Discuss AACN CCRN-Adult Exam Topic 1 Question 9

A patient's IV with norepinephrine (Levophed) infusing is red, swollen, and the IV pump is alarming. A nurse should anticipate

Aadministering phentolamine (Regitine).

Bproviding a warm compress.

Clowering the extremity below heart level.

Dremoving the IV immediately.

Suggested Answer: A

Phentolamine (Regitine) is the antidote for norepinephrine extravasation, which is the leakage of the vasopressor from the vein into the surrounding tissue. Phentolamine reverses the vasoconstriction and ischemia caused by norepinephrine by blocking the alpha-adrenergic receptors. Phentolamine should be administered intradermally around the site of extravasation as soon as possible, and the infusion should be stopped but the IV catheter should not be removed until some of the norepinephrine is aspirated. A warm compress may worsen the tissue damage by increasing the absorption of norepinephrine, and lowering the extremity may increase the edema and pain. Removing the IV immediately may prevent the aspiration of norepinephrine and the administration of phentolamine.

Episode 240: What to do with norepinephrine extravasation: This article explains the steps to take when norepinephrine extravasates, including the use of phentolamine, and the reasons to avoid cold compress, lowering the extremity, and removing the IV.

What are current recommendations for treatment of drug extravasation?: This article summarizes the latest recommendations for treatment of extravasation, and lists phentolamine as the immediate topical therapy for norepinephrine extravasation.

Get Premium CCRN-Adult Questions as Interactive Web-Based Practice Test or PDF Real Exam Format Detailed Explanations Instant Access Get Your Practice Test

29 comments · newest first

Trinidad 10 months ago

Definitely should consider phentolamine if it's norepinephrine!

Benedict 10 months ago

I think removing the IV is the right call here.

Gussie 10 months ago

Warm compresses might help, but I’d prioritize the IV removal.

Denise 10 months ago

Wait, are we sure it's not just a reaction to the pump?

Annett 11 months ago

Sounds like a classic case of extravasation.

Nakita 11 months ago

Lowering the extremity below heart level sounds familiar, but I can't recall if that's the best action in this scenario. I feel like it might not address the underlying problem.

Elena 11 months ago

I practiced a similar question about IV complications, and I think removing the IV immediately is crucial if there's an issue like this.

Julio 11 months ago

I'm not entirely sure, but I think providing a warm compress might help with swelling? I need to double-check that.

Mireya 12 months ago

I remember studying about extravasation with norepinephrine and how it can cause tissue necrosis. I think phentolamine is the right choice to counteract that.

Rupert 12 months ago

I've seen questions like this before. The key is to recognize that the extravasation of norepinephrine is causing the issue, and the appropriate intervention is to administer phentolamine to counteract the vasoconstriction. I'm confident that A is the correct answer.

Edwin 12 months ago

Okay, let me think this through. The patient has an IV infusing norepinephrine, which is a vasoconstrictor, and the IV site is red and swollen. I believe the best course of action would be to administer phentolamine, which is an alpha-blocker that can reverse the effects of the norepinephrine extravasation.

Barrett 1 year ago

Hmm, I'm not entirely sure about this one. The IV is red and swollen, so I'm thinking it might be a good idea to try a warm compress first, but I'm not confident that's the right answer.

Laila 1 year ago

This is a straightforward question. The correct answer is A - administering phentolamine (Regitine) to counteract the effects of the extravasated norepinephrine.

Oliva 1 year ago

That's a good point, but I still think removing the IV is the best course of action.

Novella 1 year ago

Haha, all these options sound like a party! I'll take one of each, please.

Yvonne 1 year ago

But wouldn't lowering the extremity below heart level also help?

Eleni 1 year ago

B) warm compress, no doubt. Soothe that poor swollen arm, stat!

Hobert 1 year ago

↳ replying to Eleni

C: Lowering the extremity below heart level.

Ollie 1 year ago

↳ replying to Eleni

B: Providing a warm compress.

Cathern 1 year ago

↳ replying to Eleni

A: Administering phentolamine (Regitine).

Dannie 1 year ago

I'd go with A) administering phentolamine. Gotta counteract that vasoconstriction, stat!

Ona 1 year ago

↳ replying to Dannie

Agreed, we need to counteract that vasoconstriction quickly.

Brianne 1 year ago

↳ replying to Dannie

Administering phentolamine is the right call here.

Oliva 1 year ago

I disagree, I believe the correct answer is A) administering phentolamine (Regitine).

Irma 1 year ago

Definitely D) remove the IV immediately. Can't let that norepinephrine go haywire!

Valene 1 year ago

↳ replying to Irma

C: Lowering the extremity below heart level can help reduce the swelling and improve circulation.

Lourdes 1 year ago

↳ replying to Irma

B: Providing a warm compress can help with the swelling and discomfort.

Louvenia 1 year ago

↳ replying to Irma

A: Administering phentolamine (Regitine) may also be necessary to counteract the effects of norepinephrine.

Yvonne 1 year ago

I think the answer is D) removing the IV immediately.

AACN CCRN-Adult Exam - Topic 1 Question 9 Discussion