A critical care team is managing a client with a severe hypertensive emergency, presenting… — NCLEX-RN

A critical care team is managing a client with a severe hypertensive emergency, presenting with a blood pressure of $210/120 \text{ mm Hg}$ . Because sodium nitroprusside can cause profound hypotension, it must be administered via a controlled infusion pump. The primary healthcare provider orders a continuous intravenous infusion starting at $4 \text{ mcg/kg/min}$ . The medication arrives from the pharmacy as a solution containing $100 \text{ mg}$ of sodium nitroprusside diluted in $100 \text{ mL}$ of normal saline. The client weighs $87 \text{ kg}$ .

Calculate the infusion pump rate in $\text{mL/hr}$ . Round the final answer to the nearest tenth.

Answer: 20.9 mL/hr

Answer

The infusion pump should be programmed to

20.9 \text{ mL/hr}

To determine the correct IV pump rate, first calculate the total micrograms required per minute by multiplying the dose by the client's weight (

4 \times 87 = 348 \text{ mcg/min}

). Next, convert this to an hourly rate (

348 \times 60 = 20,880 \text{ mcg/hr}

). Then, find the concentration of the IV solution in micrograms by converting

100 \text{ mg}

100,000 \text{ mcg}

, which yields

1000 \text{ mcg/mL}

. Finally, divide the required hourly dose by the concentration (

20,880 \div 1000 = 20.88

) and round to the nearest tenth to get

20.9 \text{ mL/hr}

Step-by-Step Solution

Calculate the total mcg required per minute.

4 \text{ mcg/kg/min} \times 87 \text{ kg} = 348 \text{ mcg/min}

The prescription is weight-based, so the ordered dose must be multiplied by the client's weight in kilograms.

Convert the per-minute dose to an hourly dose.

348 \text{ mcg/min} \times 60 \text{ min/hr} = 20,880 \text{ mcg/hr}

Infusion pumps are programmed in mL per hour, requiring a time conversion from minutes to hours.

Determine the concentration of the medication in mcg/mL.

100 \text{ mg} = 100,000 \text{ mcg}

. Concentration =

100,000 \text{ mcg} \div 100 \text{ mL} = 1000 \text{ mcg/mL}

The unit of measurement for the dose (mcg) must match the unit used for the solution concentration to accurately calculate volume.

Calculate the final infusion rate.

20,880 \text{ mcg/hr} \div 1000 \text{ mcg/mL} = 20.88 \text{ mL/hr}

. Rounded to the nearest tenth:

20.9 \text{ mL/hr}

Dividing the hourly dose by the concentration yields the fluid volume to be infused per hour.

Key Concept

Weight-based critical care medication continuous infusion rate calculations (mcg/kg/min to mL/hr)

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