The client diagnosed with acute heart failure is prescribed an infusion of dopamine at a low dose. Which assessment parameter should the nurse use to best evaluate the effectiveness of this medication?
Urine output has increased from 30 mL to 50 mL per hour
Blood pressure decreased from 140/80 to 90/50
Heart rate has increased from 80 to 110 beats per minute
Client is awake, alert and oriented to time, place and person
The Correct Answer is A
A. Dopamine at low doses primarily increases renal perfusion, which can lead to improved urine output. An increase in urine output is a key indicator that the medication is effectively improving kidney function and blood flow. This is the most direct way to assess its effectiveness.
B. A decrease in blood pressure is not an expected effect of low-dose dopamine, which should actually help improve perfusion and raise blood pressure.
C. An increase in heart rate is more likely with higher doses of dopamine and is not an optimal indicator of the drug's effectiveness for acute heart failure.
D. Client alertness is important but does not directly reflect the primary effects of dopamine on renal perfusion and cardiac output in acute heart failure.
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Correct Answer is D
Explanation
A. The 20-gauge catheter in the right wrist is not ideal for blood transfusions, as wrist veins are smaller and may be less optimal for high-flow transfusions.
B. An 18-gauge catheter is appropriate for blood transfusions, but the catheter is currently in use for potassium chloride, which would need to be discontinued. The best choice is a separate site.
C. A 22-gauge catheter is not large enough for blood transfusion; it may cause hemolysis or slow the transfusion rate.
D. The 20-gauge catheter in the right forearm is an appropriate size for a blood transfusion and is currently infusing normal saline, which does not interfere with the blood transfusion.
Correct Answer is C
Explanation
A. Hypermagnesemia can cause bradycardia and hypotension, but it is less commonly associated with PVCs. This does not align with the lab results provided.
B. Hypocalcemia can cause arrhythmias, but it is not the most likely cause of PVCs in this case, considering other findings.
C. Hypokalemia (low potassium) is a known cause of PVCs. The patient's potassium level is 2.8 mEq/L, which is significantly low and most likely contributing to the PVCs.
D. Although hyperglycemia can affect cardiac function, it is less commonly linked to PVCs compared to electrolyte imbalances, such as hypokalemia.
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