The patient is receiving norepinephrine (Levophed). When monitoring the patient's blood pressure, the nurse notes a pressure of 230/120 mmHg. What is the priority nursing action?
1. Assess the patient for signs/symptoms of a stroke.
2. Notify the physician.
3. Slow the rate of the infusion
4. Increase the infusion.
3
Rationale 1: Assessing for signs of stroke is not the highest priority.
Rationale 2: The nurse would notify the physician, but this should occur after another intervention.
Rationale 3: The nurse would slow the infusion rate while monitoring the blood pressure. This medication is titrated to effect.
Rationale 4: This medication is given to raise blood pressure, but the drug must be titrated to effect. There is no reason to want the blood pressure to be higher.
Global Rationale: The nurse would slow the infusion rate while monitoring the blood pressure. This medication is titrated to effect. Assessing for signs of stroke is not the highest priority. The nurse would notify the physician, but this should occur after another intervention. This medication is given to raise blood pressure, but the drug must be titrated to effect. There is no reason to want the blood pressure to be higher.
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