A client who is in shock is receiving norepinephrine in addition to IV fluids. What principle should influence the nurse's care planning during the administration of a vasoactive drug?
The drug should be discontinued immediately after blood pressure increases.
The drug dose should be tapered down once vital signs improve.
The client should have arterial blood gases drawn every 10 minutes during treatment.
The infusion rate should be titrated according to client's subjective sensation of adequate perfusion.
The Correct Answer is B
A. The drug should be discontinued immediately after blood pressure increases: Stopping norepinephrine abruptly can cause a sudden drop in blood pressure. Vasoactive drugs must be adjusted gradually to maintain stable perfusion as the client responds. Sudden withdrawal places the client at risk for rapid hemodynamic deterioration.
B. The drug dose should be tapered down once vital signs improve: Vasoactive drugs like norepinephrine require gradual titration based on the client’s hemodynamic response to avoid abrupt shifts in perfusion. As blood pressure and cardiac stability improve, doses are slowly reduced while monitoring for recurrent hypotension.
C. The client should have arterial blood gases drawn every 10 minutes during treatment: Frequent ABGs are unnecessary and impractical unless the client is experiencing severe respiratory instability. Hemodynamic monitoring, vital signs, and urine output provide more precise ongoing indicators of perfusion during vasoactive therapy.
D. The infusion rate should be titrated according to client's subjective sensation of adequate perfusion: Clients in shock cannot reliably assess their own perfusion status due to impaired cognition, altered mental status, or stress. Vasoactive medications must be titrated based on objective data such as MAP, blood pressure, and urine output.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Lactated Ringer's at 150 mL/hr: Large-volume fluid administration increases preload, which can worsen pulmonary congestion and stress an already failing heart. In cardiogenic shock, the problem is pump failure rather than fluid deficit, making aggressive fluid infusion harmful. This intervention increases myocardial workload instead of reducing it.
B. Morphine sulfate 4 mg IV: Morphine decreases preload and afterload through venous dilation, which reduces the heart’s workload and oxygen demand. It also decreases anxiety and sympathetic stimulation, helping limit further cardiac strain. These effects support myocardial rest and improved efficiency.
C. Norepinephrine 2 mg/min: Norepinephrine causes potent vasoconstriction that raises afterload, forcing the failing heart to pump against greater resistance. This can worsen cardiac workload and oxygen consumption in cardiogenic shock. It is usually avoided unless severe hypotension is present and unresponsive to other treatments.
D. Dobutamine 3 mcg/kg/min: Dobutamine improves contractility and cardiac output, but it also increases myocardial oxygen demand. While helpful for improving perfusion, it does not primarily reduce workload. Its inotropic effect can stress the heart further if not titrated carefully. It is supportive but not the priority intervention for conserving energy.
Correct Answer is C
Explanation
A. Narrowing pulse pressure, bradycardia, irregular heart rate: Narrowing pulse pressure is not characteristic of increasing ICP. ICP elevation typically causes widening pulse pressure, making this combination inconsistent with the classic signs of herniation.
B. Stiff neck, bradycardia, narrowing pulse pressure: While a stiff neck may indicate meningeal irritation, it is not a primary sign of rising ICP. Narrowing pulse pressure does not align with the hemodynamic changes seen in Cushing’s triad.
C. Bradycardia, irregular breathing, widening pulse pressure: The Cushing’s triad is the hallmark of increased ICP. It reflects the body’s response to maintain cerebral perfusion: systolic hypertension widening pulse pressure, bradycardia from baroreceptor reflex, and irregular respirations from brainstem compression.
D. Narrow pulse pressure, bradycardia, irregular respirations: Narrow pulse pressure is inconsistent with elevated ICP, which usually produces hypertension with a widened pulse pressure. The other signs may occur, but the combination does not match the classic presentation of ICP elevation.
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