Question

Ana's postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question?

A. Put the client in modified Trendelenberg's position.
B. Administer oxygen at 100%.
C. Monitor urine output every hour.
D. Administer Demerol 50mg IM q4h

Answer 1

The nurse would question the order to administer Demerol to a patient exhibiting signs of shock, as the medication may lower blood pressure, further complicating the patient's condition. the correct answer is B.

Step-by-step explanation:

The nurse would question the order to administer Demerol 50mg IM q4h. When suspecting shock, which in Ana's case is indicated by low blood pressure (80/50 mm Hg), a high pulse (140), and increased respirations (32), it's important to focus on treatments that stabilize the patient's vital signs and support circulation. Demerol, or meperidine, is a narcotic pain medication that can lead to decreased blood pressure and is generally avoided in patients with compromised vital signs due to shock.

Instead, interventions should prioritize: placing the client in a modified Trendelenburg's position to improve blood flow to vital organs, administering oxygen to support cellular metabolism which is often compromised in shock, and monitoring urine output to assess kidney function and the effectiveness of resuscitation efforts. The goal with these interventions is to restore and maintain adequate circulation and tissue oxygenation, which are critically threatened during a shock state.