# A 68-year-old client with septic shock has received 30 mL/kg of crystalloid (a total of 2.4 L) over the first 3 hours. The most recent vital signs are BP 84/52, mean arterial pressure (MAP) 58, HR 116, lactate 4.6 mmol/L, urine output 15 mL/h. The provider is at the bedside. Which intervention does the nurse anticipate next, consistent with current sepsis guidelines?

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> subject: Medical Emergencies  
> category: PA

## Question

A 68-year-old client with septic shock has received 30 mL/kg of crystalloid (a total of 2.4 L) over the first 3 hours. The most recent vital signs are BP 84/52, mean arterial pressure (MAP) 58, HR 116, lactate 4.6 mmol/L, urine output 15 mL/h. The provider is at the bedside. Which intervention does the nurse anticipate next, consistent with current sepsis guidelines?

## Option

1. Initiate norepinephrine through a central venous catheter (or temporarily through a large proximal IV until central access is obtained), and titrate to a MAP of 65 mmHg or greater while continuing source control and antibiotics. **✔ Correct answer**
2. Initiate a continuous infusion of dopamine at 2 mcg/kg/min through a peripheral intravenous line, with the expectation that it will increase renal perfusion as a first-line agent and raise the mean arterial pressure to at least 65 mmHg.
3. Administer 100 mL of 5% albumin intravenously to expand the intravascular volume more effectively than crystalloid, and then reassess the mean arterial pressure and urine output before deciding on vasopressor therapy.
4. Defer the initiation of vasopressors and administer a second crystalloid bolus of 30 mL/kg to achieve a total of 60 mL/kg, then reevaluate the mean arterial pressure and urine output to determine if pressors are needed.

**Correct answer: 1**

## Explanation

Septic shock — vasopressor of choice and MAP target
Surviving Sepsis Campaign and current AHA/ACS guidelines:
• Initial resuscitation: crystalloid 30 mL/kg within 3 hours for sepsis-induced hypoperfusion.
• If hypotension persists despite adequate fluid (i.e., MAP

## In-depth explanation

Clinical reasoning summary
Septic shock — vasopressor of choice and MAP target
Surviving Sepsis Campaign and current AHA/ACS guidelines:
• Initial resuscitation: crystalloid 30 mL/kg within 3 hours for sepsis-induced hypoperfusion.
• If hypotension persists despite adequate fluid (i.e., MAP

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