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.

Answer and Explanation

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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Correct Answer is B

Explanation

Mean arterial pressure (MAP) is a measure of the average pressure within the arteries during one cardiac cycle. It represents the perfusion pressure that drives blood flow to organs and tissues. MAP is calculated using the formula:
MAP = Diastolic blood pressure + 1/3 (Systolic blood pressure - Diastolic blood pressure)
Blood loss, particularly in cases of significant hemorrhage, leads to a decrease in blood volume. When blood volume decreases, there is less circulating blood available to generate pressure within the arterial system. This reduction in blood volume results in decreased MAP.
Therefore, in the case of massive blood loss after trauma, the student can correlate it with a lower blood volume, which in turn leads to a lower MAP. The decrease in blood volume reduces the perfusion pressure, compromising organ and tissue perfusion
A. It causes vasoconstriction and increased MAP in (option A) is incorrect because: While vasoconstriction can occur as a compensatory mechanism to maintain blood pressure, it does not necessarily lead to an increased MAP in the context of significant blood loss.
C. It raises cardiac output and MAP in (option C) is incorrect because Blood loss typically leads to a reduction in cardiac output due to decreased blood volume. Therefore, it does not raise cardiac output and MAP.
D. There is no direct correlation to MAP in (option D) is incorrect because: There is indeed a direct correlation between blood loss and MAP. As blood volume decreases, MAP decreases as well.
Therefore, the correct correlation between blood loss and MAP is that lower blood volume lowers MAP.

A. Tachypnoea B. Heart blocks C. Vomiting D. Bradycardia E. Hypotension

Correct Answer is A

Explanation

Tachypnoea, which refers to an increased respiratory rate, is an early symptom of hypovolemic shock. It is the body's compensatory response to inadequate tissue perfusion and decreased oxygen delivery. The increased respiratory rate is an attempt to improve oxygenation and maintain vital organ function.
B. Heart blocks in (option B) are incorrect because Heart blocks refer to disruptions in the electrical conduction system of the heart and are not specific to hypovolemic shock.
C. Vomiting in (option C) is incorrect because: Vomiting may occur in various conditions, including shock, but it is not exclusive to hypovolemic shock and can be present in other forms of shock or illnesses.
D. Bradycardia in (option D) is incorrect because Bradycardia, or a slow heart rate, is not typically an early symptom of hypovolemic shock. Instead, tachycardia (rapid heart rate) is more commonly observed as a compensatory response to maintain cardiac output.
E. Hypotension in (option E) is incorrect because Hypotension, or low blood pressure, can occur in hypovolemic shock but is generally considered a later-stage symptom. In the early stages, compensatory mechanisms may help maintain blood pressure, so hypotension may not be present initially.
F. Bradypnea in (option F) is incorrect because: Bradypnea refers to a slow respiratory rate, which is not typically an early symptom of hypovolemic shock. Tachypnoea, as mentioned earlier, is the more common early respiratory symptom.

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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?

Nursing Test Bank

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