A patient arrives at the hospital emergency department via EMS, complaining of being “lightheaded”. The patient has a heart rate of 42 and BP 90/50 mmHg.
What medication should the RN anticipate being prescribed and administered immediately?
Adenosine.
Amiodarone.
Magnesium sulfate.
Atropine sulfate.
The Correct Answer is D
Choice A rationale:
Adenosine is a medication used to treat supraventricular tachycardia (SVT), a type of rapid heart rhythm that originates in the upper chambers of the heart. It works by slowing the conduction of electrical impulses through the heart's AV node.
In this patient, the heart rate is already slow (42 beats per minute), so adenosine would not be appropriate. It could further slow the heart rate and potentially cause a dangerous drop in blood pressure.
Choice B rationale:
Amiodarone is a medication used to treat a variety of heart rhythm problems, including ventricular tachycardia (VT) and ventricular fibrillation (VF). It works by slowing the conduction of electrical impulses through the heart muscle.
Amiodarone is not typically used as a first-line treatment for bradycardia (slow heart rate). It is usually reserved for more serious or life-threatening arrhythmias.
Choice C rationale:
Magnesium sulfate is a medication used to treat a variety of conditions, including preeclampsia, eclampsia, and torsades de pointes. It can also be used to treat certain types of arrhythmias.
Magnesium sulfate is not typically used as a first-line treatment for bradycardia. It may be used in some cases of bradycardia caused by electrolyte imbalances or certain medications.
Choice D rationale:
Atropine sulfate is a medication that blocks the action of acetylcholine, a neurotransmitter that slows the heart rate. It is the first-line treatment for symptomatic bradycardia.
Atropine works by increasing the heart rate and improving conduction through the AV node. It is a rapid-acting medication that can be given intravenously, intramuscularly, or subcutaneously.
In this patient, atropine sulfate would be the most appropriate medication to increase the heart rate and improve blood pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Sildenafil (Viagra) is a phosphodiesterase-5 (PDE-5) inhibitor that is primarily used to treat erectile dysfunction. However, it also has vasodilatory effects, meaning it widens blood vessels. This can lead to a significant drop in blood pressure, especially when combined with nitroglycerin, another potent vasodilator.
Nitroglycerin is commonly used to treat chest pain (angina) and heart failure. It works by relaxing the smooth muscles in blood vessels, which allows them to widen and increase blood flow to the heart. This can help to relieve chest pain and improve heart function.
When sildenafil and nitroglycerin are taken together, their combined vasodilatory effects can cause a severe drop in blood pressure, known as hypotension. This can lead to a number of serious complications, including: dizziness, lightheadedness, fainting, heart attack, stroke.
The risk of hypotension is particularly high in patients who are already taking other medications that can lower blood pressure, such as alpha-blockers or nitrates. It is also important to note that the effects of sildenafil can last for up to 24-48 hours, so it is important to avoid taking nitroglycerin within this timeframe.
Due to the significant risk of hypotension, it is generally recommended that sildenafil be avoided within 24-48 hours of nitroglycerin administration.
Rationales for other choices:
Choice B: Aspirin
Aspirin is an antiplatelet medication that is often used to prevent blood clots. It does not have significant vasodilatory effects and does not interact with nitroglycerin in a way that would contraindicate its use.
Choice C: Adenosine
Adenosine is a medication that is used to treat certain types of arrhythmias (irregular heartbeats). It can cause a brief drop in blood pressure, but this effect is usually mild and transient. Adenosine does not interact with nitroglycerin in a way that would contraindicate its use.
Choice D: Oxygen
Oxygen is a gas that is often used to treat patients with respiratory problems. It does not have any direct vasodilatory effects and does not interact with nitroglycerin.
Correct Answer is A
Explanation
Choice A rationale:
Calcium gluconate is the antidote for magnesium sulfate toxicity. It directly counteracts the effects of magnesium on the neuromuscular system, cardiovascular system, and central nervous system. It is essential to have calcium gluconate readily available at the bedside of any client receiving magnesium sulfate, as toxicity can occur quickly and without warning.
Mechanism of action:
Calcium gluconate competes with magnesium for binding sites on cell membranes and proteins. It displaces magnesium from these sites, thereby restoring normal cellular function.
Calcium gluconate also enhances calcium influx into cells, which further counteracts the effects of magnesium. Indications for use in magnesium sulfate toxicity:
Respiratory depression (respiratory rate <12 breaths per minute) Loss of deep tendon reflexes
Seizures
Cardiac arrhythmias (including heart block and cardiac arrest) Hypotension (systolic blood pressure <90 mmHg)
Dosage and administration:
The typical dose of calcium gluconate for magnesium sulfate toxicity is 1 gram (10 mL of a 10% solution) given IV push over 3- 5 minutes.
This dose may be repeated as needed, depending on the severity of the toxicity and the client's response to treatment. Nursing considerations:
Monitor the client's vital signs, respiratory status, and deep tendon reflexes closely during magnesium sulfate infusion and after administration of calcium gluconate.
Have a crash cart and code equipment readily available in case of cardiac arrest. Document the administration of calcium gluconate and the client's response to treatment.
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