Cardiac Question #32


The nurse is caring for a client in Intensive Care Unit for myocardial infarction. The client has a 18 gauge peripheral IV site and will utilize the site for starting an intravenous nitroglycerin infusion. The nurse understands that intra-arterial monitoring of blood pressure is preferred for monitoring; however, until the arterial line is established, the nurse will monitor the patient using which type of equipment?


  1. Noninvasive blood pressure monitor will be utilized.
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  2. Central Venous Pressure gauge will be utilized.
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  3. The nurse will hold the Nitroglycerin infusion until arterial line is inserted.
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  4. Pulse oximeter connected to monitor console
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Nitroglycerin infusions are indicated for myocardial infarction since the drug dilates vessels with goal of reducing myocardial effort by decreasing preload and afterload, and increasing myocardial oxygen supply. Hypotension is the main side effect due to dilation. Infusion of nitroglycerin may be titrated for chest pain and blood pressure. Clients should be in a controlled setting with continuous monitoring of cardiac and frequent blood pressure. Blood pressure must be monitored frequently and each time a titrated dose is changed. While arterial pressures are often used in the Intensive Care Unit, blood pressure may be monitored via noninvasive devices. The nurse should NOT hold the medication. Oximeter does not measure blood pressure response to nitroglycerin. Central Venous Pressure (CVP) is a reflection of preload and may guide decisions regarding fluid volume status, and CVP entails insertion into central venous system (via jugular or subclavian).

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