Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario:
A 68-year-old male patient with a history of hypertension, type
2 diabetes, and benign prostatic hyperplasia is admitted to the
medical-surgical unit with acute decompensated heart failure.
The healthcare provider orders dobutamine 250 mg in 250 mL
D5W, titrated to maintain a systolic blood pressure >90 mmHg.
The patient's current vital signs are: blood pressure 82/48
mmHg, heart rate 118 bpm, respiratory rate 24/min, oxygen
saturation 89% on room air. The nurse notes that the patient
has received metoprolol 50 mg twice daily for the past 3 years.
Question Stem:
The nurse is preparing to initiate the dobutamine infusion.
Which action is most important for the nurse to implement
first?
Answer Options:
A. Administer a 500 mL normal saline fluid bolus to increase
preload before starting the dobutamine
B. Obtain a baseline electrocardiogram (ECG) and continuous
cardiac monitoring
C. Increase the oxygen delivery to 4 L/min via nasal cannula
,D. Notify the healthcare provider that dobutamine is
contraindicated due to the patient's metoprolol use
Correct Answer: B
Comprehensive Rationale:
Dobutamine is a direct-acting synthetic catecholamine with
predominant beta-1 receptor agonism and mild beta-2 and
alpha-1 effects. It increases cardiac contractility (positive
inotropic effect) with relatively less chronotropic effect
compared to dopamine. The primary mechanism involves
activation of beta-1 adrenergic receptors in cardiac muscle,
stimulating adenylate cyclase and increasing intracellular cyclic
AMP, which enhances calcium influx and myocardial
contractility.
In this patient with cardiogenic shock (blood pressure 82/48,
tachycardia, hypoxemia), dobutamine is appropriate to improve
cardiac output and tissue perfusion. However, dobutamine can
precipitate or exacerbate cardiac dysrhythmias, including
supraventricular tachycardia, ventricular ectopy, and atrial
fibrillation, particularly in patients with underlying cardiac
disease. Continuous ECG monitoring is essential for early
detection and management of dysrhythmias.
Distractor Analysis:
• A - Incorrect: While fluid resuscitation may be indicated in
some forms of shock, this patient is in cardiogenic shock
, secondary to heart failure. Excessive fluid administration
could worsen pulmonary congestion and heart failure
symptoms. The dobutamine is ordered to improve
contractility and cardiac output, not to expand volume.
Without knowing the patient's volume status, this action
could be harmful.
• C - Incorrect: While oxygen supplementation is appropriate
for a patient with oxygen saturation of 89%, it is not the
priority action before initiating an inotropic agent that
requires cardiac monitoring. Oxygen delivery is an
independent nursing action that can be implemented
simultaneously, but the priority is to ensure patient safety
during dobutamine administration.
• D - Incorrect: Dobutamine is not absolutely
contraindicated in patients receiving beta-blockers. While
beta-blockers may competitively inhibit the effects of
dobutamine at beta-1 receptors, higher doses of
dobutamine may overcome this blockade. The clinical
context of cardiogenic shock with hypotension warrants
the use of dobutamine despite the patient's metoprolol
use, though the patient may require higher doses. This
option reflects a misunderstanding of pharmacodynamic
interactions and the risk-benefit assessment in critical care.
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,Question 1
Item Type: MCQ
Clinical Scenario:
A 68-year-old male patient with a history of hypertension, type
2 diabetes, and benign prostatic hyperplasia is admitted to the
medical-surgical unit with acute decompensated heart failure.
The healthcare provider orders dobutamine 250 mg in 250 mL
D5W, titrated to maintain a systolic blood pressure >90 mmHg.
The patient's current vital signs are: blood pressure 82/48
mmHg, heart rate 118 bpm, respiratory rate 24/min, oxygen
saturation 89% on room air. The nurse notes that the patient
has received metoprolol 50 mg twice daily for the past 3 years.
Question Stem:
The nurse is preparing to initiate the dobutamine infusion.
Which action is most important for the nurse to implement
first?
Answer Options:
A. Administer a 500 mL normal saline fluid bolus to increase
preload before starting the dobutamine
B. Obtain a baseline electrocardiogram (ECG) and continuous
cardiac monitoring
C. Increase the oxygen delivery to 4 L/min via nasal cannula
,D. Notify the healthcare provider that dobutamine is
contraindicated due to the patient's metoprolol use
Correct Answer: B
Comprehensive Rationale:
Dobutamine is a direct-acting synthetic catecholamine with
predominant beta-1 receptor agonism and mild beta-2 and
alpha-1 effects. It increases cardiac contractility (positive
inotropic effect) with relatively less chronotropic effect
compared to dopamine. The primary mechanism involves
activation of beta-1 adrenergic receptors in cardiac muscle,
stimulating adenylate cyclase and increasing intracellular cyclic
AMP, which enhances calcium influx and myocardial
contractility.
In this patient with cardiogenic shock (blood pressure 82/48,
tachycardia, hypoxemia), dobutamine is appropriate to improve
cardiac output and tissue perfusion. However, dobutamine can
precipitate or exacerbate cardiac dysrhythmias, including
supraventricular tachycardia, ventricular ectopy, and atrial
fibrillation, particularly in patients with underlying cardiac
disease. Continuous ECG monitoring is essential for early
detection and management of dysrhythmias.
Distractor Analysis:
• A - Incorrect: While fluid resuscitation may be indicated in
some forms of shock, this patient is in cardiogenic shock
, secondary to heart failure. Excessive fluid administration
could worsen pulmonary congestion and heart failure
symptoms. The dobutamine is ordered to improve
contractility and cardiac output, not to expand volume.
Without knowing the patient's volume status, this action
could be harmful.
• C - Incorrect: While oxygen supplementation is appropriate
for a patient with oxygen saturation of 89%, it is not the
priority action before initiating an inotropic agent that
requires cardiac monitoring. Oxygen delivery is an
independent nursing action that can be implemented
simultaneously, but the priority is to ensure patient safety
during dobutamine administration.
• D - Incorrect: Dobutamine is not absolutely
contraindicated in patients receiving beta-blockers. While
beta-blockers may competitively inhibit the effects of
dobutamine at beta-1 receptors, higher doses of
dobutamine may overcome this blockade. The clinical
context of cardiogenic shock with hypotension warrants
the use of dobutamine despite the patient's metoprolol
use, though the patient may require higher doses. This
option reflects a misunderstanding of pharmacodynamic
interactions and the risk-benefit assessment in critical care.
