Progressive Care Nursing Certification (PCCN) Practice Exam

A patient with heart failure is having atrial tachycardia and presents with low blood pressure and crackles in lung fields. What medication should the nurse anticipate administering?

1. A fluid bolus to enhance preload

2. Dopamine to support BP

3. Dobutamine to augment cardiac output

4. Adenosine to reverse tachycardia

The correct answer is: Dobutamine to augment cardiac output

In this scenario, the patient is experiencing atrial tachycardia, low blood pressure, and crackles in the lung fields, which suggest heart failure with compromised cardiac output. Dobutamine is the appropriate medication to anticipate because it is a positive inotropic agent that increases myocardial contractility, leading to improved cardiac output. This can help stabilize the patient by enhancing the heart's ability to pump blood effectively despite the tachycardia. Selecting dobutamine makes sense in the context of heart failure, as this medication not only improves the strength of the heart's contractions but also has vasodilatory effects, which can help reduce the workload on the heart while simultaneously improving perfusion. In contrast, a fluid bolus may further exacerbate heart failure symptoms by increasing volume overload, especially since the patient already has crackles in the lung fields, indicating possible pulmonary congestion. Dopamine could support blood pressure, but it does not specifically address the underlying issue of decreased cardiac output as effectively as dobutamine in the context of heart failure. Adenosine, while effective for terminating certain types of tachycardia, is not appropriate here, as it does not address the underlying cardiac output issues and may not effectively manage the heart failure state alongside the tach