A client with septic shock has received the prescribed crystalloid bolus. The mean arterial pressure remains below the perfusion target and lactate is elevated. Which prescription should the nurse anticipate next?
1Begin a norepinephrine infusion and titrate it according to the order✓ Correct answer
2Give a loop diuretic to lower the elevated serum lactate and blood pressure
3Delay vasoactive therapy until the serum lactate has returned to normal
4Administer a beta blocker to reduce the persistent heart rate
Explanation
Persistent hypotension after initial crystalloid resuscitation requires vasopressor support. Norepinephrine is the first-line vasopressor in septic shock and is titrated toward the prescribed mean arterial pressure target while perfusion is reassessed.
Quick answer Begin norepinephrine for persistent septic shock hypotension after the initial fluid bolus.
Why this is correct The mean arterial pressure remains below the perfusion target despite initial crystalloid. Current adult sepsis guidance recommends vasopressor support when hypotension persists and identifies norepinephrine as the first-line agent for most adults.
Easy analogy or mental picture Fluids fill the vascular container, while a vasopressor helps restore pressure when the container remains too relaxed. This model is simplified; ongoing reassessment must distinguish persistent vasodilation from additional fluid need or cardiac dysfunction.
Memory hook Shock after fluid plus low pressure leads to norepinephrine and perfusion reassessment.
NCLEX decision rule After initial crystalloid, persistent septic hypotension calls for prompt vasopressor support rather than waiting for lactate normalization. Use the ordered pressure target and reassess perfusion, rhythm, access, and fluid responsiveness.
Why the other choices are wrong A diuretic can worsen hypovolemia and does not directly correct lactate. Waiting prolongs hypoperfusion, and a beta blocker does not restore vasodilatory shock pressure as the next intervention.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
Surviving Sepsis Campaign Adult Guidelines 2026Society of Critical Care Medicine and European Society of Intensive Care Medicine
Clinical Practice GuideFor Acute pancreatitis initial care, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
CautionDo not choose an action from one isolated cue when the full scenario changes priority or safety.
Pancreatitis — Inflammation of the pancreas that can cause severe abdominal pain and systemic effects.
Nothing by Mouth — Withholding oral intake to rest the gastrointestinal tract or prevent complications.
Analgesia — Medication or intervention used to relieve pain.