Examkin

Question

Difficulty: HardPharmacological and Parenteral Therapies

A client admitted with a hypertensive emergency is receiving a continuous intravenous infusion of sodium nitroprusside at 3 mcg/kg/min3 \text{ mcg/kg/min}. The client weighs 220 lbs220 \text{ lbs}. The medication is supplied as 50 mg50 \text{ mg} of sodium nitroprusside in 250 mL250 \text{ mL} of 5%5\% dextrose in water (D5W). Upon assessment, the nurse notes the client's blood pressure has decreased to 86/52 mmHg86/52 \text{ mmHg}. The healthcare provider prescribes titrating the infusion rate down to 1 mcg/kg/min1 \text{ mcg/kg/min}. Which action is most appropriate for the nurse to take?

  1. Adjust the infusion pump to deliver 30 mL/hr30 \text{ mL/hr} and assess the client's blood pressure every 5 minutes.Answer
  2. B
    Adjust the infusion pump to deliver 66 mL/hr66 \text{ mL/hr} to ensure the dose accurately reflects the client's weight.
  3. C
    Pause the medication infusion and assist the client into a high-Fowler's position to promote cerebral perfusion.
  4. D
    Adjust the infusion pump to deliver 60 mL/hr60 \text{ mL/hr} to accurately execute the prescribed dosage reduction.

Answer

The nurse should adjust the infusion pump to 30 mL/hr30 \text{ mL/hr} and assess the blood pressure every 5 minutes.
The correct action involves accurately calculating the new weight-based infusion rate and implementing vigilant clinical monitoring. By completing the dimensional analysis (100 kg×1 mcg/kg/min×60 minutes=6000 mcg/hr100 \text{ kg} \times 1 \text{ mcg/kg/min} \times 60 \text{ minutes} = 6000 \text{ mcg/hr}; 6000 mcg÷200 mcg/mL=30 mL/hr6000 \text{ mcg} \div 200 \text{ mcg/mL} = 30 \text{ mL/hr}), the nurse ensures precise drug delivery. Furthermore, because sodium nitroprusside is a potent vasodilator with a very short half-life (approximately 2 minutes), blood pressure must be monitored continuously or at minimum every 5 to 10 minutes during active titration.

Step-by-Step Solution

1
Convert the client's weight from pounds to kilograms.
220 lbs÷2.2 lbs/kg=100 kg220 \text{ lbs} \div 2.2 \text{ lbs/kg} = 100 \text{ kg}
Nitroprusside is dosed based on metric body weight.
2
Calculate the total required dose per minute based on the new prescribed rate.
100 kg×1 mcg/kg/min=100 mcg/min100 \text{ kg} \times 1 \text{ mcg/kg/min} = 100 \text{ mcg/min}
Determines the exact amount of medication the client needs every sixty seconds.
3
Convert the dose per minute to the dose per hour.
100 mcg/min×60 min/hr=6000 mcg/hr100 \text{ mcg/min} \times 60 \text{ min/hr} = 6000 \text{ mcg/hr}
IV pumps are programmed in mL per hour, so the dose must reflect an hourly requirement.
4
Determine the concentration of the supplied medication in mcg/mL.
50 mg=50,000 mcg50 \text{ mg} = 50,000 \text{ mcg}. 50,000 mcg÷250 mL=200 mcg/mL50,000 \text{ mcg} \div 250 \text{ mL} = 200 \text{ mcg/mL}
Establishes how much active drug is in each milliliter of the IV fluid.
5
Calculate the final infusion rate in mL/hr.
6000 mcg/hr÷200 mcg/mL=30 mL/hr6000 \text{ mcg/hr} \div 200 \text{ mcg/mL} = 30 \text{ mL/hr}
Provides the correct volume to set on the infusion pump to deliver the prescribed dose.

Key Concept

Weight-Based Continuous Infusion Titration and Hypotension Management
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic