The nurse caring for a client who is post-operative thoracic surgery. An intravenous (IV) fluid bolus is ordered STAT for blood pressure 72/42. Which finding indicates that the client is progressing to septic shock?

Blood pressure of 70/34 after the IV fluid bolus

White blood cell count decreased to 9,500/mm3 from 11,000/mm3

Serum lactate increased to 1.8 mmol/L from 1.2 mmol/L

Urine output of 300mL after the IV fluid bolus

Answer and Explanation

The Correct Answer is A

Choice A reason: Septic shock is defined by persistent hypotension that does not respond to intravenous fluid resuscitation, requiring vasopressors to maintain a mean arterial pressure ≥ 65 mm Hg. A drop in blood pressure to 70/34 despite a bolus is a hallmark indicator of the transition to shock.

Choice B reason: A decrease in white blood cell count toward the normal range (5,000 to 10,000/mm3) generally suggests an improving inflammatory or infectious state. In severe sepsis, a very low WBC (leukopenia) might be seen, but a shift from 11,000 to 9,500 is not a primary indicator of shock.

Choice C reason: While an increase in lactate suggests worsening tissue perfusion, a value of 1.8 mmol/L is still within the normal range (typically < 2.0 mmol/L). In septic shock, one would expect the lactate to rise significantly, usually above 2.0 mmol/L, as anaerobic metabolism becomes more widespread.

Choice D reason: A urine output of 300 mL following a fluid bolus is an excellent clinical sign, suggesting that the kidneys are being well perfused and are responding to the volume expansion. This finding would indicate an improvement in hemodynamic status rather than a progression toward shock.

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Correct Answer is B

Explanation

Choice A reason: Irritable bowel syndrome is a functional gastrointestinal disorder that affects the large intestine but does not typically involve systemic inflammation or significant immunosuppression. While uncomfortable, it does not predispose a relatively young patient to the profound infectious vulnerability required for the development of septic shock.

Choice B reason: Chemotherapy agents frequently induce myelosuppression, specifically neutropenia, which severely compromises the host's immune surveillance and response. An older adult with a diminished absolute neutrophil count is highly susceptible to opportunistic infections that can rapidly escalate into systemic inflammatory response syndrome and subsequent septic shock.

Choice C reason: Being 20% above ideal body weight indicates overweight status or mild obesity. While chronic obesity can be associated with low-grade systemic inflammation and long-term metabolic risks, it is not an independent, acute risk factor for sepsis that carries the same weight as active pharmacological immunosuppression.

Choice D reason: While advanced age is a risk factor for infection, the use of beta blockers for hypertension does not inherently suppress the immune system. Although these medications might mask compensatory tachycardia during the early stages of shock, they do not increase the physiological risk of developing an infection.

A. Sodium 140 mEq/L B. Calcium 9.0 mEq/L C. Arterial pH 7.38 D. Potassium 7.2 mEq/L

Correct Answer is D

Explanation

Choice A reason: A sodium level of 140 mEq/L is perfectly within the normal reference range (135 to 145 mEq/L). It does not provide any diagnostic clues regarding a traumatic crush injury or the subsequent cellular destruction associated with rhabdomyolysis.

Choice B reason: A calcium level of 9.0 mg/dL is within the normal reference range (8.5 to 10.5 mg/dL). In a severe crush injury, one would more likely expect to see hypocalcemia in the early stages as calcium binds to damaged muscle tissues, followed by hypercalcemia later.

Choice C reason: An arterial pH of 7.38 is within the normal physiological range (7.35 to 7.45). Significant crush injuries typically result in metabolic acidosis (a low pH) due to the release of lactic acid and other organic acids from ischemic and necrotic muscle tissues.

Choice D reason: Potassium is the primary intracellular cation. When muscle cells are crushed and destroyed (rhabdomyolysis), massive amounts of potassium are released into the extracellular fluid. A level of 7.2 mEq/L is a critically high value that is highly characteristic of the cell lysis associated with traumatic crush injuries.

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The nurse caring for a client who is post-operative thoracic surgery. An intravenous (IV) fluid bolus is ordered STAT for blood pressure 72/42. Which finding indicates that the client is progressing to septic shock?

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