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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. Assessing the patient's level of consciousness (LOC) is essential to determine their neurological status and assess for any signs of deterioration. Changes in LOC could indicate worsening sepsis, hypoperfusion, or other underlying issues that require immediate attention.
A. Administering amiodarone, an antiarrhythmic medication, is not the first action to take in this situation. While amiodarone may be used to manage certain arrhythmias, its use should be based on a thorough assessment and specific arrhythmia diagnosis. In this case, with only three seconds of PVCs followed by sinus tachycardia, immediate administration of amiodarone is not warranted.
B. Carotid massage is not indicated in this scenario. Carotid massage is typically used to slow down or terminate supraventricular tachycardias (SVTs), such as paroxysmal supraventricular tachycardia (PSVT). However, it is contraindicated in patients with a history of stroke, transient ischemic attack (TIA), carotid artery disease, or recent myocardial infarction (MI). Furthermore, PVCs are not typically responsive to carotid massage.
C. Administering Tylenol (acetaminophen) may be appropriate in this situation. The patient's elevated temperature (101.1°F) suggests the presence of fever, which could contribute to the patient's tachycardia. Lowering the fever with acetaminophen may help reduce the heart rate and alleviate symptoms associated with fever, such as discomfort.
Correct Answer is A
Explanation
A. The insertion of a pulmonary artery catheter can help in assessing hemodynamic parameters and distinguishing between these two conditions. It provides direct measurement of pulmonary artery pressures, which can be elevated in the case of heart failure.
B. A ventilation-perfusion (V/Q) scan is used to evaluate ventilation and perfusion in the lungs. While it can help identify areas of ventilation-perfusion mismatch, it may not be the most appropriate initial test for distinguishing between ARDS and pulmonary edema.
C. Drawing blood for arterial blood gases is also a critical step as it helps in assessing the severity of hypoxemia and respiratory failure.
D. A chest x-ray can show the presence of bilateral opacities, which are indicative of ARDS when cardiac failure or fluid overload is not the primary cause. However, transthoracic echocardiography (TTE) is often performed to seek evidence of cardiac dysfunction when cardiogenic pulmonary edema cannot be excluded by clinical evaluation, laboratory findings, or imaging.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.