A client comes to the emergency department with complaints of chest pain after using cocaine. The nurse assesses the client and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?

Sinus bradycardia

Ventricular tachycardia

Normal sinus rhythm

Sinus tachycardia

Answer and Explanation

The Correct Answer is D

A. Sinus bradycardia is characterized by a heart rate below 60 beats/min, which is inconsistent with this client’s elevated heart rate of 128.
B. Ventricular tachycardia is a potentially life-threatening rhythm with wide QRS complexes, usually not the immediate expected rhythm without other signs such as hypotension or loss of consciousness.
C. Normal sinus rhythm has a heart rate between 60–100 beats/min; this client’s rate of 128 exceeds that range.
D. Sinus tachycardia is the most likely rhythm, especially in a client who has used cocaine, a stimulant known to increase sympathetic nervous system activity, leading to increased heart rate and elevated blood pressure.

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Correct Answer is B

Explanation

A. An atrial rhythm regular and ventricular rhythm irregular would suggest an arrhythmia such as atrial fibrillation or flutter with variable conduction—not sinus tachycardia.
B. In sinus tachycardia, the rhythm is regular, the P:QRS ratio is 1:1, meaning each P wave is followed by a QRS complex, and the origin is from the sinus node.
C. A 2:1 P:QRS ratio is characteristic of certain types of heart block or atrial flutter—not sinus tachycardia.
D. Irregular ventricular and atrial rhythms are seen in atrial fibrillation or other irregular arrhythmias, not sinus tachycardia.

A. Decreased cardiac output and increased MAP B. Decreased cardiac output and decreased MAP C. Increased cardiac output and increased afterload D. Increased cardiac output and increased MAP

Correct Answer is B

Explanation

A. Decreased cardiac output with increased mean arterial pressure (MAP) does not typically occur in cardiogenic shock. In shock states, MAP tends to decrease.
B. Decreased cardiac output and decreased MAP are the hallmark pathophysiologic changes in cardiogenic shock following a myocardial infarction. The damaged myocardium cannot pump effectively, leading to poor perfusion and hypotension.
C. Increased cardiac output and increased afterload are not features of cardiogenic shock; in fact, cardiac output is decreased.
D. Increased cardiac output and increased MAP suggest improved perfusion, not the compromised state seen in cardiogenic shock.

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Naxlex Comprehensive Predictor Exams

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