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Master-Level Nursing Exam Question (Adult Critical Care)

Question:
A 68-year-old patient with septic shock is receiving norepinephrine infusion. Blood pressure remains 82/48 mmHg (MAP 59 mmHg) despite adequate fluid resuscitation. Lactate is 4.5 mmol/L. What is the next best clinical intervention, and why?

Expert Solution:
The patient meets criteria for persistent septic shock with hypotension and elevated lactate despite fluid resuscitation. According to Surviving Sepsis Campaign guidelines, the target MAP is ≥65 mmHg. Since norepinephrine is already initiated, the next best intervention is to add vasopressin (0.03 units/min) as an adjunct vasopressor.

Rationale:

Vasopressin improves vascular tone via V1 receptor stimulation.

It reduces norepinephrine dosage requirements.

Evidence shows improved hemodynamic stability in refractory septic shock.

Additionally, continuous lactate monitoring, urine output assessment (>0.5 mL/kg/hr), and evaluation for infection source control are critical. This demonstrates advanced clinical reasoning expected at the master’s level.

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