Which of the following is the initial step in the management of a patient with asystole?

Check for a pulse every 30 seconds

Administer 1 mg of epinephrine

Administer a defibrillation shock

Begin chest compressions immediately

Answer and Explanation

The Correct Answer is D

Rationale:

A. In a patient with asystole, a pulse check is not performed repeatedly in 30-second intervals; the rhythm is already pulseless, so delaying intervention to check the pulse wastes critical time.

B. Epinephrine is an important medication in asystole management, but it is administered after initiating CPR, not as the first step. Immediate medication without circulation is ineffective.

C. Defibrillation is ineffective in asystole because there is no organized electrical activity to reset. Defibrillation is reserved for shockable rhythms such as ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT).

D. This is the correct initial step because asystole represents a complete absence of cardiac electrical activity, and immediate high-quality CPR is essential to maintain circulation and oxygen delivery to vital organs. Early initiation of chest compressions increases the chance of survival while advanced life support measures (airway, epinephrine) are prepared.

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Correct Answer is D

Explanation

Rationale:

A. Although at the upper limit of normal (10–20 mg/dL), BUN alone is not a definitive indicator of AKI. It can be temporarily elevated due to dehydration, high-protein intake, or catabolic states, and must be interpreted alongside creatinine and other clinical findings.

B. This value is within the normal adult range (1.5–2.5 mEq/L). Magnesium levels generally remain stable until more significant kidney dysfunction occurs, so this does not indicate increased AKI risk.

C. This is within the normal range (3.5–5.0 mEq/L). While potassium imbalances can develop in AKI due to impaired excretion, a normal value does not reflect kidney injury.

D. This is elevated above the normal range for adult females (0.6–1.3 mg/dL) and reflects impaired kidney function. After a myocardial infarction, decreased cardiac output can reduce renal perfusion, placing the client at high risk for acute kidney injury. An elevated creatinine in this context warrants close monitoring, potential adjustments to medications, and prompt interventions to prevent further renal damage.

A. Fluid volume deficit B. Anxiety C. Lightheadedness D. Elevated temperature

Correct Answer is C

Explanation

Rationale:
A. While dehydration or hypovolemia can lead to tachycardia as the body attempts to maintain cardiac output, it does not typically cause bradycardia. Bradycardia usually results from conduction abnormalities, medications, or increased vagal tone rather than low fluid volume.

B. Anxiety triggers sympathetic nervous system activation, which increases heart rate and blood pressure. Therefore, it is more likely to produce tachycardia rather than a slow heart rate.

C. Bradycardia reduces cardiac output, which lowers cerebral perfusion. This decrease in blood flow to the brain commonly manifests as dizziness, lightheadedness, fainting, or syncope. These symptoms are critical for assessing the clinical significance of bradycardia, especially in older adults or those with cardiovascular disease.

D. Fever increases metabolic demand, leading to compensatory tachycardia, not bradycardia. A slow heart rate in a febrile client would be atypical and may suggest other underlying conditions, such as conduction disorders or drug effects.

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Which of the following is the initial step in the management of a patient with asystole?

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Naxlex Comprehensive Predictor Exams

A nurse is monitoring an older adult female client who had a myocardial infarction (MI) for the development of an acute kidney injury. Which of the following findings should the nurse identify as indicating an increased risk of acute kidney injury (AKI)?

Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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