Your patient is a 54-year-old male who was admitted to the hospital with a severe wound infection in his leg. He is malnourished and in poor health before his arrival. His condition has continued to deteriorate, and septic shock has been diagnosed. His laboratory values reveal decreasing fibrinogen and platelet levels. You are unable to maintain an acceptable MAP with IV fluids. The physician orders an infusion of Dopamine. What is the action of this medication?
To decrease myocardial oxygen consumption
To increase cardiac output and MAP
To decrease preload
To decrease afterload
The Correct Answer is B
Rationale:
A. Decreasing myocardial oxygen consumption is not the primary action of dopamine. In fact, dopamine can increase heart rate and myocardial contractility, which may actually increase oxygen demand on the heart.
B. Dopamine is a vasoactive medication used to increase cardiac output and mean arterial pressure (MAP). At moderate doses, dopamine stimulates beta-1 adrenergic receptors, which increases heart rate and myocardial contractility, enhancing cardiac output. At higher doses, it also stimulates alpha-adrenergic receptors, causing vasoconstriction that increases systemic vascular resistance and supports MAP. This is particularly useful in septic shock when fluid resuscitation alone is insufficient to maintain adequate perfusion.
C. Dopamine does not primarily decrease preload. Preload refers to the volume of blood returning to the heart, which is usually managed through fluid resuscitation rather than vasoactive medications.
D. Dopamine does not primarily decrease afterload. In fact, at higher doses, dopamine can increase afterload through vasoconstriction, which helps raise blood pressure in hypotensive patients.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Decreased respiratory rate is not an early sign of shock. In the early or compensatory stage, patients typically tachypneic as the body attempts to increase oxygen delivery to tissues. Bradypnea usually occurs in late or decompensated stages.
B. A change in level of consciousness is the earliest indicator of shock. As perfusion to the brain decreases, even slightly, the patient may become anxious, restless, or confused. Mental status changes often precede measurable changes in blood pressure or urine output, making it a sensitive early warning sign.
C. Anuria (absence of urine output) occurs later in shock when renal perfusion is severely compromised. It is a sign of progressive or decompensated shock, not an early indicator.
D. Hypotension is a late sign of shock. Blood pressure may remain normal in the compensatory stage due to vasoconstriction and increased heart rate. By the time hypotension develops, the patient may already be in a progressive stage of shock requiring aggressive intervention.
Correct Answer is D
Explanation
Rationale:
A. Soft-tissue edema is a common consequence of facial trauma, but it is not immediately life-threatening. While swelling can worsen airway compromise over time, initial assessment must focus on airway patency.
B. Facial asymmetry may indicate fractures or underlying injury but does not directly threaten airway or breathing. It is important for diagnosis and treatment planning but is not the first priority in emergency care.
C. Controlled bleeding suggests that active hemorrhage is being managed. While ongoing bleeding requires monitoring, it is less urgent than airway compromise, which can rapidly become life-threatening.
D. Altered respirations are the priority because airway and breathing (ABCs) take precedence over circulation and other assessments in trauma. Facial trauma can cause airway obstruction from soft-tissue swelling, bleeding, or structural damage. Recognizing and addressing airway compromise immediately is critical to prevent hypoxia and death
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