In suspected pheochromocytoma with hypertensive crisis, which prescription should the nurse implement first?

• A. Draw labs to assess electrolyte panel
• B. Give acetaminophen 650 mg by mouth as needed for headache
• C. Place a fan in the room
• D. Start nitroprusside infusion at 0.5 mcg/kg/min

Answer: (D)

Rapidly lowering blood pressure is the priority in a hypertensive crisis from suspected pheochromocytoma because the catecholamine surge can cause stroke and organ damage. An IV nitroprusside infusion is the best choice because it provides immediate, titratable vasodilation that lowers systemic vascular resistance within seconds and can be adjusted in real time to reach a safe BP. Start at 0.5 mcg/kg/min and increase as needed while closely monitoring BP to avoid hypotension. This intervention directly addresses the acute hemodynamic emergency, whereas other actions (like drawing labs, giving a headache reliever, or cooling the room) do not treat the crisis promptly. After stabilization, management typically includes alpha-adrenergic blockade and eventual planning for definitive tumor removal. Monitor for potential side effects, including the risk of cyanide toxicity with prolonged infusions, and ensure continuous BP monitoring during titration.