AACN CCRN-Adult Exam - Topic 1 Question 9 Discussion

Actual exam question for AACN's CCRN-Adult exam

Question #: 9
Topic #: 1

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.

Show Suggested Answer

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.

by Xuan at May 01, 2025, 05:49 AM

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Trinidad

5 months ago

Definitely should consider phentolamine if it's norepinephrine!

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Benedict

5 months ago

I think removing the IV is the right call here.

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Gussie

6 months ago

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

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Denise

6 months ago

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

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Annett

6 months ago

Sounds like a classic case of extravasation.

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Nakita

6 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.

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Elena

7 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.

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Julio

7 months ago

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

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Mireya

7 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.

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Rupert

7 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.

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Edwin

7 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.

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Barrett

8 months 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.

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Laila

8 months ago

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

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