NCLEX-RNPharmacological and Parenteral TherapiesMedium
A client is receiving a continuous infusion of dobutamine. The nurse notes the client's heart rate has increased from 88 bpm to 118 bpm and blood pressure from 102/68 mmHg to 138/84 mmHg. The nurse should anticipate an order to take which action?
- AAdminister a beta-blocker.
- BDecrease the dobutamine infusion rate.
- CIncrease the dobutamine infusion rate.
- DAdminister a bolus of intravenous fluids.
Show answer & explanationAnswer & explanation
Correct answer: B. Decrease the dobutamine infusion rate.
Dobutamine is a positive inotrope used to improve cardiac output. Tachycardia (heart rate >100 bpm) and hypertension are common dose-related adverse effects. The significant increase in both heart rate and blood pressure indicates the client is experiencing adverse effects, and the nurse should anticipate an order to decrease the infusion rate to mitigate these effects.
Why the other options are wrong
- A. Administering a beta-blocker would treat the symptoms but not the underlying cause (excessive dobutamine effect) and typically requires a provider's order, often after reducing the primary drug.
- C. Increasing the rate would worsen the tachycardia and hypertension.
- D. Administering fluids would not address the dobutamine-induced tachycardia and hypertension and might worsen fluid overload.
Dobutamine Adverse Effects
Dobutamine, a positive inotrope, can cause dose-related adverse effects including tachycardia, hypertension, and arrhythmias, requiring careful titration and monitoring.
- Increases cardiac contractility and heart rate.
- Used for acute heart failure and cardiogenic shock.
- Monitor HR, BP, ECG, and urine output.
- Adverse effects indicate need for dose reduction.
Memory trick: Dobutamine's 'Up' means watch for too much 'Up' in HR/BP.