A nurse is caring for a client with cardiogenic shock and metabolic acidosis who currently… — NCLEX-RN

A nurse is caring for a client with cardiogenic shock and metabolic acidosis who currently has a single peripheral intravenous (IV) line. The client is receiving a continuous IV infusion of $8.4\%$ sodium bicarbonate at $50\text{ mL/hr}$ . The healthcare provider prescribes a new continuous IV infusion of dopamine at $5\text{ mcg/kg/min}$ . The client weighs $176\text{ lbs}$ . The pharmacy dispenses dopamine $400\text{ mg}$ diluted in $250\text{ mL}$ of $5\%$ dextrose in water (D5W). Based on this prescription, which of the following actions is the most appropriate for the nurse to take?

Establish a secondary peripheral IV line, set the dopamine infusion pump to $15\text{ mL/hr}$ , and monitor the insertion site closely for extravasation.Answer
B
Establish a secondary peripheral IV line, set the dopamine infusion pump to $33\text{ mL/hr}$ , and monitor the insertion site closely for extravasation.
C
Connect the dopamine to the Y-site of the sodium bicarbonate infusion, set the pump to $15\text{ mL/hr}$ , and continuously monitor the client's blood pressure.
D
Connect the dopamine to the Y-site of the sodium bicarbonate infusion, set the pump to $33\text{ mL/hr}$ , and observe the IV tubing for precipitate formation.

Answer

The most appropriate action is to establish a secondary peripheral IV line, set the dopamine infusion pump to

15\text{ mL/hr}

, and monitor the insertion site closely for extravasation.

The correct action requires both accurate dosage calculation and knowledge of intravenous compatibility. First, dopamine is a catecholamine, which is rapidly inactivated in alkaline solutions such as sodium bicarbonate. Therefore, connecting dopamine to the Y-site of a sodium bicarbonate infusion is contraindicated; a secondary IV line must be established. Additionally, dopamine is a potent vesicant that can cause severe tissue necrosis if extravasation occurs, so the peripheral site must be monitored meticulously. Second, the correct infusion rate must be calculated: Convert the weight (

176\text{ lbs} \div 2.2 = 80\text{ kg}

), determine the dose (

5\text{ mcg} \times 80 = 400\text{ mcg/min}

), calculate the concentration (

400,000\text{ mcg} \div 250\text{ mL} = 1,600\text{ mcg/mL}

), and determine the hourly rate (

400 \div 1,600 = 0.25\text{ mL/min} \times 60\text{ min/hr} = 15\text{ mL/hr}

Step-by-Step Solution

Determine the physical and chemical compatibility of the prescribed medications.

Dopamine and sodium bicarbonate are chemically incompatible.

Dopamine is a catecholamine that undergoes chemical breakdown when exposed to highly alkaline solutions (like sodium bicarbonate). Therefore, a separate IV line is mandatory.

Convert the client's weight from pounds to kilograms.

176\text{ lbs} \div 2.2 = 80\text{ kg}

Critical care continuous infusions are dosed based on the client's weight in kilograms.

Calculate the required dose per minute.

5\text{ mcg/kg/min} \times 80\text{ kg} = 400\text{ mcg/min}

Determines the total amount of medication the client requires every minute to achieve the therapeutic effect.

Determine the concentration of the supplied dopamine solution.

400\text{ mg} = 400,000\text{ mcg}

. Concentration =

400,000\text{ mcg} \div 250\text{ mL} = 1,600\text{ mcg/mL}

Standardizes the units (mcg to mcg) to prepare for volume calculation.

Calculate the final IV pump flow rate in mL/hr.

Rate =

(400\text{ mcg/min} \div 1,600\text{ mcg/mL}) \times 60\text{ min/hr} = 15\text{ mL/hr}

IV infusion pumps must be programmed in milliliters per hour.

Key Concept

Chemical incompatibility of catecholamines with alkaline solutions and complex weight-based intravenous medication calculations.

Estimated Time:2m 30s

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