A client with septic shock remains hypotensive with a mean arterial pressure of 58 mm Hg after initial fluid resuscitation. Which intervention should the nurse anticipate?
1Delay vasoactive therapy while giving repeated fixed-volume fluid boluses without reassessing perfusion.
2Begin low-dose dopamine to improve renal perfusion and use urine output as the sole endpoint.
3Begin norepinephrine, titrate to the ordered hemodynamic goal, and reassess tissue perfusion.✓ Correct answer
4Give a small albumin bolus and wait for urine output to improve before treating the hypotension.
Explanation
Persistent hypotension after initial fluid resuscitation indicates a need for vasopressor support. Norepinephrine is the recommended first-line vasopressor in adult septic shock, with an initial mean arterial pressure target near 65 mm Hg and repeated assessment of tissue perfusion. Additional fluid should be individualized rather than given as fixed repeated boluses without reassessment. Low-dose dopamine is not used for renal protection, and albumin should not delay indicated vasopressor therapy.
Clinical reasoning summary When septic shock remains hypotensive after initial fluids, start norepinephrine and titrate toward an initial MAP near 65 mm Hg while reassessing perfusion. Do not delay vasopressors for routine extra fluid or albumin, and do not use low-dose dopamine for renal protection.