A nurse is preparing to titrate a continuous nitroprusside infusion for a client. The nurse should plan to titrate the infusion according to which of the following assessments?
Blood pressure
Stroke volume
Cardiac output
Urine output
The Correct Answer is A
Choice A Reason:
Blood pressure is correct. Nitroprusside is a medication used to lower blood pressure in conditions such as hypertensive emergencies. It's titrated based on blood pressure readings, with the goal of achieving the desired target blood pressure range as directed by the healthcare provider. The nurse would monitor the client's blood pressure closely and adjust the infusion rate accordingly to achieve the prescribed blood pressure parameters.
Choice B Reason:
Stroke volume is incorrect. While stroke volume (the amount of blood ejected by the heart with each contraction) is important in assessing heart function, it's not directly used to titrate a nitroprusside infusion. Nitroprusside primarily acts as a vasodilator to reduce blood pressure, rather than affecting stroke volume.
Choice C Reason:
Cardiac output is incorrect. Cardiac output (the volume of blood pumped by the heart per minute) is also a crucial measure of heart function, but adjusting a nitroprusside infusion based on cardiac output is not a common practice. Nitroprusside's primary action is to dilate blood vessels, impacting blood pressure regulation more directly than cardiac output.
Choice D Reason:
Urine output is incorrect. While urine output is an important indicator of renal function and overall fluid balance, it is not typically used as the main parameter for titrating nitroprusside. Nitroprusside's primary effect is on vasodilation and blood pressure control rather than directly impacting urine output.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Bilateral muscle weakness is not typically associated specifically with fluid volume excess. Muscle weakness can result from various causes, such as electrolyte imbalances or certain medical conditions, but it's not a primary manifestation of fluid volume excess.
Choice B Reason:
Thready pulse is not correct. A thready pulse refers to a weak and barely palpable pulse. This is more commonly associated with conditions like shock or reduced cardiac output rather than fluid volume excess.
Choice C Reason:
Decreased bowel sounds is not correct. Reduced or absent bowel sounds may indicate gastrointestinal issues, but they are not a direct manifestation of fluid volume excess. Increased bowel sounds might be more associated with certain types of gastrointestinal disturbances or fluid imbalances, but decreased sounds are not a typical sign of fluid volume excess.
Choice D Reason:
Distended neck veins is correct. In a client experiencing fluid volume excess, distended neck veins can often be observed due to increased venous pressure. This occurs as a result of the body retaining more fluid than it can handle, leading to an increase in blood volume and pressure within the vascular system. This can cause the jugular veins in the neck to appear distended or prominent.
Correct Answer is A
Explanation
Choice A Reason:
Identify the client using two identifiers is correct. Prior to administering any medication, especially controlled substances, it's crucial to confirm the client's identity using two unique identifiers, such as their name and date of birth or an identification band and verbal confirmation. Ensuring accurate identification helps prevent medication errors and ensures the right medication is given to the right patient.
Choice B Reason:
Compare the amount of medication available to the inventory record is incorrect. This is part of maintaining accurate documentation and inventory control, ensuring that the amount of medication matches the recorded inventory. However, it typically occurs after confirming the client's identity.
Choice C Reason:
Document the administration of the medication is incorrect. Documentation of medication administration is crucial for legal and medical purposes but should occur after the medication has been safely administered to the correct patient.
Choice D Reason:
Remove the medication from the medication dispensing cabinet is incorrect. Retrieving the medication from the dispensing cabinet is an essential step in the administration process, but it should occur after confirming the client's identity to ensure the right medication is administered to the right individual.
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