Which of these would the nurse implement as the priority action for the patient with newly diagnosed septic shock?
Provide ordered enteral nutrition.
Monitor ordered IV fluids.
Obtain blood cultures before antibiotics.
Give broad-spectrum antibiotics within one hour of septic shock diagnosis.
The Correct Answer is D
Choice A reason: While nutrition is important, it is not the immediate priority in the management of septic shock.
Choice B reason: Monitoring IV fluids is important, but the initial priority is to treat the infection causing the septic shock.
Choice C reason: Obtaining blood cultures is important, but it should not delay the administration of antibiotics.
Choice D reason: The administration of broad-spectrum antibiotics within one hour of diagnosing septic shock is critical to improve outcomes and is considered a priority action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: A urine output of 18 mL/hr is significantly lower than the normal range (typically around 0.5-1 mL/kg/hr), indicating possible renal hypoperfusion, an early sign of shock.
Choice B reason: While blood pressure is an important indicator, it may not drop until later stages of shock.
Choice C reason: Lethargy can be a sign of shock, but it is a more subjective and later symptom compared to the objective measure of urine output.
Choice D reason: An elevated pulse is a compensatory mechanism in shock, but it is not as specific an early indicator as a decrease in urine output.
Correct Answer is D
Explanation
Choice A reason: OCD is not characterized by an unconscious need to manipulate others but by anxiety-driven compulsions.
Choice B reason: While clients with OCD may feel a need to clean due to contamination fears, it is not a delusion but rather an obsession that drives the compulsion.
Choice C reason: The repetitive cleaning is not typically a conscious choice to decrease social interaction but a compulsion to alleviate anxiety.
Choice D reason: Repetitive behaviors in OCD, such as cleaning, are attempts to decrease the anxiety caused by obsessive thoughts.
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