An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vascular resistance (SVR). Which intervention should the nurse anticipate?
Increase the rate for the dopamine infusion.
Increase the rate for the sodium nitroprusside infusion.
Decrease the rate for the nitroglycerin infusion.
Decrease the rate for the 5% dextrose in normal saline infusion.
The Correct Answer is B
B. Sodium nitroprusside is a potent vasodilator used to reduce systemic vascular resistance and afterload, thereby improving cardiac output and tissue perfusion in cardiogenic shock. In this scenario, where the patient has cool and clammy skin with high SVR, indicating peripheral vasoconstriction,
increasing the rate of sodium nitroprusside infusion can help vasodilate peripheral vessels, reduce afterload, and improve tissue perfusion
A. Dopamine is a medication commonly used in the management of cardiogenic shock to increase cardiac output and systemic blood pressure. However, in this scenario where the patient is cool and clammy with high SVR, indicating vasoconstriction and potential peripheral hypoperfusion, increasing the rate of dopamine infusion may further increase systemic vascular resistance and exacerbate peripheral vasoconstriction. This can worsen tissue perfusion and exacerbate the patient's condition.
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C. Nitroglycerin is another vasodilator commonly used in the management of cardiogenic shock to reduce preload and afterload, thereby improving cardiac output and tissue perfusion. However, decreasing the rate of nitroglycerin infusion may further exacerbate vasoconstriction and increase SVR, worsening tissue perfusion in this scenario. Therefore, decreasing the rate of nitroglycerin infusion is not indicated.
D. Intravenous fluids such as 5% dextrose in normal saline are typically administered to maintain adequate intravascular volume and perfusion pressure in shock states. However, decreasing the rate of intravenous fluid infusion may further decrease intravascular volume and preload, potentially exacerbating hypoperfusion and worsening the patient's condition. Therefore, decreasing the rate of intravenous fluid infusion is not indicated in this scenario.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. The QT interval represents ventricular depolarization and repolarization. It starts at the beginning of the QRS complex and ends at the end of the T wave. The QT interval reflects the total time it takes for both ventricular depolarization and repolarization to occur. Prolongation of the QT interval can be associated with an increased risk of arrhythmias, including torsades de pointes.
A. The QRS complex represents ventricular depolarization, which is the electrical activation of the ventricles. The duration of the QRS complex provides information about the time it takes for ventricular depolarization to occur. A prolonged QRS complex can indicate abnormalities in ventricular conduction, such as bundle branch blocks or ventricular hypertrophy.
C. The ST segment represents the early part of ventricular repolarization. It starts at the end of the QRS complex and ends at the beginning of the T wave. Changes in the ST segment, such as elevation or depression, can indicate myocardial ischemia or injury.
D. The PR interval represents the time it takes for the electrical impulse to travel from the atria to the ventricles. It includes atrial depolarization, atrial contraction, and the delay at the atrioventricular node. The PR interval does not specifically provide information about ventricular depolarization and repolarization.
Correct Answer is C
Explanation
C. Amiodarone is a Class III antiarrhythmic medication commonly used for the acute management of atrial fibrillation with a rapid ventricular rate. It works by blocking multiple ion channels, prolonging the action potential duration, and slowing conduction in the atria and ventricles. Amiodarone is often used when other interventions such as vagal maneuvers or beta blockers are ineffective or contraindicated. In this scenario, where the patient is hypotensive and symptomatic, intravenous amiodarone may be administered to control the ventricular rate and stabilize hemodynamics
A. Bearing down, or the Valsalva maneuver, is a vagal maneuver that can sometimes help slow the heart rate in certain arrhythmias by increasing parasympathetic tone. However, it may not be effective or safe in all situations, especially if the patient is hypotensive or confused. In this scenario, immediate pharmacological intervention is likely needed to control the heart rate and stabilize hemodynamics.
B. Lidocaine is not typically used to treat atrial fibrillation with a rapid ventricular rate. Lidocaine is a Class IB antiarrhythmic medication primarily used for the treatment of ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. It is not considered a first-line agent for atrial fibrillation and may not effectively control the ventricular rate in this situation.
D. While beta blockers are commonly used for rate control in atrial fibrillation, they may not be the best choice in this scenario where the patient is hypotensive and symptomatic. Beta blockers can further decrease blood pressure and exacerbate hypotension, especially in patients with compromised hemodynamics. In such cases, other rate-controlling agents like calcium channel blockers or amiodarone may be preferred.
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