A patient has been admitted with a diagnosis of “hypertensive emergency”, with a blood pressure of 198/110 mmHg and a heart rate of 78 bpm.
Which medications would the nurse anticipate being prescribed to the patient in the ICU setting to lower the patient’s blood pressure? (Select all that apply)

Nitroglycerin IV gtt, titrate for SBP > 180mmHg

Labetalol (Normodyne) 10mg IVPq 10 minutes prn for SBP >170 mmHg

Cardizem (Diltiazem) IV gtt, titrate for SBP> 170mmHg

Nitroprusside (Nitropress) IV gtt titrate to keep SBP< 160 mmHg

Answer and Explanation

Correct Answer : A,B,D

Rationale for Choice A: Nitroglycerin IV gtt, titrate for SBP > 180mmHg

Mechanism of action: Nitroglycerin is a potent vasodilator that acts primarily on veins, but also has some arterial vasodilatory effects. It relaxes vascular smooth muscle by stimulating the production of nitric oxide, which causes vasodilation. This decrease in preload (venous return to the heart) and afterload (resistance against which the heart pumps) leads to a reduction in blood pressure.

Indications: Nitroglycerin is a preferred agent for hypertensive emergencies associated with acute heart failure, acute coronary syndromes, and aortic dissection. It is also effective in hypertensive emergencies with elevated intracranial pressure.

Dosage and administration: Nitroglycerin is typically administered as an intravenous infusion, starting at a low dose and titrating up based on blood pressure response. The goal is to titrate the medication to maintain systolic blood pressure below 180 mmHg.

Contraindications: Nitroglycerin is contraindicated in patients with a known hypersensitivity to nitrates, severe hypotension (systolic blood pressure < 90 mmHg), or those who have recently used phosphodiesterase-5 inhibitors (such as sildenafil).

Monitoring: During nitroglycerin infusion, it's essential to monitor blood pressure closely, as well as heart rate, for any signs of hypotension or tachycardia.

Rationale for Choice B: Labetalol (Normodyne) 10mg IVP q 10 minutes prn for SBP >170 mmHg

Mechanism of action: Labetalol is a mixed alpha- and beta-adrenergic blocker. It blocks the effects of norepinephrine and epinephrine, leading to vasodilation and a decrease in heart rate.

Indications: Labetalol is a versatile agent that can be used in various hypertensive emergencies, including those associated with acute aortic dissection, acute coronary syndromes, and pre-eclampsia/eclampsia. It's also useful in patients with a history of asthma or chronic obstructive pulmonary disease (COPD), as it has less bronchoconstrictive effects than beta-blockers like propranolol.

Dosage and administration: Labetalol can be administered as an intravenous bolus or infusion. In this scenario, it's prescribed as a 10mg intravenous push every 10 minutes as needed for systolic blood pressure greater than 170 mmHg.

Contraindications: Labetalol is contraindicated in patients with severe bradycardia, heart block, cardiogenic shock, or decompensated heart failure.

Monitoring: During labetalol administration, it's important to monitor blood pressure, heart rate, and electrocardiogram (ECG) for any signs of bradycardia, heart block, or other arrythmias.

Rationale for Choice D: Nitroprusside (Nitropress) IV gtt titrate to keep SBP < 160 mmHg

Mechanism of action: Nitroprusside is a potent vasodilator that acts directly on both arterioles and veins. It relaxes vascular smooth muscle by releasing nitric oxide, leading to a rapid and profound decrease in blood pressure.

Indications: Nitroprusside is often reserved for hypertensive emergencies that are refractory to other agents or those that require rapid blood pressure control, such as hypertensive encephalopathy or acute aortic dissection.

Dosage and administration: Nitroprusside is administered as an intravenous infusion and titrated to the desired blood pressure response. The goal is to keep systolic blood pressure below 160 mmHg.

Contraindications: Nitroprusside is contraindicated in patients with severe renal impairment or those with increased intracranial pressure.

Monitoring: Nitroprusside therapy requires close monitoring of blood pressure, as well as monitoring for thiocyanate toxicity (a metabolite of nitroprusside) in patients with prolonged infusion or renal impairment.

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Correct Answer is A

Explanation

Choice A rationale:

Glucagon directly addresses the underlying issue of severe hypoglycemia: In a patient with Type 1 diabetes mellitus, a blood glucose level of 40 mg/dL signifies a critical condition known as severe hypoglycemia. This condition occurs when blood sugar levels drop dangerously low, depriving the brain and other vital organs of glucose, their primary source of energy. Glucagon, a hormone that acts opposite to insulin, is the most effective and rapid treatment for severe hypoglycemia. It works by stimulating the liver to release stored glucose into the bloodstream, quickly raising blood sugar levels and restoring normal brain function.

Rationale for other choices:

Choice B: Give orange juice: While orange juice contains carbohydrates that can raise blood sugar, it is not ideal for treating severe hypoglycemia due to its slower absorption rate compared to glucagon. In an unconscious patient, there's also a risk of aspiration if given orally.

Choice C: Perform CPR: CPR is not indicated in this scenario as the patient has a pulse. CPR is a lifesaving technique that is only used when a person's heart has stopped beating.

Choice D: Give insulin: Insulin, which lowers blood glucose, would be contraindicated in this situation as the patient is already experiencing severe hypoglycemia. Administering insulin would further decrease blood sugar levels, worsening the patient's condition.

Key points to remember:

Severe hypoglycemia is a medical emergency that requires prompt treatment with glucagon.

Glucagon is the only medication that can effectively and quickly raise blood glucose levels in severe hypoglycemia. It's crucial to administer glucagon as soon as possible to prevent irreversible brain damage or even death.

Healthcare professionals should be proficient in recognizing the signs and symptoms of severe hypoglycemia and administering glucagon appropriately.

A. To provide moisture B. To prevent chemical conjunctivitis C. To prevent infection D. To treat infection

Correct Answer is C

Explanation

Choice A rationale:

Erythromycin ointment does not have moisturizing properties. Its primary function is to act as an antibiotic to prevent bacterial infections.

While it may have a slightly lubricating effect due to its ointment base, this is not its intended purpose.

If moisture is the primary goal, artificial tears or other ophthalmic lubricants would be more appropriate choices.

Choice B rationale:

Chemical conjunctivitis is typically caused by irritants such as chlorine, smoke, or chemicals, not bacteria. Erythromycin is not effective in preventing or treating chemical conjunctivitis.

Treatment for chemical conjunctivitis usually involves flushing the eyes with saline or water and applying cool compresses, as well as potentially using topical antihistamines or corticosteroids to reduce inflammation.

Choice D rationale:

Erythromycin ointment is not typically used to treat active eye infections in newborns.

While it can be used for this purpose in certain cases, it is more commonly used as a prophylactic measure to prevent infections from developing in the first place.

If a newborn has a suspected eye infection, a healthcare provider would likely collect a sample of discharge for testing and culture to determine the specific causative organism and select the most appropriate antibiotic treatment.

Choice C rationale:

The primary purpose of applying erythromycin ointment to a newborn's eyes is to prevent bacterial eye infections, specifically ophthalmia neonatorum.

Ophthalmia neonatorum is a serious condition that can lead to vision loss if not treated promptly.

It is most commonly caused by the bacteria Neisseria gonorrhoeae and Chlamydia trachomatis, which can be transmitted to the newborn during childbirth if the mother is infected.

Erythromycin ointment is effective in preventing these infections by killing or inhibiting the growth of these bacteria. It is typically applied to the newborn's eyes within 1 hour of birth as a standard practice in many countries.

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Naxlex Comprehensive Predictor Exams

A client is brought to the emergency room unconscious, with a pulse, and with a blood glucose of 40. The client is wearing a Medic-Alert bracelet indicating that he has Type 1 diabetes mellitus.What order should the nurse anticipate?

Correct Answer is A

Explanation

The nurse is applying erythromycin ointment to the lower lid of the newborn’s eyes. What is the purpose of this medication for the newborn?

Correct Answer is C

Explanation

The nurse is instilling erythromycin ointment to the lower lid of the newborn’s eyes. Why is this medication being given to the newborn?

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

Which medication, if taken within the last 24-48 hours, would prevent a nurse from administering nitroglycerin?

A client with diabetes is scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern?

A patient has been prescribed levothyroxine (Synthroid) for hypothyroidism. The patient inquires if the medication should be taken with food.What would be the most appropriate response from the nurse?

A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?