Following two defibrillation shocks, the client's electrocardiogram (ECG) continues to indicate ventricular fibrillation (VF). Which intervention should the nurse implement next?

Resume CPR immediately.

Obtain an arterial blood gas sample.

Perform the third defibrillation shock.

Administer an IV bolus of epinephrine.

Answer and Explanation

The Correct Answer is C

Choice A: CPR is important but should be performed in conjunction with defibrillation. Since two defibrillation shocks have already been administered, the next step should be another shock.

Choice B : Obtaining an arterial blood gas sample is not the immediate priority when the client is in ventricular fibrillation. Defibrillation should be continued.

Choice C: Performing the third defibrillation shock is the next appropriate step in the advanced cardiac life support (ACLS) algorithm for ventricular fibrillation.

Choice D: Administering an IV bolus of epinephrine may be part of the ACLS protocol, but it is typically administered after defibrillation attempts.

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Correct Answer is A

Explanation

Choice A: cottage cheese has about 364 mg of sodium per 100 g, which is much higher than the other options.

Choice B: Broccoli is a generally healthy vegetable and does not need to be avoided solely for sodium intake unless heavily salted. Broccoli has only 33 mg of sodium per 100g.

Choice C: Ground sirloin has 75 mg of sodium per 100g which is much lower than that contained by cottage cheese.

Choice D: Bananas are a low-sodium food and do not need to be avoided for sodium intake.

A. Strict intake and output. B. Maintain a large bore IV. C. Keep NPO except for ice. D. Monitor laboratory values

Correct Answer is D

Explanation

Choice A: Strict intake and output monitoring is important in the care of clients with DKA, but it is not the most critical intervention among the choices provided.

Choice B: Maintaining a large bore intravenous (IV) is important for providing the necessary fluids and medications in DKA treatment, but it is not the highest priority.

Choice C: Keeping the client NPO except for ice may be part of the initial management of DKA to address fluid and electrolyte imbalances, but it is not the most important intervention in the client's overall plan of care.

Choice D: Monitoring laboratory values is the most important intervention for a client with diabetic ketoacidosis (DKA). Regular assessment of blood glucose levels, electrolytes (e.g., potassium, sodium), and arterial blood gases (ABGs) is crucial for guiding treatment and ensuring that DKA is resolving. Adjustments to insulin and fluids are based on these laboratory values to prevent complications such as cerebral edema or cardiac arrhythmias.

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Following two defibrillation shocks, the client's electrocardiogram (ECG) continues to indicate ventricular fibrillation (VF). Which intervention should the nurse implement next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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