A nurse is caring for a patient with shock of unknown etiology ...

[jman1234]

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.

Question 2

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.

[Tabitha_2016]

Answer to Question 1

ANS: A
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.

Answer to Question 2

ANS: A
Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock. The other orders are appropriate.

[jman1234]

TYSM

[ebonylittles]

Excellent