The nurse recognizes which client as being at highest risk for septic shock?

82-year-old with leukemia receiving broad-spectrum IV antibiotics via a triple-lumen central line.

35-year-old with HIV receiving enteral feedings via a percutaneous endoscopic gastrostomy (PEG) tube.

12-year-old with open fracture of the left femur and two peripheral IVs.

65-year-old with pneumonia receiving IV fluids and broad-spectrum oral antibiotics.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Advanced age and leukemia significantly compromise the immune system through decreased white blood cell function. A triple-lumen central line provides a direct vascular portal for opportunistic pathogens, increasing the risk of healthcare-associated infections. Leukemia results in neutropenia, where absolute neutrophil counts often fall below 1500 cells/mm, hindering the body's ability to mount an inflammatory response. Consequently, this patient is at the highest statistical risk for developing overwhelming systemic infection and subsequent septic shock.

Choice B rationale

While HIV causes immunodeficiency by depleting CD4+ T-lymphocytes, typically defined as fewer than 500 cells/mm in symptomatic stages, the use of a PEG tube for enteral feeding is a relatively closed system compared to a central venous catheter. While the risk of peritonitis or localized site infection exists, it does not carry the same immediate high-level risk of direct bloodstream seeding as a central line in an elderly, neutropenic patient with a hematologic malignancy.

Choice C rationale

A pediatric patient with an open fracture faces risks related to osteomyelitis or localized tissue infection from environmental contaminants. However, younger patients generally possess more robust physiological reserves and more active immune systems compared to the elderly. Peripheral IVs carry a lower risk of systemic bacteremia than central venous access devices. While serious, an open fracture in a 12-year-old is less likely to progress rapidly to septic shock than a central line infection in leukemia.

Choice D rationale

Pneumonia is a common precursor to sepsis, but a 65-year-old receiving oral antibiotics is likely hemodynamically stable and managing the infection at a localized pulmonary level. The use of oral rather than IV antibiotics suggests a less severe clinical presentation. While the elderly are vulnerable, the absence of profound immunosuppression or invasive central vascular access makes this individual a lower risk for immediate septic shock compared to the patient described in Choice A.

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Correct Answer is C

Explanation

Choice A rationale

Acute respiratory distress syndrome involves diffuse alveolar damage and noncardiogenic pulmonary edema causing severe hypoxemia. While the pulse oximetry reading of 86 percent is consistent with the hypoxemia found in this syndrome, the clinical hallmark is bilateral infiltrates on a chest radiograph. This condition does not typically cause the mechanical shifting of mediastinal structures. Therefore, the presence of tracheal deviation makes this diagnosis unlikely compared to other obstructive mechanical pathologies of the thoracic cavity.

Choice B rationale

A pulmonary contusion is essentially a bruise of the lung tissue caused by blunt chest trauma, leading to alveolar hemorrhage and edema. This can certainly cause a pulse oximetry reading of 86 percent due to impaired gas exchange at the capillary level. However, a contusion is a parenchymal injury and does not create the positive pressure required to shift the trachea. Normal oxygen saturation is 95 percent to 100 percent, so 86 percent indicates significant respiratory compromise.

Choice C rationale

Tension pneumothorax occurs when air enters the pleural space but cannot escape, causing a rapid buildup of positive pressure. This pressure collapses the affected lung and pushes the mediastinum toward the opposite side, resulting in tracheal deviation. The high intrapleural pressure also compresses the vena cava, reducing venous return and cardiac output. This explains the severe dyspnea and the low pulse oximetry reading of 86 percent seen in this life-threatening medical emergency requiring immediate needle decompression.

Choice D rationale

Flail chest results from multiple rib fractures in two or more places, creating a free-floating segment of the chest wall. This causes paradoxical chest movement where the injured area moves inward during inspiration and outward during expiration. While this can lead to severe dyspnea and low oxygen saturation, it does not create the unilateral tension needed to deviate the trachea. Tracheal deviation is a specific sign of tension within the pleural space rather than chest wall instability.

A. To increase cardiac output and MAP. B. To decrease preload. C. To decrease myocardial oxygen consumption. D. To decrease afterload.

Correct Answer is A

Explanation

Choice A rationale

Dopamine is a potent vasopressor and inotropic agent used in septic shock to improve hemodynamic stability. At moderate to high doses, it stimulates beta-1 adrenergic receptors to increase myocardial contractility and alpha-adrenergic receptors to induce peripheral vasoconstriction. These combined actions result in an increased stroke volume and systemic vascular resistance, effectively raising the cardiac output and the mean arterial pressure. This is essential for maintaining adequate tissue perfusion when intravenous fluids alone fail.

Choice B rationale

Dopamine does not primarily act to decrease preload; in fact, its vasoconstrictive properties may increase venous return to the heart, potentially maintaining or slightly increasing preload. Preload reduction is typically achieved through diuretics or venous vasodilators like nitroglycerin. In the context of septic shock, the therapeutic goal is to support blood pressure and flow rather than reducing the volume or pressure within the ventricles before contraction, which could further compromise the patient's precarious hemodynamic state.

Choice C rationale

Dopamine actually increases myocardial oxygen consumption rather than decreasing it. By increasing the heart rate through its chronotropic effects and enhancing the force of contraction through its inotropic effects, the heart must work harder and requires more oxygen. This can be a significant side effect, especially in patients with underlying coronary artery disease. The drug is used in shock because the benefit of improving systemic perfusion outweighs the risk of increased cardiac oxygen demand.

Choice D rationale

Dopamine typically increases afterload because it causes systemic vasoconstriction via alpha-receptors, especially at higher infusion rates. Afterload is the resistance the heart must pump against to eject blood. In septic shock, systemic vascular resistance is pathologically low due to massive vasodilation. Therefore, increasing afterload is a desired therapeutic effect to restore vascular tone and ensure that the mean arterial pressure remains high enough to perfuse vital organs like the brain and kidneys.

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The nurse recognizes which client as being at highest risk for septic shock?

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Naxlex Comprehensive Predictor Exams

The nurse assesses a client with dyspnea, tracheal deviation, and pulse oximetry reading of 86 What is the nurse's interpretation of these findings?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

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