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Your client is receiving continuous IV infusions of dobutamine, epinephrine, dopamine and nitroprusside sodium. The hemodynamic readings are:

normal central venous pressure (CVP) of 6 mmHg;

normal pulmonary artery pressure (PAP) of 25/10 mmHg:

high cardiac output (CO) of 7.5 L/min;

low systemic vascular resistance (SVR) of 400 dynes/sec/cm(-5).

You should reduce the infusion rate of which of these drugs?

A.

Dopamine

B.

Epinephrine

C.

Dobutamine

D.

Nitroprusside sodium

Answer and Explanation

The Correct Answer is D

A. Dopamine primarily increases cardiac output and blood pressure; CVP is normal, so hypotension is not a concern. Reducing dopamine is not indicated.
B. Epinephrine increases heart rate, contractility, and systemic vascular resistance. SVR is already low, but epinephrine tends to increase SVR at moderate doses, so it is not the primary contributor to low SVR here.
C. Dobutamine primarily increases cardiac output by enhancing contractility. The patient’s CO is already high, but dobutamine does not significantly decrease SVR.
D. Nitroprusside sodium is a potent vasodilator that lowers systemic vascular resistance. In this client, SVR is critically low (400 dynes/sec/cm⁻⁵), contributing to hypotension despite high CO. Reducing the nitroprusside infusion is appropriate to prevent further drops in SVR and maintain adequate perfusion pressure.


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Related Questions

Correct Answer is D

Explanation

A. The subclavian artery is located near the clavicle and is not assessed using the Allen’s test.
B. The popliteal artery is located behind the knee and is unrelated to arterial line placement in the wrist.
C. While the radial artery is commonly used for arterial line insertion, the Allen’s test assesses the ulnar artery to ensure collateral circulation is adequate if the radial artery is cannulated.
D. The Allen’s test evaluates ulnar artery patency by occluding both the radial and ulnar arteries, having the patient make a fist to blanch the hand, then releasing pressure on the ulnar artery to see if normal color returns. This ensures sufficient blood flow from the ulnar artery before inserting a radial arterial line.

Correct Answer is D

Explanation

A. Pain that is relieved by nitroglycerin is more characteristic of angina pectoris, not necessarily an acute myocardial infarction.
B. Pain that worsens with arm movement is more typical of musculoskeletal causes.
C. Pain that increases with deep breathing is more consistent with pleuritic pain, such as in pericarditis or pulmonary embolism.
D. Chest pain from an acute myocardial infarction is typically persistent, often lasting longer than 30 minutes, and may not respond to rest or nitroglycerin. This prolonged, unrelieved pain is a key clinical indicator of AMI.

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