NR 464 - Exam 4 (BoostGrade) With
complete verified solutions (Guaranteed
Pass)
A 78-kg patient with septic shock has a urine output of 30 mL/hr for the
past 3 hours. The pulse rate is 120/minute and the central venous
pressure and pulmonary artery wedge pressure are low. Which order by
the health care provider will the nurse question?
a. Give PRN furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Administer hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg. -
answer a. Give PRN furosemide (Lasix) 40 mg IV.
Furosemide will lower the filling pressures and renal perfusion further
for the patient with septic shock. The other orders are appropriate.
A nurse is caring for a patient with shock of unknown etiology whose
hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated
,pulmonary artery wedge pressure. Which collaborative intervention
ordered by the health care provider should the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg. -
answer a. Infuse normal saline at 250 mL/hr.
The patient's elevated pulmonary artery wedge pressure indicates
volume excess. A saline infusion at 250 mL/hr will exacerbate the
volume excess. The other actions are appropriate for the patient.
An older patient with cardiogenic shock is cool and clammy and
hemodynamic monitoring indicates a high systemic vascular resistance
(SVR). Which intervention should the nurse anticipate doing next?
a. Increase the rate for the dopamine (Intropin) infusion.
b. Decrease the rate for the nitroglycerin (Tridil) infusion.
,c. Increase the rate for the sodium nitroprusside (Nipride) infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS)
infusion. - answer c. Increase the rate for the sodium nitroprusside
(Nipride) infusion.
Nitroprusside is an arterial vasodilator and will decrease the SVR and
afterload, which will improve cardiac output. Changes in the D5/.9 NS
and nitroglycerin infusions will not directly decrease SVR. Increasing the
dopamine will tend to increase SVR.
After receiving 2 L of normal saline, the central venous pressure for a
patient who has septic shock is 10 mm Hg, but the blood pressure is still
82/40 mm Hg. The nurse will anticipate an order for
a. nitroglycerine (Tridil).
b. norepinephrine (Levophed).
c. sodium nitroprusside (Nipride).
, d. methylprednisolone (Solu-Medrol). - answer b. norepinephrine
(Levophed).
When fluid resuscitation is unsuccessful, vasopressor drugs are
administered to increase the systemic vascular resistance (SVR) and
blood pressure, and improve tissue perfusion. Nitroglycerin would
decrease the preload and further drop cardiac output and BP.
Methylprednisolone (Solu-Medrol) is considered if blood pressure does
not respond first to fluids and vasopressors. Nitroprusside is an arterial
vasodilator and would further decrease SVR
To evaluate the effectiveness of the pantoprazole (Protonix) ordered for
a patient with systemic inflammatory response syndrome (SIRS), which
assessment will the nurse perform?
a. Auscultate bowel sounds.
b. Palpate for abdominal pain.
c. Ask the patient about nausea.
d. Check stools for occult blood. - answer d. Check stools for occult
blood.
complete verified solutions (Guaranteed
Pass)
A 78-kg patient with septic shock has a urine output of 30 mL/hr for the
past 3 hours. The pulse rate is 120/minute and the central venous
pressure and pulmonary artery wedge pressure are low. Which order by
the health care provider will the nurse question?
a. Give PRN furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Administer hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg. -
answer a. Give PRN furosemide (Lasix) 40 mg IV.
Furosemide will lower the filling pressures and renal perfusion further
for the patient with septic shock. The other orders are appropriate.
A nurse is caring for a patient with shock of unknown etiology whose
hemodynamic monitoring indicates BP 92/54, pulse 64, and an elevated
,pulmonary artery wedge pressure. Which collaborative intervention
ordered by the health care provider should the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg. -
answer a. Infuse normal saline at 250 mL/hr.
The patient's elevated pulmonary artery wedge pressure indicates
volume excess. A saline infusion at 250 mL/hr will exacerbate the
volume excess. The other actions are appropriate for the patient.
An older patient with cardiogenic shock is cool and clammy and
hemodynamic monitoring indicates a high systemic vascular resistance
(SVR). Which intervention should the nurse anticipate doing next?
a. Increase the rate for the dopamine (Intropin) infusion.
b. Decrease the rate for the nitroglycerin (Tridil) infusion.
,c. Increase the rate for the sodium nitroprusside (Nipride) infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS)
infusion. - answer c. Increase the rate for the sodium nitroprusside
(Nipride) infusion.
Nitroprusside is an arterial vasodilator and will decrease the SVR and
afterload, which will improve cardiac output. Changes in the D5/.9 NS
and nitroglycerin infusions will not directly decrease SVR. Increasing the
dopamine will tend to increase SVR.
After receiving 2 L of normal saline, the central venous pressure for a
patient who has septic shock is 10 mm Hg, but the blood pressure is still
82/40 mm Hg. The nurse will anticipate an order for
a. nitroglycerine (Tridil).
b. norepinephrine (Levophed).
c. sodium nitroprusside (Nipride).
, d. methylprednisolone (Solu-Medrol). - answer b. norepinephrine
(Levophed).
When fluid resuscitation is unsuccessful, vasopressor drugs are
administered to increase the systemic vascular resistance (SVR) and
blood pressure, and improve tissue perfusion. Nitroglycerin would
decrease the preload and further drop cardiac output and BP.
Methylprednisolone (Solu-Medrol) is considered if blood pressure does
not respond first to fluids and vasopressors. Nitroprusside is an arterial
vasodilator and would further decrease SVR
To evaluate the effectiveness of the pantoprazole (Protonix) ordered for
a patient with systemic inflammatory response syndrome (SIRS), which
assessment will the nurse perform?
a. Auscultate bowel sounds.
b. Palpate for abdominal pain.
c. Ask the patient about nausea.
d. Check stools for occult blood. - answer d. Check stools for occult
blood.
