A client in cardiogenic shock is receiving a continuous intravenous (IV) infusion of dopam… — NCLEX-RN

A client in cardiogenic shock is receiving a continuous intravenous (IV) infusion of dopamine through a single-lumen peripheral IV line. The healthcare provider prescribes a stat dose of furosemide $120$ mg IV push for acute pulmonary edema. The facility protocol dictates that furosemide should not be administered faster than $20$ mg/minute to prevent adverse effects. Furosemide is physically incompatible with dopamine. Based on these parameters, which action by the nurse is the safest and most appropriate?

Establish a second peripheral IV access and administer the furosemide over a minimum of $6$ minutes.Answer
B
Pause the dopamine infusion, flush the IV line with normal saline, administer the furosemide over $6$ minutes, and resume the dopamine.
C
Administer the furosemide through the lowest Y-site port on the primary IV tubing over a minimum of $6$ minutes.
D
Establish a second peripheral IV access and administer the furosemide over $2$ minutes to ensure rapid relief of the pulmonary edema.

Answer

The safest and most appropriate action is to establish a second peripheral IV access and administer the furosemide over a minimum of

6

minutes.

This action correctly addresses all three critical safety factors in the scenario. First, calculating

120

mg at a maximum rate of

20

mg/minute dictates a minimum administration time of

6

minutes to prevent ototoxicity. Second, because furosemide and dopamine are physically incompatible, they cannot be mixed in the same line. Third, dopamine is a life-sustaining vasoactive infusion with a half-life of roughly

2

minutes; pausing it for

6

or more minutes would result in a severe, potentially fatal drop in blood pressure. Therefore, establishing a separate, dedicated IV line is the only action that safely accommodates the continuous vasopressor and the slow IV push of an incompatible medication.

Step-by-Step Solution

Analyze the prescribed dose and maximum administration rate.

Dividing

120

mg by the maximum rate of

20

mg/minute yields a minimum administration time of

6

minutes.

Calculating the correct IV push time is critical to prevent adverse effects like ototoxicity.

Evaluate the physical compatibility of the medications.

Furosemide and dopamine are incompatible and cannot be mixed in the same IV line.

Mixing them at the Y-site would cause an immediate chemical reaction and precipitate formation.

Determine the physiological impact of pausing the continuous infusion.

Dopamine is a critical vasoactive medication with a very short half-life. It cannot be safely paused for

6

minutes.

Interrupting the vasopressor would likely cause catastrophic hemodynamic collapse in a client with cardiogenic shock.

Synthesize the findings to select the safest administration method.

Establishing a second, dedicated peripheral IV access is required.

This allows the safe, slow administration of furosemide without interrupting the life-sustaining dopamine infusion.

Key Concept

Safe Parenteral Administration of Incompatible High-Risk Medications

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