The nurse is preparing to administer dopamine, a beta and alpha agonist, to a client in cardiogenic shock. What intervention should the nurse implement?

• A. Request the respiratory therapist to perform a 12-lead ECG.
• B. Assess the client's blood pressure (BP) every 2 hours.
• C. Use an urimeter to evaluate the intake and output every hour.
• D. Cover the intravenous bag and tubing with foil.

Answer: (C)

When a vasoactive infusion like dopamine is used for cardiogenic shock, the most important ongoing assessment is how well the kidneys are being perfused and how fluid is being balanced. Measuring intake and output every hour provides a clear, objective signal of renal perfusion and overall fluid status, which helps guide dose titration and identify early signs of overload or underfilling. Using an urimeter ensures the urine output is measured accurately, so you can detect whether the medication is producing the desired hemodynamic effects without compromising renal function.

Dopamine acts on beta-1 receptors to boost contractility and heart rate and on alpha-1 receptors to raise systemic vascular resistance, which can improve blood pressure and perfusion. However, these effects can change quickly with dose adjustments, making hourly I&O a reliable barometer for how the patient is responding and whether further therapy is needed.

Other precautions, like protecting the IV bag from light or monitoring the ECG for arrhythmias, are important in practice, but hourly urine output directly reflects the patient’s response to the dopamine infusion and guides safe, effective management.