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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Assess the client's potassium level:
While electrolyte imbalances, including low potassium, can contribute to symptoms like restlessness or muscle weakness, it is not the first priority in a client with COPD who suddenly becomes restless and anxious. Restlessness and anxiety in this context are more likely to be due to hypoxia (low oxygen levels), hypercapnia (high carbon dioxide levels), or respiratory distress.
B) Check the client's temperature:
An elevated temperature may indicate an infection, such as pneumonia or a respiratory tract infection, which can exacerbate COPD symptoms. However, in the context of sudden restlessness and anxiety, this is less likely to be the most immediate cause. The primary concern should be addressing the potential respiratory issues, such as hypoxia or acute exacerbation, rather than focusing on fever, unless other signs of infection are present.
C) Increase the client's oxygen flow rate to 15 L/min:
While it is important to ensure adequate oxygenation in a client with COPD, increasing the oxygen flow rate to 15 L/min may not be appropriate, as COPD patients are typically at risk for oxygen-induced hypercapnia. These patients often rely on low levels of oxygen to stimulate breathing, and administering high-flow oxygen can suppress their respiratory drive, potentially worsening carbon dioxide retention.
D) Encourage the client to perform pursed-lip breathing:
Pursed-lip breathing is a highly effective technique for COPD patients to help increase oxygenation and decrease the work of breathing. This technique involves the client breathing in through the nose and exhaling slowly through pursed lips, which helps to keep the airways open longer and facilitates the removal of trapped air in the lungs.
Correct Answer is A
Explanation
A) Women should start yearly mammograms at age 40:
Mammography is a key screening tool for breast cancer detection. According to guidelines from the American Cancer Society (ACS) and other leading health organizations, women should begin annual mammograms at age 40. This recommendation applies to average-risk women who are not showing any symptoms of breast cancer. Mammograms are effective in detecting early-stage breast cancer, which is crucial for better treatment outcomes.
B) Women should have a yearly clinical breast examination starting at age 50:
The clinical breast examination (CBE) is a physical exam performed by a healthcare provider to check for breast cancer. However, the recommendation is to have a clinical breast examination every 1-3 years for women in their 20s and 30s and annually for women 40 and older, not just beginning at age 50. It is not necessary to wait until age 50 to start yearly CBEs.
C) Clients should have fecal occult blood test every other year:
The fecal occult blood test (FOBT) is used to detect hidden blood in the stool, which may be a sign of colon cancer. However, this test is not typically performed every other year for all clients. The recommended schedule for colorectal cancer screening depends on risk factors. The American Cancer Society recommends annual FOBT or fecal immunochemical test (FIT) for clients over the age of 45 who are at average risk for colon cancer. More invasive tests, such as colonoscopy, are generally recommended for people at higher risk or after positive results from non-invasive tests like FOBT.
D) Clients should have a colonoscopy at age 40 and every 10 years thereafter:
The recommended age for the first colonoscopy is age 45 for individuals at average risk of colorectal cancer, not 40. Colonoscopies are typically performed every 10 years after the initial screening unless there are risk factors (e.g., family history, genetic conditions) that require earlier or more frequent screenings.
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