Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which data indicate that the nurse should consult with the health care provider before starting the norepinephrine?

D. Myocardial infarction (heart attack) is a common cause of cardiogenic shock. In myocardial infarction, part of the heart muscle becomes ischemic or necrotic due to occlusion of a coronary artery. This leads to impaired cardiac function and reduced cardiac output, resulting in cardiogenic shock. Prompt recognition and treatment of myocardial infarction are crucial to prevent or manage cardiogenic shock.
A. Anaphylaxis is a severe allergic reaction that can lead to systemic vasodilation and distributive shock, but it is not a common cause of cardiogenic shock. In anaphylaxis, the primary mechanism of shock is typically related to widespread vasodilation and increased vascular permeability rather than impaired cardiac function.
B. Hypovolemic shock occurs due to a decrease in intravascular volume, leading to inadequate tissue perfusion. It is not a common cause of cardiogenic shock, as the underlying mechanism is different. In hypovolemic shock, the primary issue is the loss of circulating blood volume, whereas cardiogenic shock involves impaired cardiac function.
C. Pulmonary embolism can lead to acute right heart strain or failure, which may result in hemodynamic instability and shock. However, pulmonary embolism typically causes obstructive shock rather than cardiogenic shock. Obstructive shock occurs when blood flow is obstructed, such as by a pulmonary embolism, leading to reduced cardiac output.

A. Nitroglycerin is a vasodilator commonly used to reduce preload and afterload in critical care settings. By dilating blood vessels, nitroglycerin decreases systemic vascular resistance (afterload), which reduces the workload on the heart and improves cardiac output. It is often used to manage conditions such as acute heart failure, hypertensive emergencies, and acute coronary syndromes.

B. Metoprolol is a beta-blocker that primarily acts to reduce heart rate and myocardial contractility. While it can indirectly reduce afterload by lowering blood pressure, its primary mechanism of action is not targeted at afterload reduction. Metoprolol is commonly used in critical care for various indications, including hypertension, myocardial infarction, and heart failure, but it is not primarily used for afterload reduction.

C. Furosemide is a loop diuretic commonly used to manage volume overload and reduce preload in critical care settings. By promoting diuresis, furosemide decreases circulating blood volume, venous return, and preload, which indirectly reduces afterload. However, its primary mechanism of action is not targeted at afterload reduction but rather at reducing volume overload.

D. Epinephrine is a potent sympathomimetic agent that acts on alpha and beta-adrenergic receptors. While it can increase systemic vascular resistance (afterload) at higher doses due to its alpha-adrenergic effects, it is not commonly used for afterload reduction in critical care settings. Epinephrine is primarily used as a vasopressor to increase blood pressure and cardiac output in patients with shock or cardiac arrest.