The nurse is caring for a client during a cardiac arrest. The monitor displays the rhythm below. Which intervention should the nurse perform at this time?

Administer amiodarone 200 mg IV push

Defibrillate the client using 200 joules

CPR until the physician stops the code

Administer adenosine 12 mg IV push

Answer and Explanation

The Correct Answer is C

A. Administer amiodarone 200 mg IV push: Amiodarone is used for shockable rhythms like ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) that are refractory to defibrillation. The rhythm on the monitor is asystole, which is non-shockable, and amiodarone is not indicated here.

B. Defibrillate the client using 200 joules: Defibrillation is only appropriate for shockable rhythms such as VF or pulseless VT. Asystole is not shockable, and defibrillation in this rhythm would be ineffective and inappropriate.

C. CPR until the physician stops the code: The rhythm strip shows asystole, a flatline with no electrical activity. The priority intervention is to initiate and continue high-quality cardiopulmonary resuscitation (CPR) immediately and continue until the code is terminated by the physician. This is consistent with Advanced Cardiac Life Support (ACLS) guidelines.

D. Administer adenosine 12 mg IV push: Adenosine is used to terminate supraventricular tachycardia (SVT) and is not indicated in asystole or during cardiac arrest. It would have no effect in a rhythm with no electrical activity.

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Correct Answer is C

Explanation

A. Hypermagnesemia: Hypermagnesemia (high magnesium levels) can cause bradycardia, hypotension, and prolonged PR and QRS intervals. While it can affect cardiac rhythm, it's less commonly associated with PVCs. The client's magnesium level of 2.5 mg/dL is within the normal range (1.5-2.5 mg/dL).

B. Hypocalcemia: While the calcium level of 8.0 mg/dL is slightly low (normal: ~8.5–10.5 mg/dL), mild hypocalcemia is less commonly associated with PVCs compared to hypokalemia. It can affect cardiac contractility but is not the most likely cause of these arrhythmias.

C. Hypokalemia: The potassium level is 2.8 mEq/L, which is significantly below normal (normal: 3.5–5.0 mEq/L). Potassium is a crucial electrolyte for maintaining normal cardiac electrical activity. Hypokalemia increases myocardial excitability and can lead to various cardiac dysrhythmias and a known cause of ventricular irritability, including multifocal PVCs, and increases the risk of life-threatening arrhythmias in clients with cardiac or metabolic conditions.

D. Hyperglycemia: The glucose level of 200 mg/dL is elevated but not severely high. While it reflects poor glycemic control, it is not directly linked to the occurrence of PVCs. Electrolyte imbalances, particularly low potassium, are more arrhythmogenic.

A. Maintain the infusion because the client had a cardiac arrest. B. Continue to monitor the client's rhythm closely. C. Suggest that the client's medication be changed to norepinephrine. D. Ask the physician if the dose can be decreased.

Correct Answer is D

Explanation

A. Maintain the infusion because the client had a cardiac arrest: While epinephrine is essential during cardiac arrest, continuing a high-dose infusion post-resuscitation without reassessment may lead to complications like tachycardia, hypertension, and increased myocardial oxygen demand.

B. Continue to monitor the client's rhythm closely: Ongoing monitoring is important, but it is a passive intervention. The heart rate of 120 bpm may reflect excessive adrenergic stimulation from epinephrine, and further action is needed to prevent deterioration.

C. Suggest that the client's medication be changed to norepinephrine: Norepinephrine is another vasopressor that has less of a beta-1 adrenergic effect compared to epinephrine. It is primarily used for hypotension and septic shock, not as a direct substitute for epinephrine post-cardiac arrest. Changing to another vasopressor without indication is not the best initial step.

D. Ask the physician if the dose can be decreased: A heart rate of 120 bpm may indicate that the epinephrine dose is too high, causing sympathetic overstimulation. Prolonged or excessive tachycardia increases myocardial oxygen demand, which can be detrimental, especially in a post-arrest heart. Decreasing the dose can help prevent arrhythmias or myocardial ischemia, making this the most appropriate and proactive action.

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Potassium 2.8 mEq/L
Sodium 133 mEq/L
Chloride 90 mEq/L
Glucose 200 mg/dl
Magnesium 2.5 mg/dL
Calcium 8.0 mg/dL

The nurse is caring for a client during a cardiac arrest. The monitor displays the rhythm below. Which intervention should the nurse perform at this time?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

The nurse is caring for a client who has been successfully resuscitated following a cardiac arrest and is now on an IV infusion of epinephrine. The cardiac monitor shows a heart rate of 120 beats/minute. What should be the nurse's best action?

Correct Answer is D

Explanation

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