Question

a nurse is caring for a client who has heart failure and is receiving an iv infusion of dopamine. which of the following findings indicates that the medication is effective?

decreased blood pressure
increased heart rate
increased cardiac output
decreased serum potassium

Explanation:

Analyze the mechanism of dopamine in heart failure

Dopamine is an intravenous inotropic vasoactive medication used in the treatment of severe heart failure. At moderate to high therapeutic infusion rates, it primarily stimulates beta-1 adrenergic receptors in the myocardium. This stimulation increases myocardial contractility (positive inotropic effect) and stroke volume.

Evaluate the physiological outcomes of dopamine therapy

The primary therapeutic goal of administering an inotropic agent like dopamine to a client with heart failure is to improve the heart's pumping efficiency. By increasing myocardial contractility and stroke volume, dopamine directly leads to an increase in cardiac output. Improved cardiac output enhances systemic perfusion to vital organs and tissues.

Assess the clinical significance of each option

• Decreased blood pressure: This would indicate worsening heart failure or inadequate perfusion, rather than therapeutic effectiveness.
• Increased heart rate: While dopamine can cause tachycardia as an adverse effect due to beta-1 stimulation, a significant increase in heart rate is not the desired therapeutic indicator of effectiveness, as it increases myocardial oxygen demand.
• Increased cardiac output: This is the direct, desired therapeutic outcome of dopamine's positive inotropic action, demonstrating that the medication is successfully supporting the failing heart.
• Decreased serum potassium: This is not a therapeutic indicator of dopamine effectiveness.

Answer:

• Decreased blood pressure
• Increased heart rate
• Increased cardiac output (Correct answer)
• Decreased serum potassium