the drug, the nurse ensures that the

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has hypovolemic shock. Which of the following should the nurse recognize as an expected finding?

Correct Answer is C

Explanation

A nurse is caring for a client who is in the compensatory stage of shock. Which of the following findings should the nurse expect?

Correct Answer is A

Explanation

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