During assessment of a client with pheochromocytoma, the nurse records 210/110 mm Hg. What is the nurse's best action?

• A. To ask the client to lie down and rest.
• B. To assess the client’s dietary intake of sodium and fluid
• C. To administer phentolamine (Regitine).
• D. To administer nitroprusside (Nipride)

Answer: (C)

In a pheochromocytoma crisis, the body is dumping large amounts of catecholamines, causing severe vasoconstriction and dangerously high blood pressure. The immediate priority is to block those alpha-adrenergic effects to rapidly reduce systemic vascular resistance and bring the BP under control.

Administering an alpha-adrenergic blocker like phentolamine provides quick, direct reversal of the vasoconstrictive effects. It acts fast when given IV and lowers blood pressure by preventing catecholamines from constricting the vessels. This approach addresses the root cause of the crisis in this scenario and helps prevent end-organ damage.

Options that involve simply lying the patient down or assessing sodium and fluid intake don’t address the acute, life-threatening rise in blood pressure. A direct vasodilator like nitroprusside can lower blood pressure, but in pheochromocytoma you want alpha blockade first to avoid unpredictable swings in hemodynamics and potential reflex responses driven by the ongoing catecholamine excess. After adequate alpha blockade, beta-blockers may be added if tachycardia persists.