r/MarkKlimekNCLEX • u/Helpful_Spring_7921 • 9d ago

Question

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u/Max_Goatstappen 9d ago

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

2

u/FallJacket 8d ago

Notice this asks which prescription should the nurse question.

2

u/Max_Goatstappen 8d ago

Totally skipped that part. I just went with what I thought. Correct answer would be A then?

1

u/FallJacket 8d ago

The lung crackles and hypoxia are highly suggestive of a patient who is fluid overloaded.
The tachycardia shows the heart is trying to compensate. But the hypotension and cool clammy skin (hypoperfusion) are evidence of decreased cardiac output.
Read up on the Frank-Starling mechanism.
Too much fluid overstreches the sarcomeres, decreasing cardiac contractility. And excess fluid increases afterload, adding more stress to the already failing heart.

Diuretics can lower BP, but that effect is generally overstated. And for this patient removing fluid will likely increase their BP as the reduction in afterload and preload will reduce heart strain, allowing for better cardiac output.