Medical Surgical Hypertension #8

Question

The nurse is caring for a client in the 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 monitoring; however, until the arterial line is established, the nurse will monitor the client using which type of equipment?

Answers

  1. Noninvasive blood pressure monitors will be utilized.
    • Rationale:

      This answer is correct because while arterial pressures are often used in the Intensive Care Unit, blood pressure may be monitored via noninvasive devices, especially while awaiting an arterial line to be placed. The client has to be carefully monitored for hypotension since nitroglycerin infusion dilates blood vessels to reduce myocardial effort by decreasing preload and afterload.

  2. Central Venous Pressure gauge will be utilized.
    • Rationale:

      This answer is not correct because central venous pressure (CVP) is a reflection of preload and may guide decisions regarding fluid volume status, it does not give arterial blood pressure. The best action is to monitor blood pressure via noninvasive devices.

  3. The nurse will hold the nitroglycerin infusion until the arterial line is inserted.
    • Rationale:

      This answer is not correct because nitroglycerin therapy should not be held because it is an order from the health care provider and the client needs the vasodilation provided from the nitroglycerin to prevent further damage to the myocardium and complications associated with this.

  4. Pulse oximeter connected to monitor console.
    • Rationale:

      This answer is not correct because although the pulse oximeter is important to have on the client, it is not the equipment needed to monitor the client’s blood pressure while receiving nitroglycerin therapy. The best action is to monitor blood pressure via noninvasive devices.

Overview

Clients on intravenous nitroglycerin therapy must be monitored closely for hypotension. While arterial pressures are often used in the Intensive Care Unit, blood pressure may be monitored via noninvasive devices, especially while awaiting an arterial line to be placed.

Explanation

Learning Outcomes

Nitroglycerin infusions are indicated for myocardial infarction since the drug dilates vessels with the 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, especially while awaiting an arterial line to be placed.

Test Taking Tip

Using common sense and critical thinking to figure questions out is important. Use the knowledge you know from various courses, such as anatomy and physiology and foundations. Blood pressure measures arterial pressure, not venous. Therefore, even though central venous pressure (CVP) sounds so important and intimidating as an answer, it is not correct because blood pressures measure arterial pressure.

Video Rationale