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: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

In an emergency involving a sudden drop in blood pressure (acute hypotension/shock), vasopressors are the primary class of drugs used.
Both Dopamine and Norepinephrine (NORAD) are powerful vasopressors that can be administered via continuous IV infusion to raise blood pressure.
Dopamine acts on dopaminergic, beta-1, and alpha-1 receptors in a dose-dependent manner to increase cardiac output and cause vasoconstriction.
Norepinephrine primarily acts on alpha-1 receptors, causing potent vasoconstriction, and is often the first-choice vasopressor for septic shock.
Since the specific clinical context (e.g., type of shock, patient's heart rate) is not given, both drugs are potential immediate treatments a doctor might order.

Option A: Selecting only Dopamine is incomplete. While it is a vasopressor used for hypotension, Norepinephrine is also a primary treatment and is often preferred as the first-line agent in many forms of shock.
Option B: Selecting only NORAD (Norepinephrine) is too narrow. Although it is the first-line vasopressor for many shock states, Dopamine remains a valid therapeutic option that a physician might order depending on the specific situation.
Option D: This is incorrect because a sudden, severe drop in blood pressure is a medical emergency that requires immediate pharmacological intervention. Dopamine and Norepinephrine are standard, life-saving drugs used in this exact scenario.

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 primary role during vasopressor administration is meticulous monitoring. This includes continuous blood pressure monitoring (often via an arterial line), heart rate, and cardiac rhythm (ECG).
Nurses must be vigilant for signs of extravasation (leakage of the drug into surrounding tissue) when administering vasopressors through a peripheral IV, as it can cause severe tissue necrosis. A central line is the preferred route.
Titration of these potent drugs requires critical thinking and strict adherence to protocols to achieve the target mean arterial pressure (MAP) while avoiding hypertension and other adverse effects.

How to Approach the Question

First, identify the core clinical problem presented in the question: a patient experiencing a sudden, severe drop in blood pressure.
Recognize this as a medical emergency, likely shock, which requires immediate pharmacological support to maintain organ perfusion.
Recall the primary drug class used to treat severe hypotension: vasopressors (adrenergic agonists).
Examine the options provided. Identify Dopamine and NORAD (Norepinephrine) as two major drugs in this class.
Consider the relationship between the options. The question asks what is 'expected' to be ordered. Since both are potent vasopressors used in this setting, and no further clinical details are given to differentiate, the option encompassing both possibilities is the most comprehensive and correct choice.
Therefore, select 'Both a and b' as it correctly reflects that either drug could be the immediate choice depending on the specific, unstated clinical scenario.

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, which drug
Clinical cues: The sudden drop in blood pressure signifies an acute, potentially life-threatening event requiring immediate intervention.

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

E6 Pharmacology Katzung 16e p. 235-237

Practise the full Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Attempt every question from this paper in a timed mock, then review the full solution for each one.