NCLEX-PN® ExaminationPhysiological AdaptationHard
A client is experiencing signs of impending cardiogenic shock, including a blood pressure of 80/50 mmHg, heart rate of 120 bpm, cool and clammy skin, and decreased urine output. Which of the following medications would the nurse anticipate administering to improve cardiac output and tissue perfusion?
- AFurosemide
- BLisinopril
- CMetoprolol
- DNorepinephrine
Show answer & explanationAnswer & explanation
Correct answer: D. Norepinephrine
Cardiogenic shock involves severe pump failure, leading to profound hypotension and hypoperfusion. Norepinephrine is a potent vasopressor and inotrope that increases systemic vascular resistance (SVR) and myocardial contractility, thereby raising blood pressure and improving tissue perfusion, which are critical in cardiogenic shock.
Why the other options are wrong
- A. Furosemide is a diuretic that would further decrease circulating volume and worsen hypotension in cardiogenic shock.
- B. Lisinopril is an ACE inhibitor that would cause vasodilation and further lower blood pressure, which is contraindicated in severe hypotension.
- C. Metoprolol is a beta-blocker that would decrease heart rate and contractility, worsening the impaired cardiac output in cardiogenic shock.
Cardiogenic Shock Pharmacologic Management
Pharmacologic management of cardiogenic shock focuses on improving cardiac output, blood pressure, and tissue perfusion, often utilizing vasopressors and inotropes.
- Cardiogenic shock is characterized by severe pump failure.
- Goals are to increase myocardial contractility and systemic vascular resistance.
- Norepinephrine is a common first-line agent, often combined with dobutamine.
Memory trick: Norepi for shock, makes the heart's pump rock!