A patient arrives in the emergency department after a syncopal episode. The nurse observes the patient's rhythm on the cardiac monitor (see the 6-second rhythm strip below or in the attachment). The patient's blood pressure is 84/52 mmHg, and the patient is confused and lethargic. Which intervention does the nurse anticipate the provider to order?

Administer amiodarone 150 mg IV

Begin transcutaneous pacing

Begin cardioversion

Administer nitroglycerine 5 mcg/min IV

Answer and Explanation

The Correct Answer is B

A. Administer amiodarone 150 mg IV: Amiodarone is used to treat ventricular arrhythmias such as ventricular tachycardia or fibrillation. Second-degree Mobitz type II block is a conduction failure at the level of the His-Purkinje system, leading to dropped QRS complexes and bradycardia, not a tachyarrhythmia requiring antiarrhythmic therapy.

B. Begin transcutaneous pacing: Mobitz type II block is a high-grade AV block with a significant risk of progressing to complete heart block. The patient is hypotensive and symptomatic (confused, lethargic), indicating poor perfusion. Immediate transcutaneous pacing is recommended to maintain adequate heart rate and cardiac output until a more permanent solution, such as transvenous pacing, is established.

C. Begin cardioversion: Cardioversion is indicated for unstable tachyarrhythmias with a pulse, such as atrial fibrillation with rapid ventricular response or ventricular tachycardia with a pulse. This patient has a bradyarrhythmia due to AV block, so cardioversion would not correct the underlying conduction defect.

D. Administer nitroglycerine 5 mcg/min IV: Nitroglycerin reduces preload and can lower blood pressure. Given the patient’s hypotension (84/52 mmHg), administering nitroglycerin would worsen perfusion and does not address the underlying conduction abnormality causing the syncopal episode.

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Free Nursing Study Resources

Correct Answer is ["A","B","D","E"]

Explanation

A. Tachycardia: An elevated heart rate is a compensatory response to hypoxemia or increased work of breathing. In COPD exacerbations, tachycardia often accompanies early respiratory distress and signals the body’s attempt to maintain oxygen delivery to tissues.

B. Dyspnea: Shortness of breath or difficulty breathing is a primary and direct indicator of respiratory compromise. Progressive dyspnea reflects increased airway resistance, impaired gas exchange, and impending respiratory failure if not addressed promptly.

C. Muscle Tremors: Muscle tremors are not typically a direct sign of respiratory distress. They may occur from anxiety, medications such as beta-agonists, or metabolic disturbances, but they are not a reliable indicator of worsening pulmonary function.

D. Diaphoretic: Excessive sweating is a common autonomic response to hypoxia, increased work of breathing, or sympathetic activation. Diaphoresis in the context of COPD exacerbation signals significant physiologic stress and potential respiratory compromise.

E. Unable to speak in full sentences: Inability to complete sentences without pausing to breathe indicates severe respiratory effort and decreased ventilatory reserve. This is a critical sign of impending respiratory failure requiring immediate assessment and intervention.

F. Nausea: Nausea may occur due to medications, hypoxia, or anxiety but is not a primary manifestation of respiratory distress. It is a nonspecific symptom and less relevant in assessing acute respiratory compromise.

A. Infection B. Hypervolemia C. Air embolism D. Pneumothorax

Correct Answer is ["A","C","D"]

Explanation

A. Infection: Central venous catheters used for CVP monitoring provide direct access to the bloodstream, increasing the risk of catheter-related bloodstream infections. The nurse must monitor for signs of infection such as fever, redness, swelling, or purulent drainage at the insertion site and follow strict aseptic technique during care.

B. Hypervolemia: CVP monitoring measures central venous pressure to assess fluid status, but the presence of the catheter itself does not cause hypervolemia. Hypervolemia is a patient condition rather than a complication of the monitoring system, so it is not directly monitored as a catheter-related complication.

C. Air embolism: An air embolism can occur if air enters the central venous catheter during insertion, dressing changes, or disconnection. The nurse monitors for sudden respiratory distress, hypotension, and hypoxia, and ensures all connections are secure and the patient is positioned appropriately during procedures.

D. Pneumothorax: Pneumothorax is a potential complication during the insertion of a central venous catheter, especially with subclavian or jugular access. The nurse monitors for sudden chest pain, decreased breath sounds on the affected side, and respiratory distress, and prepares to intervene if a pneumothorax develops.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient who was admitted for COPD exacerbation. Which of the following manifestations most likely suggestive of the development of respiratory distress? Select all that apply.

Correct Answer is ["A","B","D","E"]

Explanation

The intensive care unit (ICU) nurse plans care for a patient with a hemodynamic monitoring system for central venous pressure (CVP). In the plan of care, which complications does the nurse monitor for? Select all that apply.

Correct Answer is ["A","C","D"]

Explanation

The critical care nurse is assessing a patient for readiness to be weaned from the ventilator. Which of the following indicates that the patient is most likely to have successful weaning from the ventilator?

The nurse is evaluating interventions for a patient who had a chest tube placed one hour ago for a right sided pneumothorax. Which of the following findings would indicate a need for further intervention?

The nurse is assessing the level of sedation for a patient who is intubated and receiving mechanical ventilation. The nurse observes that the patient's RASS (see RASS tool below or in the attachment) is +2. What is the nurse's best action?

During a code blue, the nurse observes the following rhythm on the monitor (see below or in the attachment of a 6 second rhythm strip) following a defibrillation shock. What is the nurses' first action?

An ICU nurse is at the nurse's station when they suddenly hear their patient's ventilator alarming. Which actions should the nurse take when responding to ventilator alarms? Select all that apply.

The nurse is assisting with the intubation of a patient in respiratory distress who has just had an endotracheal tube (ETT) placed. What is the nurse's first action following placement of the ETT?

The nurse is caring for a male patient diagnosed with a Pulmonary Embolism (PE) who has been receiving a heparin IV infusion for 12 hours. Which of the following labs would require the nurse to titrate the heparin drip down?

The nurse assigned a patient who was diagnosed with a pulmonary embolism. Which of the following potential complication during the treatment for pulmonary embolism should the nurse monitor for?