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.

Answer and Explanation

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.

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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Free Nursing Study Resources

Correct Answer is ["B","D","E"]

Explanation

B. This is an essential nursing intervention to ensure that the ventilator is delivering the appropriate settings as ordered by the healthcare provider. Ventilator settings may need to be adjusted based on the client's condition, so daily verification is important for patient safety and optimal ventilator management.

D. Pantoprazole is a proton pump inhibitor commonly used to prevent stress ulcers in critically ill patients receiving mechanical ventilation. It helps reduce gastric acid secretion and can prevent complications such as gastrointestinal bleeding. Administering pantoprazole as prescribed is an appropriate intervention to prevent complications related to stress ulcers in ventilated patients.

E. Elevating the head of the bed to at least 30 degrees is a crucial intervention to prevent ventilator- associated pneumonia (VAP) by reducing the risk of aspiration. This position helps promote drainage of oral and gastric secretions, reducing the likelihood of aspiration into the lungs. It's considered a standard practice in ventilated patients to minimize the risk of pulmonary complications.

A. Apply restraints if the client becomes agitated: While it may be necessary to use restraints in certain situations to ensure the safety of the client and prevent self-extubation or injury, they should be used judiciously and only when other measures to manage agitation have failed. Restraints should not be the first-line intervention and should be used in accordance with facility policies and regulations.

C. Repositioning the endotracheal tube to the opposite side of the mouth daily is not a standard nursing intervention. Once the endotracheal tube is properly positioned and secured, it should not routinely need to be repositioned unless clinically indicated due to complications such as mucosal irritation or tube displacement.

A. The patient's central venous pressure is 3 mm Hg. B. The patient is receiving low dose dopamine. C. The patient is in sinus tachycardia at 120 beats/min. D. The patient has had no urine output since admission.

Correct Answer is A

Explanation

A Adequate fluid administration is essential before giving vasopressors to patients with hypovolemic shock. The patient’s low central venous pressure indicates a need for more volume replacement. The other patient data are not contraindications to norepinephrine administration.

B Low dose dopamine is not a contraindication to epinephrine administration.

C A sinus tachycardia is not a contraindication to epinephrine administration

D Lack of urine output is not a contraindication to epinephrine administration

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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?

Nursing Test Bank

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