Which of the following medications is commonly used for afterload reduction in critical care?

Nitroglycerin

Metoprolol

Furosemide

Epinephrine

Answer and Explanation

The Correct Answer is A

A. Nitroglycerin is a vasodilator commonly used to reduce preload and afterload in critical care settings. By dilating blood vessels, nitroglycerin decreases systemic vascular resistance (afterload), which reduces the workload on the heart and improves cardiac output. It is often used to manage conditions such as acute heart failure, hypertensive emergencies, and acute coronary syndromes.

B. Metoprolol is a beta-blocker that primarily acts to reduce heart rate and myocardial contractility. While it can indirectly reduce afterload by lowering blood pressure, its primary mechanism of action is not targeted at afterload reduction. Metoprolol is commonly used in critical care for various indications, including hypertension, myocardial infarction, and heart failure, but it is not primarily used for afterload reduction.

C. Furosemide is a loop diuretic commonly used to manage volume overload and reduce preload in critical care settings. By promoting diuresis, furosemide decreases circulating blood volume, venous return, and preload, which indirectly reduces afterload. However, its primary mechanism of action is not targeted at afterload reduction but rather at reducing volume overload.

D. Epinephrine is a potent sympathomimetic agent that acts on alpha and beta-adrenergic receptors. While it can increase systemic vascular resistance (afterload) at higher doses due to its alpha-adrenergic effects, it is not commonly used for afterload reduction in critical care settings. Epinephrine is primarily used as a vasopressor to increase blood pressure and cardiac output in patients with shock or cardiac arrest.

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Correct Answer is ["C","D","E","F"]

Explanation

A. Administering antibiotics helps target the suspected infection and prevent its spread. Broad-spectrum antibiotics are typically initiated until the specific pathogen is identified through cultures. This action should be completed as soon as possible within the first hour.

D. Lactate measurement is important in assessing tissue perfusion and the severity of sepsis. Elevated lactate levels indicate tissue hypoperfusion and can help identify patients at higher risk of mortality. Monitoring lactate levels guides resuscitation efforts and helps in assessing the response to treatment.

E. Fluid resuscitation is a cornerstone in the management of sepsis. Administering a large volume of intravenous fluids helps restore intravascular volume, improve tissue perfusion, and prevent further organ dysfunction. The recommended initial fluid bolus is 30 ml/kg of crystalloid solution, such as normal saline, administered rapidly within the first few hours of recognition of sepsis.

F. Blood cultures help identify the causative organism(s) responsible for the sepsis. This information is crucial for guiding antibiotic therapy, especially in cases of severe sepsis or septic shock. Blood cultures should be obtained before initiating antibiotic therapy to maximize their sensitivity and specificity.

B. Type and cross-match for packed red blood cells (PRBCs) are indicated in situations where blood transfusion may be required, such as severe anemia or active bleeding. While sepsis can lead to various complications, such as disseminated intravascular coagulation (DIC), the priority in the first hour is resuscitation and antibiotic administration.

G. Obtaining a urine specimen may be indicated to assess for urinary tract infection (UTI), which can be a potential source of sepsis. However, in the initial management of sepsis, obtaining blood cultures (option F) takes precedence as blood cultures provide more critical information for guiding antibiotic therapy.

H. Obtaining a wound culture may help identify the specific pathogens present in the wound and guide antibiotic therapy if the wound is suspected to be the source of sepsis. However, in the first hour of managing sepsis, the priority is to initiate broad-spectrum antibiotics and obtain blood cultures, as these interventions are more urgent in preventing further complications from sepsis.

A. Insertion of a pulmonary artery catheter B. Obtaining a ventilation-perfusion scan C. Drawing blood for arterial blood gases D. Positioning the patient for a chest x-ray

Correct Answer is A

Explanation

A. The insertion of a pulmonary artery catheter can help in assessing hemodynamic parameters and distinguishing between these two conditions. It provides direct measurement of pulmonary artery pressures, which can be elevated in the case of heart failure.

B. A ventilation-perfusion (V/Q) scan is used to evaluate ventilation and perfusion in the lungs. While it can help identify areas of ventilation-perfusion mismatch, it may not be the most appropriate initial test for distinguishing between ARDS and pulmonary edema.

C. Drawing blood for arterial blood gases is also a critical step as it helps in assessing the severity of hypoxemia and respiratory failure.

D. A chest x-ray can show the presence of bilateral opacities, which are indicative of ARDS when cardiac failure or fluid overload is not the primary cause. However, transthoracic echocardiography (TTE) is often performed to seek evidence of cardiac dysfunction when cardiogenic pulmonary edema cannot be excluded by clinical evaluation, laboratory findings, or imaging.

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Which of the following medications is commonly used for afterload reduction in critical care?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a 73-year-old client in the emergency department (ED) Exhibits It has been identified that the client is in sepsis. Select the 4 actions that the nurse should complete in the first hour to manage sepsis and prevent further complications?

Correct Answer is ["C","D","E","F"]

Explanation

A patient develops increasing dyspnea and hypoxemia 2 days after heart surgery. What procedure should the nurse anticipate assisting with to determine whether the patient has acute respiratory distress syndrome (ARDS) or pulmonary edema caused by heart failure?

Correct Answer is A

Explanation

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