A patient with a suspected myocardial infarction is in the emergency department. The nurse is preparing to administer 325 mg of aspirin.
What action should the nurse take?

Choice A rationale:

Albuterol (Proventil) is a bronchodilator that is used to treat acute asthma attacks and chronic obstructive pulmonary disease (COPD). It works by relaxing the smooth muscles in the airways, which allows more air to flow into the lungs. While albuterol can be helpful in relieving shortness of breath, it is not the first-line treatment for a patient with chest pain and low oxygen saturation. This is because albuterol does not address the underlying cause of the chest pain, which is likely a lack of oxygen to the heart muscle.

Choice C rationale:

Nitroglycerin is a vasodilator that is used to treat angina (chest pain) and heart failure. It works by relaxing the blood vessels, which allows more blood to flow to the heart. Nitroglycerin can be helpful in relieving chest pain, but it is not the first-line treatment for a patient with low oxygen saturation. This is because nitroglycerin can actually worsen hypoxemia (low oxygen levels in the blood) by dilating blood vessels in the lungs.

Choice D rationale:

Aspirin is a blood thinner that is used to prevent and treat blood clots. It is often given to patients with chest pain who are suspected of having a heart attack. However, aspirin is not the first-line treatment for a patient with low oxygen saturation. This is because aspirin does not address the underlying cause of the low oxygen saturation, which is likely a problem with the lungs or heart.

Choice A rationale:

Dopamine is a catecholamine that acts on both alpha- and beta-adrenergic receptors. It has inotropic (increases heart contractility), chronotropic (increases heart rate), and vasopressor (constricts blood vessels) effects.

It was previously used as a first-line agent for cardiogenic shock, but it has fallen out of favor due to concerns about its potential to increase heart rate and arrhythmias, which can worsen myocardial oxygen demand and ischemia.

Additionally, dopamine's effects on renal blood flow can be unpredictable, and it may not be as effective as norepinephrine in increasing blood pressure in patients with severe shock.

Choice B rationale:

Norepinephrine is a potent alpha-adrenergic agonist that causes vasoconstriction, leading to an increase in blood pressure. It has minimal beta-adrenergic effects, so it does not significantly increase heart rate.

Norepinephrine is the preferred first-line vasopressor for cardiogenic shock because it effectively raises blood pressure without significantly increasing heart rate or myocardial oxygen demand.

It also has beneficial effects on renal blood flow and may improve organ perfusion.

Choice C rationale:

Epinephrine is a potent alpha- and beta-adrenergic agonist. It has strong inotropic, chronotropic, and vasopressor effects.

It can be used in cardiogenic shock, but it is typically reserved for patients who do not respond adequately to norepinephrine or who have severe bradycardia.

Epinephrine's potent beta-adrenergic effects can increase heart rate and myocardial oxygen demand, which can be detrimental in patients with cardiogenic shock.

Choice D rationale:

Vasopressin (Pitressin) is a hormone that acts on V1 receptors in vascular smooth muscle to cause vasoconstriction. It is not a first-line agent for cardiogenic shock, but it can be used as an adjunct to norepinephrine in patients who are refractory to other vasopressors.

Vasopressin may be particularly useful in patients with septic shock, as it has been shown to improve outcomes in this population.