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A client who is on the progressive care unit develops atrial flutter, rate 150 with dyspnea, shortness of breath and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first?

A.

Adenosine 6 mg IV push

B.

Immediate cardioversion

C.

Adenosine 12 mg IV push

D.

Amiodarone 150 mg bolus followed by a 24 hour drip

Answer and Explanation

The Correct Answer is B

A. Adenosine 6 mg IV push: Adenosine is used for certain supraventricular tachycardias, but immediate cardioversion is the first priority for a client with atrial flutter and chest pain.

B. Immediate cardioversion: This is the correct answer. Immediate cardioversion is indicated for atrial flutter with signs of hemodynamic instability, such as chest pain and shortness of breath.

C. Adenosine 12 mg IV push: Adenosine may be used after the first dose of 6 mg if the initial dose was ineffective, but cardioversion takes precedence for unstable patients.

D. Amiodarone 150 mg bolus followed by a 24-hour drip: Amiodarone is an antiarrhythmic used for rate control or rhythm conversion but is not the first step for hemodynamically unstable clients with atrial flutter.


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Related Questions

Correct Answer is B

Explanation

A. Base deficit (HCO3): Acidosis: A base deficit indicates metabolic acidosis, but respiratory acidosis is more likely with the high rate of ventilation.

B. Acid excess (CO2): Acidosis: This is the correct answer. A high respiratory rate can lead to hyperventilation, decreasing CO2 levels and causing respiratory alkalosis, which may be a concern with an elevated rate.

C. Base excess (HCO3): Alkalosis: This would indicate metabolic alkalosis, but it is not as related to ventilator settings.

D. Acid deficit (CO2): Alkalosis: If the CO2 level is too low due to hyperventilation, this can lead to alkalosis, which the nurse is questioning here.

Correct Answer is C

Explanation

A. This is an underestimation due to a miscalculation of the dose rate.

B. This is an overestimation due to a miscalculation of the dose rate.

C. 1. Calculate the desired dose of dobutamine:

Desired dose (mcg/min) = Dose per kg (mcg/kg/min) x Weight (kg)

Desired dose (mcg/min) = 12 mcg/kg/min x 75 kg = 900 mcg/min

2. Convert mcg/min to mg/hr:

900 mcg/min x 60 min/hr = 54,000 mcg/hr

54,000 mcg/hr ÷ 1000 mcg/mg = 54 mg/hr

3. Calculate the concentration of dobutamine in the solution:

Concentration (mg/mL) = Total amount of dobutamine (mg) / Total volume (mL)

Concentration (mg/mL) = 1000 mg (1 g) / 250 mL = 4 mg/mL

4. Calculate the infusion rate (mL/hr):

Infusion rate (mL/hr) = Desired dose (mg/hr) / Concentration (mg/mL)

Infusion rate (mL/hr) = 54 mg/hr / 4 mg/mL = 13.5 mL/hr

5. Round to the nearest whole number:

Infusion rate (mL/hr) = 14 mL/hr

Therefore, the IV pump should be programmed for 14 mL/hr.

D. This is an overestimation due to a miscalculation of the dose rate.

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