The nurse is caring for a patient receiving a continuous norepinephrine (Levophed) IV infusion. Which patient assessment information indicates that the infusion rate may be too high?
Mean arterial pressure is 55 mm Hg.
Systemic vascular resistance (SVR) is elevated.
Pulmonary artery wedge pressure (PAWP) is low.
Heart rate is 58 beats/min.
The Correct Answer is D
Norepinephrine is a potent vasoconstrictor and inotropic agent commonly used to increase blood pressure in cases of hypotension or shock. However, if the infusion rate is too high, it can lead to excessive vasoconstriction and potentially compromise organ perfusion.
A heart rate of 58 beats/min suggests bradycardia, which can be an indication of excessive vasoconstriction caused by a high dose or rate of norepinephrine infusion. Excessive vasoconstriction can reduce cardiac output and worsen tissue perfusion.
A. Mean arterial pressure is 55 mm Hg in (option A) is incorrect because A mean arterial pressure of 55 mm Hg may be within an acceptable range for a patient receiving norepinephrine infusion, depending on the patient's baseline blood pressure and clinical condition.
B. Systemic vascular resistance (SVR) is elevated in (option B) is incorrect because An elevated SVR indicates increased peripheral vascular resistance and can be a desired effect of norepinephrine infusion to improve blood pressure and perfusion.
C. Pulmonary artery wedge pressure (PAWP) is low in (option C) which is incorrect because A low PAWP may indicate decreased left ventricular preload, which can be a desired effect of norepinephrine infusion to reduce fluid overload in certain clinical conditions.
It is important for the nurse to carefully monitor the patient's hemodynamic parameters, including blood pressure, heart rate, and organ perfusion when titrating norepinephrine infusion to ensure optimal dosing and minimize potential adverse effects. If concerns arise regarding the infusion rate, the healthcare provider should be promptly notified for further evaluation and adjustment of the treatment plan.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Neurogenic shock is a type of distributive shock that occurs due to the loss of sympathetic nervous system tone after a spinal cord injury or other traumatic brain injuries. This loss of sympathetic tone leads to vasodilation and decreased systemic vascular resistance, resulting in inadequate perfusion to vital organs.
One of the hallmark signs of neurogenic shock is bradycardia (a heart rate less than 60 beats/min) due to the unopposed parasympathetic activity. The parasympathetic system becomes dominant when sympathetic activity is impaired. Therefore, a heart rate of 48 beats/min in this patient suggests the possibility of neurogenic shock.
A. Cool, clammy skin in (option A) is incorrect because Cool, clammy skin is a characteristic of hypovolemic shock, where reduced blood volume leads to vasoconstriction to redirect blood flow to vital organs.
B. BP of 82/40 mm Hg in (option B) is incorrect because: Hypotension is a common finding in both neurogenic shock and hypovolemic shock. A low blood pressure reading alone does not specifically indicate neurogenic shock.
D. Shortness of breath in (option D) is incorrect because Shortness of breath is not specific to neurogenic shock but can occur in various types of shock, including hypovolemic shock. It may result from inadequate oxygenation or impaired respiratory function due to the underlying condition or associated injuries.
Therefore, the heart rate of 48 beats/min suggests the possibility of neurogenic shock in addition to hypovolemic shock in this patient.
Correct Answer is D
Explanation
When the low-pressure alarm sounds, it indicates that the pressure being detected by the arterial line is below the set threshold. This could be due to a variety of reasons, such as a loose connection, air bubbles, or a shift in the zero-reference point.
Rezeroing the monitoring equipment involves recalibrating or resetting the baseline reference point for the arterial pressure waveform. This ensures accurate measurement and monitoring of the patient's arterial pressure.
A. Checking the right hand for a rash in (option A) is incorrect because While assessing the patient for any skin changes or rashes is important, it is not the first action to take in response to a low-pressure alarm.
B. Assessing the waveform for under-dampening in (option B) is incorrect because Assessing the waveform characteristics is important in arterial line monitoring, but it may not be the initial action when the low-pressure alarm sounds. Rezeroing the equipment should be performed before assessing waveform characteristics.
C. Assessing for cardiac dysrhythmias in (option C) is incorrect because Assessing for dysrhythmias is an important aspect of patient care, but it may not be directly related to the low-pressure alarm from the arterial line. Rezeroing the monitoring equipment takes precedence.
Therefore, when the low-pressure alarm sounds for a patient with an arterial line, the nurse should first re-zero the monitoring equipment to ensure accurate measurement of arterial pressure.
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