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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Correct Answer is A

Explanation

A. In a patient receiving a dobutamine infusion, which is a vasopressor medication used to increase cardiac output, a cool and pale IV infusion site could indicate inadequate perfusion despite treatment. This finding requires immediate action to assess the patient's hemodynamic status and ensure adequate tissue perfusion.

B. Warm and dry extremities are typically indicative of adequate tissue perfusion. In neurogenic shock, vasodilation can lead to warm extremities due to decreased systemic vascular resistance. While this finding may be expected in neurogenic shock, it does not necessarily indicate a need for immediate action if other parameters are stable.

C. Decreased urine output can be indicative of inadequate renal perfusion and impaired kidney function. In a patient with neurogenic shock, maintaining adequate renal perfusion is crucial to prevent acute kidney injury. While decreased urine output warrants close monitoring and intervention, it may not require immediate action unless other signs of worsening perfusion are present.

D. A heart rate of 58 beats/min may be within the normal range for some patients, especially those who are receiving dobutamine, which can have a chronotropic effect. However, in the context of neurogenic shock, bradycardia may indicate a compensatory response to hypotension and decreased tissue perfusion. While bradycardia alone may not always require immediate action, it should prompt further assessment of the patient's hemodynamic status and response to treatment.

A. Hypotension due to neurogenic shock B. Hypotension due to septic shock C. Hypotension due to hypovolemic shock D. Hypotension due to cardiogenic shock

Correct Answer is C

Explanation

C. its use in hypovolemic shock is generally not appropriate because the primary treatment for hypovolemic shock is fluid resuscitation to address the volume loss.

A. Dopamine is often used in neurogenic shock to increase systemic vascular resistance and improve blood pressure. Therefore, dopamine is an appropriate choice for the management of hypotension due to neurogenic shock.

B. Dopamine is commonly used in septic shock to improve cardiac output and systemic vascular resistance. It helps to support blood pressure and perfusion in septic shock patients.

D. It is indicated for cardiogenic shock as it increases cardiac contractility.

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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

Naxlex Comprehensive Predictor Exams

A patient who has neurogenic shock is receiving a dobutamine infusion through a right forearm IV. Which assessment finding obtained by the nurse indicates a need for immediate action?

Correct Answer is A

Explanation

Which of the following is NOT an appropriate indication for the use of dopamine in critical care?

Correct Answer is C

Explanation

Which of the following is an appropriate nursing intervention for a patient with a pulmonary artery catheter?

A patient with respiratory failure has a respiratory rate of 6 breaths/min and an oxygen saturation (SpO2) of 78%. The patient is increasingly lethargic. Which intervention will the nurse anticipate?

A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective?

A patient who has been involved in a motor vehicle crash arrives in the emergency department (ED) with cool, clammy skin; tachycardia; and hypotension. Which intervention prescribed by the health care provider should the nurse implement first?

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A nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury?