A client with stroke symptoms has a blood pressure of 240/124 mm Hg. The nurse prepares the prescribed nicardipine intravenous (IV) infusion solution correctly to yield 0.1 mg/mL. The nurse then administers the initial prescription to infuse at 5 mg/hr by setting the infusion pump at 50 mL/hr. What is the nurse's priority action at this time?

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A client with an acute stroke presentation (brain attack) requires "permissive hypertension" during the first 24-48 hours to allow for adequate perfusion through the damaged cerebral tissues. However, the blood-brain barrier is no longer intact once the blood pressure is >220/120 mm Hg. Therefore, "mild" lowering is required, usually to a systolic pressure that is not below 170 mm Hg. Nicardipine (Cardene) is a prototype of nifedipine and is a potent calcium channel blocking vasodilator. It takes effect within 1 minute of IV administration. It is essential to monitor that the blood pressure is not being lowered too quickly or too slowly as this would extend the stroke. Hypotension can occur with or without reflex tachycardia. The drug must be discontinued if hypotension or reflex tachycardia occurs. (Option A) It is important to watch for signs of adequate perfusion to the kidneys as indicated by adequate urine output. Approximately 25% of the cardiac output goes to the kidney. However, the priority is to monitor for the rapid onset of effect that this potent antihypertensive agent has after initiation. The nurse should not wait until the urine output drops. (Option B) The initial rate set by the nurse is correct as desired dose/dose on hand is 5 mg/hr divided by 0.1 mg/mL and equals 50 mL/hr. (Option D) Widening of the QT interval can increase the risk of life-threatening torsades de pointes. It is most commonly seen with haloperidol (Haldol), methadone, ziprasidone (Geodon), and erythromycin. However, this is not an expected complication of nicardipine. Educational objective: Nicardipine (Cardene) is a potent calcium channel blocking vasodilator. The priority nursing intervention with IV administration is to monitor the hypotensive effects of this drug.

A Client with Stroke Symptoms Has a Blood Pressure of 240/124