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?
Adenosine 6 mg IV push
Immediate cardioversion
Adenosine 12 mg IV push
Amiodarone 150 mg bolus followed by a 24 hour drip
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 C
Explanation
A. Defibrillation is used for life-threatening arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia, not for SVT.
B. Cardioversion is appropriate for certain arrhythmias, but in this case, SVT with a stable pulse can be treated initially with medication like adenosine.
C. Adenosine is the first-line treatment for SVT. The typical starting dose is 6 mg IVP, which can be repeated if necessary. Adenosine works by temporarily blocking the electrical conduction through the AV node, allowing the heart to reset to a normal rhythm.
D. A 12 mg dose of Adenosine is used if the 6 mg dose is ineffective, but the 6 mg dose is typically administered first.
Correct Answer is B
Explanation
A. P wave touching the T wave can indicate an issue but is less urgent than chest pain.
B. Midsternal chest pain could indicate myocardial ischemia or infarction, requiring immediate intervention.
C. Increased urine output is not an urgent concern in this context.
D. Mild orthostatic hypotension is not as urgent as chest pain.
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