A nurse is caring for the client on postoperative day 2. Drag words from the choices below to fill in each blank in the following sentence. The nurse anticipates a provider prescription for dropdown and dropdown

The client has hypotension, tachycardia, delayed capillary refill, oliguria, and worsening ABGs indicating metabolic acidosis with hypoxemia. These findings are consistent with septic shock likely secondary to abdominal abscess surgery, with possible ongoing infection or inadequate perfusion. Management priorities include restoring circulating volume and treating the underlying infectious process. Rationale for correct choices: • IV bolus of 0.9% sodium chloride: The client is hypotensive (80/54 mm Hg), tachycardic, and has poor perfusion (cool skin, delayed capillary refill, weak pulses), indicating shock with decreased circulating volume. A rapid IV bolus of isotonic fluid is essential to restore intravascular volume, improve tissue perfusion, and stabilize blood pressure. This intervention helps correct hypotension and supports organ perfusion in septic or hypovolemic shock states. Fluid resuscitation is the first-line priority in unstable postoperative shock. • cefepime 2 g IV every 8 hr: Cefepime is a broad-spectrum IV antibiotic used to treat serious infections, including intra-abdominal infections and sepsis. Given the client’s recent abdominal abscess surgery, fever risk, and signs of systemic deterioration, infection is a likely underlying cause of shock. Early administration of antibiotics is critical in suspected sepsis to control the infectious source and prevent progression to multiorgan failure. Rationale for incorrect choices: • Bumetanide 1 mg IV stat: Bumetanide is a loop diuretic used to remove excess fluid in conditions such as heart failure or fluid overload. This client is hypotensive, tachycardic, and showing signs of poor perfusion, indicating volume depletion or distributive shock rather than fluid overload. Administering a diuretic would worsen hypotension and decrease circulating volume further. Therefore, it is contraindicated in this clinical scenario. • Dobutamine IV 2 mcg/kg/min: Dobutamine is an inotropic medication used to improve cardiac contractility in cardiogenic shock. Although it increases cardiac output, this client’s primary issue is likely septic shock with vasodilation and fluid loss rather than pump failure. Additionally, fluid resuscitation must be initiated before inotropes are considered. Using dobutamine too early without correcting hypovolemia could worsen instability. • Morphine IV 4 mg every 4 hr: Morphine is an opioid analgesic used for pain control but is not appropriate as a priority intervention in shock. It can cause vasodilation and respiratory depression, potentially worsening hypotension and hypoxia in an unstable patient. While pain management is important, it is not the priority in a deteriorating postoperative client with signs of shock. Stabilization of circulation and infection control take precedence.