An emergency department nurse is managing a client in a hypertensive crisis. The client we… — NCLEX-RN

An emergency department nurse is managing a client in a hypertensive crisis. The client weighs $85\text{ kg}$ and is currently receiving a continuous intravenous (IV) infusion of sodium nitroprusside at $25\text{ mL/hr}$ . The IV bag contains $50\text{ mg}$ of sodium nitroprusside mixed in $250\text{ mL}$ of $5\%$ Dextrose in Water ( $D_5W$ ). According to the facility protocol, the nurse must titrate the infusion upward by $0.5\text{ mcg/kg/min}$ if the mean arterial pressure (MAP) remains above $80\text{ mm Hg}$ . The client's current MAP is $94\text{ mm Hg}$ . After increasing the dosage by one increment, what will be the new infusion pump rate in $\text{mL/hr}$ ? Record your answer to the nearest tenth.

Answer: 37.8 mL/hr

Answer

37.8

To safely titrate the sodium nitroprusside, the nurse must first establish the concentration of the solution (

50,000\text{ mcg} / 250\text{ mL} = 200\text{ mcg/mL}

). Next, the nurse calculates the required dose increase based on the client's weight (

0.5\text{ mcg/kg/min} \times 85\text{ kg} = 42.5\text{ mcg/min}

). Because infusion pumps run in

\text{mL/hr}

, this dose must be multiplied by

60

minutes to find the hourly dose increase (

2,550\text{ mcg/hr}

). Dividing the hourly dose by the concentration yields the rate increase in volume (

2,550\text{ mcg/hr} \div 200\text{ mcg/mL} = 12.75\text{ mL/hr}

). Finally, adding this increase to the current rate gives the new total rate (

25\text{ mL/hr} + 12.75\text{ mL/hr} = 37.75\text{ mL/hr}

), which rounds to

37.8\text{ mL/hr}

Step-by-Step Solution

Convert the total medication mass from milligrams to micrograms.

50\text{ mg} \times 1,000\text{ mcg/mg} = 50,000\text{ mcg}

The prescribed titration increment is provided in micrograms, so the concentration must be in the same unit.

Calculate the concentration of the sodium nitroprusside IV solution.

50,000\text{ mcg} \div 250\text{ mL} = 200\text{ mcg/mL}

Determining the amount of medication per milliliter of fluid is necessary to convert the required dose into a pump rate.

Calculate the dose increase per minute based on the client's weight.

0.5\text{ mcg/kg/min} \times 85\text{ kg} = 42.5\text{ mcg/min}

Weight-based dosing requires multiplying the prescribed parameter by the client's total body weight in kg.

Convert the per-minute dose increase to a per-hour dose.

42.5\text{ mcg/min} \times 60\text{ min/hr} = 2,550\text{ mcg/hr}

IV infusion pumps are programmed in milliliters per hour, so the dose must reflect an hourly rate.

Calculate the volume increase required to deliver the hourly dose.

2,550\text{ mcg/hr} \div 200\text{ mcg/mL} = 12.75\text{ mL/hr}

Dividing the desired hourly dose by the fluid concentration yields the required increase in the pump rate.

Add the rate increase to the client's current continuous infusion rate.

25\text{ mL/hr} + 12.75\text{ mL/hr} = 37.75\text{ mL/hr}

The question asks for the new total infusion rate, which is the sum of the previous rate and the titration increase.

Round the final answer to the nearest tenth as directed.

37.8\text{ mL/hr}

Clinical calculations must adhere strictly to the rounding instructions provided in the order or prompt.

Key Concept

Weight-based Intravenous Medication Titration

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