An ICU patient's cardiac monitor displays the following rhythm. The crash cart is at the bedside. The nurse's first action should be
IV administration of epinephrine.
IV administration of vasopressin.
immediate cardioversion.
immediate defibrillation.
The Correct Answer is D
A. IV administration of epinephrine: Epinephrine is part of advanced cardiac life support for pulseless rhythms, but medication administration is secondary to establishing circulation through defibrillation in shockable rhythms. Immediate electrical therapy takes priority to restore a perfusing rhythm.
B. IV administration of vasopressin: Vasopressin may be used as an alternative to epinephrine in certain ACLS protocols, but it does not replace the need for immediate defibrillation in pulseless ventricular tachycardia or ventricular fibrillation. Delaying defibrillation for medications can decrease survival chances.
C. Immediate cardioversion: Cardioversion is synchronized and intended for unstable tachyarrhythmias in clients with a pulse. In a pulseless patient or one in ventricular fibrillation, synchronized cardioversion is not appropriate and would delay life-saving defibrillation.
D. Immediate defibrillation: Defibrillation is the priority for pulseless ventricular tachycardia or ventricular fibrillation. Delivering an unsynchronized shock as quickly as possible maximizes the chance of restoring a perfusing rhythm and is the most time-sensitive intervention in this scenario.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Restrict fluids: The client’s hemodynamics indicate low blood pressure and low systemic vascular resistance, suggesting distributive shock rather than fluid overload. Fluid restriction would worsen hypotension and further compromise perfusion, making it inappropriate in this scenario.
B. Administer norepinephrine bitartrate: Norepinephrine is a potent vasoconstrictor that increases systemic vascular resistance and blood pressure, improving perfusion in septic shock. Given the client’s low SVR and hypotension despite adequate cardiac output, norepinephrine is the first-line vasoactive agent to restore hemodynamic stability.
C. Administer sodium nitroprusside: Nitroprusside is a vasodilator that decreases SVR and is used for hypertensive emergencies. In this client with septic shock and already low SVR, it would exacerbate hypotension and worsen perfusion, making it contraindicated.
D. Administer lidocaine: Lidocaine is an antiarrhythmic used for ventricular arrhythmias. There is no indication of arrhythmia in this client’s hemodynamic data, so lidocaine would not address the primary problem of hypotension due to low SVR.
Correct Answer is D
Explanation
A. It usually involves tubule damage: Tubular damage is characteristic of intrinsic (intrarenal) acute kidney injury, not prerenal AKI. In prerenal failure, the kidney structure is initially intact, and injury results primarily from reduced perfusion.
B. The kidneys are unable to retain sodium and water: In prerenal AKI, the kidneys are still functional and attempt to conserve sodium and water to maintain intravascular volume. Inability to retain sodium and water is more typical of intrinsic kidney injury.
C. It seldom affects glomerular filtration of blood: Prerenal AKI directly reduces glomerular filtration rate (GFR) due to decreased renal perfusion. Saying it “seldom affects GFR” is incorrect because a drop in GFR is central to prerenal failure.
D. The hallmark characteristic is renal hypoperfusion: Reduced renal blood flow is the defining feature of prerenal AKI. Causes include dehydration, hemorrhage, heart failure, or shock, and the primary problem is insufficient perfusion rather than structural kidney damage.
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