A patient's blood pressure suddenly drops, what is expected from on duty nursing officer that which drug will doctor order that is to be administered immediately?

Appeared in: HPSSC Staff Nurse - 2021

Explanation

Both Dopamine and Noradrenaline (NORAD) are primary vasopressor medications used in the emergency management of acute hypotension and shock.
The question asks what a nursing officer should expect or anticipate. Since the doctor's choice between the two depends on the specific cause of shock and the patient's cardiac status, the nurse must be prepared for an order for either drug.
Noradrenaline is the first-line vasopressor for most forms of shock (especially septic shock), while Dopamine is a valid alternative, particularly in cases of shock accompanied by bradycardia.
Therefore, expecting an order for either and being prepared for both is the most appropriate and safest nursing practice.

Option A: Selecting only Dopamine is incorrect because Noradrenaline is also a primary, and often preferred, vasopressor for acute hypotension. A nurse should not limit their anticipation to only one of the possible drugs.
Option B: Selecting only NORAD is incorrect because Dopamine remains a valid therapeutic option in certain types of shock (e.g., cardiogenic shock with bradycardia). The nurse's preparedness should include the possibility of a Dopamine order.
Option D: This is incorrect because Dopamine and Noradrenaline are the cornerstone medications for the immediate treatment of severe hypotension and shock. It is highly expected that one of these would be ordered.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological Management of Acute Hypotension to guide bedside assessment, documentation, and the next nursing action.
A nurse's ability to anticipate and prepare for emergency medication orders is a critical skill that can significantly reduce the time to intervention and improve patient outcomes.
Vasopressors like Dopamine and Noradrenaline are high-alert medications. Nurses must be vigilant about correct dosing, using an infusion pump, and monitoring for adverse effects, especially extravasation (leakage into surrounding tissue), which can cause severe tissue necrosis. A central line is the preferred route for administration.
What if the patient has severe tachycardia (e.g., heart rate of 150 bpm) along with hypotension? In this scenario, Noradrenaline would be the strongly preferred agent. Dopamine's beta-1 agonist effects would likely worsen the tachycardia, increasing myocardial oxygen demand and potentially leading to dysrhythmias.

How to Approach the Question

First, identify the core clinical problem presented in the question: a sudden, severe drop in blood pressure, which is a medical emergency indicative of shock.
Next, recall the primary class of drugs used to treat this emergency. These are vasopressors, which constrict blood vessels to raise blood pressure.
Examine the options to identify the vasopressors listed. Both Dopamine and Noradrenaline (NORAD) are classic examples.
Consider the perspective of the question: 'what is expected from on duty nursing officer?'. This is about anticipation and preparedness, not just identifying a single 'correct' drug.
Since both drugs are standard treatments and the choice between them depends on the specific clinical context (which isn't fully provided), the nurse must be prepared for an order for either. Therefore, the option that includes both is the most comprehensive and correct answer.

Concept Tested & Keywords

Concept Tested: Pharmacological Management of Acute Hypotension
Stem keywords: blood pressure suddenly drops, nursing officer, drug, administered immediately
Lead-in keywords: what is expected
Negative lead-in flag: false

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E6 Pharmacology Nursing Lilley 11e Part 1 p. 318-320

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