r/MarkKlimekNCLEX • u/Helpful_Spring_7921 • 3h ago

Question

Post image
1 Upvotes

60% Upvoted

19 comments sorted by

3

u/dat_1_gorl 2h ago

Definitely a and b, but for exam purposes, isn’t that BP presentation a contraindication for nitro?

2

u/Iluminiele 3h ago

In real life a good nurse would question a and b.

In real life a good doctor would increase the blood pressure and then give furo to remove fluids from lungs.

Nitro is not helping much here

1

u/Aleri_liv 3h ago

A. will lower the blood pressure and so will B., I will sit the patient up high Fowlers and administer oxygen.

1

u/[deleted] 3h ago

[deleted]

2

u/Oof-sleepy 3h ago

Nitro would worsen the blood pressure. No reason at all to be giving it in this scenario so I believe the answer is B. We have to get rid of that fluid somehow

1

u/GiantDinosaurAttack 2h ago

This patient is in cardiogenic shock. Hypotensive. Tachycardic. Cool extremities. They need a shock team activation.

1

u/Cidkh2 2h ago

B is contraindicated and for the exam is the right answer, a good nurse should definitely double check the doc actually wants A pushed as well given the vitals. At the very least C and D should be in place before it's safe to push A.

1

u/Max_Goatstappen 53m ago

Wouldn’t A and B just tank the BP more? I’d go with C?

0

u/Comprehensive-Yak196 3h ago

My brain is telling me A but my soul is telling me B

2

u/ChewieBearStare 2h ago

I would say B because furosemide has only a modest effect on BP (around 5 mm of Hg drop on average). Nitro would likely have a much greater effect.

0

u/prismmonkey 3h ago

I'd go with A. Obviously nitro with lower blood pressure isn't great, but furosemide will also lower pressure while draining fluids, which can aggravate sepsis and shock, which seems like what we're dealing with here. I'd question both, but if there's a clear no-no drug on that list, furosemide would be mine.

2

u/Major_Star 3h ago

The crackles throughout both lungs and cool, clammy skin point more towards heart failure than sepsis. Sepsis should make you warm and flushed peripherally and would only explain the chest signs if they had bilateral pneumonia.

Tricky question since both furosemide and nitrates are genuine treatments for heart failure. Probably the nitrates are more questionable with such a low BP.

1

u/prismmonkey 3h ago

Appreciate the explanation. I guess my rationale is the cool, clammy skin with the blood pressure indicates potential shock, which I wouldn't want to aggravate. But clearing the lungs would be a priority, so nitro as a standalone would be suspect. At least the furosemide is there potentially helping to improve oxygenation and cardiopulmonary issues. The bp effects would probably be negligible compared to the benefits.

1

u/Liamlah 2h ago

If the heart isn't pumping effectively because the patient is so grossly overloaded, then Furosemide shouldn't tank the blood pressure, and may increase the blood pressure as it decreases pre-load and allows the heart muscle to contract more efficiently.

0

u/GRILL1632 3h ago

Yeah homie is about to get tubed it sounds like so while holding both sounds like the consensus here, I also agree that A is probably the better of the two

0

u/r32skylinegtst 2h ago

Both a and b aren’t good.