NSG 420 Exam 1 Ch 66 Complete And Study material 14pages LEARNEXAMS

1. 1. A 78-kg patient in septic shock has a pulse rate of 120 beats/min with lowcentral venous pressure and pulmonary artery wedge pressure. After initial fluid volume resuscitation, the patient's urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question? a.Administer furosemide (Lasix) 40 mg IV. b.Increase normalsalineinfusion to 250 mL/hr. c. Give hydrocortisone (Solu-Cortef) 100 mg IV. d. Usenorepinephrine to keep systolic BP above 90 mm Hg.: Answer A Furosemide willlower the filling pressures and renal perfusion further for the patient with septic shock. Patients in septic shock need large amounts of fluid replacement. If the patient is still hypotensive after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as norepinephrine may be added. IV corticosteroids may be considered for patients in septic shock who cannot maintain an adequate BP with vasopressor therapy despite fluid resuscitation. 2. 2. A nurse is caring for a patient whose hemodynamic monitoring indicates a blood pressure of 92/54 mmHg, a pulse of 64 beats/min, and a high pulmonaryartery wedge pressure (PAWP). Which intervention prescribed by the health care providershould the nurse question? a.Elevate head of bed to 30 degrees. b.Infuse normalsaline at 250 mL/hr. c.Hold nitroprusside ifsystolic BP islessthan 90 mm Hg. d. Titrate dobutamine to keep systolic BP is greater than 90 mm Hg: Answer B The patient's elevated PAWP indicates volume excess in relation tocardiac pumping ability, consistent with cardiogenic shock. A saline infusion at 250mL/hr will worsen the volume excess.The other actions will help to improve cardiacoutput, which should lower the PAWP and may raise the BP. 3. 3. A patient with massive trauma and possible spinal cord injury is admittedto the emergency department (ED). Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock?