An emergency department team is treating a client for a hypertensive emergency. The provid… — NCLEX-RN

An emergency department team is treating a client for a hypertensive emergency. The provider prescribes a continuous sodium nitroprusside infusion with instructions to begin at $0.3 \text{ mcg/kg/min}$ and titrate upward by $0.3 \text{ mcg/kg/min}$ every $5 \text{ minutes}$ until the mean arterial pressure (MAP) falls below $100 \text{ mm Hg}$ .

The client's admission weight is $231 \text{ lbs}$ .
The pharmacy supplies a premixed IV bag containing $50 \text{ mg}$ of sodium nitroprusside in $250 \text{ mL}$ of $5\%$ dextrose in water ( $D_5W$ ).

The nurse initiates the infusion. Because the client's MAP remains consistently above $100 \text{ mm Hg}$ during the initial monitoring period, the nurse performs exactly three protocol-directed upward titrations.

Determine the new IV pump rate in $\text{mL/hr}$ immediately following the third titration. Round your final answer to the nearest whole number.

Answer: 38 mL/hr

Answer

To determine the correct IV pump rate for a weight-based titration, the nurse must first convert the weight to kilograms (

231 \text{ lbs} \div 2.2 = 105 \text{ kg}

). Next, the new dose is calculated by adding the three titrations to the initial rate:

0.3 + (3 \times 0.3) = 1.2 \text{ mcg/kg/min}

. This weight-based dose is multiplied by the client's weight (

1.2 \times 105 = 126 \text{ mcg/min}

) and then converted to an hourly rate (

126 \times 60 = 7560 \text{ mcg/hr}

). Finally, the hourly dose is divided by the bag concentration in matching units (

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

). The result (

7560 \div 200 = 37.8 \text{ mL/hr}

) is rounded to the nearest whole number to get

38 \text{ mL/hr}

Step-by-Step Solution

Convert the client's weight from pounds to kilograms.

105 \text{ kg}

Weight-based dosing requires the client's weight in metric units (kg). Divide

231 \text{ lbs}

2.2

Determine the new prescribed dose after three upward titrations.

1.2 \text{ mcg/kg/min}

The initial dose is

0.3 \text{ mcg/kg/min}

. Each titration adds

0.3 \text{ mcg/kg/min}

. Three titrations add

0.9 \text{ mcg/kg/min}

to the baseline.

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

126 \text{ mcg/min}

Multiply the weight-based dose (

1.2 \text{ mcg/kg/min}

) by the client's weight (

105 \text{ kg}

) to find the absolute per-minute dose.

Convert the per-minute dose to an hourly dose.

7560 \text{ mcg/hr}

IV pumps are programmed in hours. Multiply the per-minute dose (

126 \text{ mcg/min}

) by

60

minutes.

Calculate the concentration of the medication in mcg/mL.

200 \text{ mcg/mL}

Convert

50 \text{ mg}

50,000 \text{ mcg}

, then divide by the

250 \text{ mL}

bag volume to align units with the ordered dose.

Calculate the required infusion volume per hour and round to the nearest whole number.

38 \text{ mL/hr}

Divide the hourly dose (

7560 \text{ mcg/hr}

) by the concentration (

200 \text{ mcg/mL}

) to get

37.8 \text{ mL/hr}

, which rounds to

38

Key Concept

Calculation and titration of weight-based continuous intravenous infusions (mcg/kg/min to mL/hr).

Question

Answer

Step-by-Step Solution

Key Concept

Common Mistakes

Topics

More questions from this topic