The nurse assesses a patient who has been given phentolamine [OraVerse] to treat pheochromo-cytoma. The nurse notes a blood pressure of 76/52 mm Hg and a heart rate of 90 beats per minute. Which action by the nurse is correct?
a. Contact the provider to request an order for epinephrine.
b. Continue to monitor the patient's vital signs and notify the provider if the heart rate increases.
c. Notify the provider and request an order for a beta blocker.
d. Notify the provider and request an order for norepinephrine.
D
Phentolamine can cause orthostatic hypotension, reflex tachycardia, nasal congestion, and inhibi-tion of ejaculation. Overdose can produce profound hypotension. When this occurs, blood pres-sure can be elevated with norepinephrine. Epinephrine should not be used because, in the pres-ence of alpha1 blockade, the ability of epinephrine to promote vasodilation by activation of beta2 receptors may outweigh its ability to cause vasoconstriction, causing further lowering of blood pressure. Norepinephrine does not activate beta2 receptors. Beta blockers may be used to treat severe reflex tachycardia. This patient has significant hypotension, so it is not correct to continue to monitor without notifying the provider.
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