The ACLS certified nurse determines a patient is in PEA.

CPR is in progress.

Three minutes after epinephrine 1 mg is given, PEA continues.

Which action should the nurse do next?

Choice A rationale

This rhythm originates above the ventricles, typically from the atrioventricular node or atria, characterized by narrow QRS complexes and a regular rhythm. In the provided strip, the absence of discernible P waves and a grossly irregular ventricular response contradicts this diagnosis. Additionally, the rate calculation based on a six second strip requires counting R waves and multiplying by ten, which leads to a specific frequency not matching this option's tachycardia profile.

Choice B rationale

This rhythm involves a regular discharge from the sinoatrial node exceeding 100 beats per minute, usually displaying identifiable P waves before every narrow QRS complex. Normal sinus rhythm features regular R-R intervals, whereas the strip demonstrates significant irregularity. Tachycardia at 150 bpm is common in stress or fever, but the chaotic nature of the atrial activity and the irregular ventricular rate on the monitor strip point toward a more disorganized supraventricular arrhythmia rather than sinus.

Choice C rationale

This life threatening rhythm is defined by a wide QRS complex (>0.12 seconds) originating from ventricular ectopic foci, typically presenting as a regular, rapid rhythm. The strip shows narrow QRS complexes, which indicates that the electrical impulse is traveling through the normal conduction system rather than originating in the ventricles. A rate of 210 bpm is possible, but the narrow morphology and irregular spacing definitively rule out a primary ventricular origin for this rhythm.

Choice D rationale

This condition is characterized by disorganized atrial electrical activity resulting in no distinct P waves and an irregularly irregular ventricular rhythm. Rapid ventricular response occurs when the atrioventricular node allows numerous impulses to pass, exceeding 100 bpm. By counting the R waves in a six second strip and multiplying by ten, a rate of 210 bpm is confirmed. The baseline shows fibrillatory waves, and the R-R intervals are inconsistent, making this the most accurate clinical diagnosis.

Choice A rationale

Diuretics are generally used to reduce fluid volume and lower preload in patients with heart failure or pulmonary edema. While a pulmonary artery catheter measures these pressures, administering diuretics right before insertion is not a standard procedural requirement. Doing so could actually alter the baseline hemodynamic data that the catheter is intended to measure, such as the pulmonary artery wedge pressure, which normally ranges from 4 to 12 mmHg.

Choice B rationale

Inserting a pulmonary artery catheter involves passing a balloon-tipped catheter through the right atrium and right ventricle. As the catheter tip touches the irritable endocardium of the right ventricle, it frequently triggers ventricular ectopy or even ventricular tachycardia. Continuous cardiac monitoring is vital to detect these dysrhythmias immediately so the clinician can reposition the catheter or provide treatment. This safety measure ensures patient stability during the invasive advancement of the device.

Choice C rationale

Auscultation of heart sounds is a standard part of a physical assessment but is not a practical or specific action for assisting with catheter insertion. The clinician performing the insertion relies on pressure waveforms displayed on a monitor to determine the location of the catheter tip. Listening to the heart would not provide real-time data on the catheter's position within the chambers or help mitigate the primary risks associated with the invasive procedure.

Choice D rationale

Cardiac enzymes such as Troponin I or T are biomarkers used to diagnose myocardial infarction or cellular damage. While these may be monitored in critically ill patients, they do not provide information relevant to the technical preparation or safety of inserting a pulmonary artery catheter. The procedure focuses on hemodynamic monitoring rather than diagnosing acute coronary syndromes, so checking these levels is not an anticipated or required step for the insertion process itself.