A client presents to the emergency department complaining of sudden onset of palpitations and chest pain. After assessment, the nurse notes the client to be diaphoretic, skin is cool to touch, BP is 80/40 mm Hg. Resp 26 and Sats of 89% [see image]. The nurse anticipates an order for which of the following interventions?

Syncronized cardioversion

Adenosine infusion over 30 minutes

Immediate defibrillation

Vagal manuevers

Answer and Explanation

The Correct Answer is A

A. Synchronized cardioversion: Synchronized cardioversion is indicated for unstable supraventricular tachycardia (SVT), especially when the client shows signs of hemodynamic instability, such as hypotension, altered mental status, or chest pain. This intervention delivers a timed shock to restore normal rhythm, prioritizing the client's immediate stabilization.

B. Adenosine infusion over 30 minutes: Adenosine is typically administered as a rapid intravenous push to terminate SVT by temporarily blocking atrioventricular nodal conduction. However, this client is unstable, and synchronized cardioversion is the preferred intervention in cases of hemodynamic compromise.

C. Immediate defibrillation: Defibrillation is used for life-threatening arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia. In this case, the rhythm is SVT, and the client is not in cardiac arrest, so defibrillation is inappropriate.

D. Vagal maneuvers: Vagal maneuvers, such as carotid sinus massage or the Valsalva maneuver, are first-line interventions for stable SVT. However, in unstable clients with severe symptoms or hemodynamic compromise, these measures are insufficient, and synchronized cardioversion is urgently required.

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Correct Answer is A

Explanation

A. Prepare for defibrillation: Defibrillation is the priority intervention for ventricular fibrillation, as it is the most effective treatment to terminate this life-threatening arrhythmia. Rapid defibrillation can restore a perfusing rhythm, which is critical for survival in a client who is unresponsive, pulseless, and apneic.

B. Atropine administration: Atropine is used to treat bradycardia or asystole but is not effective for ventricular fibrillation. In this scenario, defibrillation takes precedence over medication administration to restore a normal heart rhythm.

C. Prepare for synchronized cardioversion: Synchronized cardioversion is used for certain tachyarrhythmias when the client has a pulse. Ventricular fibrillation requires immediate unsynchronized defibrillation because the client is pulseless and unresponsive.

D. Amiodarone administration: Amiodarone is an antiarrhythmic drug that can be used after defibrillation and chest compressions to stabilize the heart rhythm. However, it is not the initial action in this emergency; defibrillation must occur first to terminate the arrhythmia and restore circulation.

A. "ALS is caused by excess chemicals in the brain. The symptoms can be controlled with medication." B. "The disease is progressive and will eventually lead to paralysis while maintaining cognitive function." C. "Before you lose cognitive function, you should consider creating an advanced directive." D. "Despite severe symptoms right now, most patients recover with treatment."

Correct Answer is B

Explanation

A) "ALS is caused by excess chemicals in the brain. The symptoms can be controlled with medication."
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that results in the progressive loss of motor neurons, which leads to muscle weakness, atrophy, and paralysis. It is not caused by "excess chemicals in the brain," and there are currently no medications that can cure ALS or completely control its symptoms. Medications such as riluzole can slow the progression slightly, but they do not stop or reverse the disease.

B) "The disease is progressive and will eventually lead to paralysis while maintaining cognitive function."
ALS is indeed a progressive neurodegenerative disease that leads to the gradual loss of muscle function due to the death of motor neurons. Over time, the patient will experience muscle weakness, atrophy, and paralysis, while the cognitive function typically remains intact until the later stages of the disease, although some patients may develop frontotemporal dementia. it is essential for the patient to understand that the disease will progressively impair their physical abilities while leaving cognitive functions largely unaffected in most cases.

C) "Before you lose cognitive function, you should consider creating an advanced directive."
While it is important for individuals with ALS to plan for the future, this statement is not entirely accurate. Cognitive function in ALS is often preserved throughout most of the disease, although there is a subset of patients who may develop frontotemporal dementia. It would be more appropriate to discuss advanced directives early in the disease, but it is not guaranteed that cognitive function will be lost before physical decline.

D) "Despite severe symptoms right now, most patients recover with treatment."
ALS is a progressive disease with no cure, and it does not typically result in recovery. While certain treatments can help manage symptoms or slow the progression of the disease, recovery is not a realistic expectation. Most patients with ALS experience gradual worsening of symptoms and ultimately may require assistance with daily activities as the disease progresses.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who develops the rhythm below. The client is unresponsive, pulseless, and apneic. Which of the following actions should the nurse expect to do first?

Correct Answer is A

Explanation

The nurse is educating a patient who is newly diagnosed with amyotrophic lateral sclerosis (ALS). Which statement would be the most appropriate for the nurse to include in education?

Correct Answer is B

Explanation

A nurse is reviewing the serum laboratory findings for a client who has heart failure and is prescribed furosemide. Which of the following findings should the nurse report to the provider?

A nurse working in the cardiac icu is caring for client with suspected left sided heart failure. For which clinical manifestation should the nurse assess for?

A nurse is preparing a client who is to receive chemotherapy for treatment of ovarian cancer. Which of the following actions should the nurse plan to take?

The nurse is preparing discharge teaching for a client with Bell's Palsy. Which of the following is most important to include in the teaching? [Select all that apply)

The nurse working in the Neuro ICU is caring for a client with Guillain Barre Syndrome. Which of the following activities would be best assigned to the Licensed practical nurse (LPN)?