Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
,TEST BANK
Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 62-year-old male patient is admitted to
the intensive care unit in cardiogenic shock. The advanced
practice provider prescribes an intravenous infusion of
norepinephrine titrated to maintain a mean arterial
pressure (MAP) greater than 65 mmHg. The patient has a
central venous catheter in place, but the infusion is
temporarily initiated through a 20-gauge peripheral IV in
the right forearm while the central line placement is
verified via X-ray.
• Question Stem: During an hourly assessment, the nurse
notes that the peripheral IV site in the right forearm is
cool, pale, swollen, and the infusion pump is alerting for an
occlusion. Which action should the nurse take first?
o A. Discontinue the peripheral IV catheter immediately
and apply a tight pressure dressing.
o B. Stop the norepinephrine infusion immediately and
leave the IV catheter in place.
, o C. Flush the IV line forcefully with 10 mL of normal
saline to clear the occlusion.
o D. Apply a cold compress to the affected forearm to
reduce local swelling and edema.
• Correct Answer: B
• Comprehensive Rationale: Norepinephrine is a potent
alpha-1 and beta-1 adrenergic agonist. When extravasation
occurs into peripheral tissues, its intense alpha-1-mediated
vasoconstrictive effects can cause localized tissue ischemia,
hypoxia, and subsequent necrosis. The immediate priority
nursing action for any suspected extravasation of a
vesicant or vasoconstrictor is to stop the infusion
immediately to prevent further drug delivery into the
subcutaneous tissue. The catheter must be left in place
initially because it serves as the access route to administer
the antidote, phentolamine (an alpha-adrenergic
antagonist), directly into the infiltrated tissue to reverse
the intense local vasoconstriction.
• Distractor Analysis:
o A is incorrect: While the IV must eventually be
discontinued, pulling the catheter immediately
eliminates the direct channel needed to inject the
antidote (phentolamine) into the extravasation site.
, Applying a tight pressure dressing would further
compromise local tissue perfusion.
o C is incorrect: Forceful flushing of an infiltrated or
occluded line containing a potent vasoconstrictor
increases tissue hydrostatic pressure, pushing more
vesicant deeper into surrounding tissues and
worsening ischemic damage.
o D is incorrect: Cold compresses cause further localized
vasoconstriction, which compounds the ischemic
tissue damage caused by norepinephrine. Warm or
neutral compresses are typically preferred for alpha-
agonist extravasations after the antidote is given to
promote vasodilation and local drug clearance.
• Nursing Process Integration:
o Primary: Implementation. Executing immediate safety
actions during an acute drug administration crisis.
o Remaining Steps: Assessment identifies the clinical
signs of extravasation. Diagnosis frames the risk for
impaired tissue integrity. Planning ensures
phentolamine is available. Evaluation checks the skin
for returning pink color and warmth after antidote
administration.
• NCJMM Competency: Take Action
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
,TEST BANK
Question 1: Multiple-Choice Question (MCQ)
• Clinical Scenario: A 62-year-old male patient is admitted to
the intensive care unit in cardiogenic shock. The advanced
practice provider prescribes an intravenous infusion of
norepinephrine titrated to maintain a mean arterial
pressure (MAP) greater than 65 mmHg. The patient has a
central venous catheter in place, but the infusion is
temporarily initiated through a 20-gauge peripheral IV in
the right forearm while the central line placement is
verified via X-ray.
• Question Stem: During an hourly assessment, the nurse
notes that the peripheral IV site in the right forearm is
cool, pale, swollen, and the infusion pump is alerting for an
occlusion. Which action should the nurse take first?
o A. Discontinue the peripheral IV catheter immediately
and apply a tight pressure dressing.
o B. Stop the norepinephrine infusion immediately and
leave the IV catheter in place.
, o C. Flush the IV line forcefully with 10 mL of normal
saline to clear the occlusion.
o D. Apply a cold compress to the affected forearm to
reduce local swelling and edema.
• Correct Answer: B
• Comprehensive Rationale: Norepinephrine is a potent
alpha-1 and beta-1 adrenergic agonist. When extravasation
occurs into peripheral tissues, its intense alpha-1-mediated
vasoconstrictive effects can cause localized tissue ischemia,
hypoxia, and subsequent necrosis. The immediate priority
nursing action for any suspected extravasation of a
vesicant or vasoconstrictor is to stop the infusion
immediately to prevent further drug delivery into the
subcutaneous tissue. The catheter must be left in place
initially because it serves as the access route to administer
the antidote, phentolamine (an alpha-adrenergic
antagonist), directly into the infiltrated tissue to reverse
the intense local vasoconstriction.
• Distractor Analysis:
o A is incorrect: While the IV must eventually be
discontinued, pulling the catheter immediately
eliminates the direct channel needed to inject the
antidote (phentolamine) into the extravasation site.
, Applying a tight pressure dressing would further
compromise local tissue perfusion.
o C is incorrect: Forceful flushing of an infiltrated or
occluded line containing a potent vasoconstrictor
increases tissue hydrostatic pressure, pushing more
vesicant deeper into surrounding tissues and
worsening ischemic damage.
o D is incorrect: Cold compresses cause further localized
vasoconstriction, which compounds the ischemic
tissue damage caused by norepinephrine. Warm or
neutral compresses are typically preferred for alpha-
agonist extravasations after the antidote is given to
promote vasodilation and local drug clearance.
• Nursing Process Integration:
o Primary: Implementation. Executing immediate safety
actions during an acute drug administration crisis.
o Remaining Steps: Assessment identifies the clinical
signs of extravasation. Diagnosis frames the risk for
impaired tissue integrity. Planning ensures
phentolamine is available. Evaluation checks the skin
for returning pink color and warmth after antidote
administration.
• NCJMM Competency: Take Action
