The nurse is caring for a client who has been successfully resuscitated following a cardiac arrest and is now on an IV infusion of epinephrine. The cardiac monitor shows a heart rate of 120 beats/minute. What should be the nurse's best action?

Maintain the infusion because the client had a cardiac arrest.

Continue to monitor the client's rhythm closely.

Suggest that the client's medication be changed to norepinephrine.

Ask the physician if the dose can be decreased.

Answer and Explanation

The Correct Answer is D

A. Maintain the infusion because the client had a cardiac arrest: While epinephrine is essential during cardiac arrest, continuing a high-dose infusion post-resuscitation without reassessment may lead to complications like tachycardia, hypertension, and increased myocardial oxygen demand.

B. Continue to monitor the client's rhythm closely: Ongoing monitoring is important, but it is a passive intervention. The heart rate of 120 bpm may reflect excessive adrenergic stimulation from epinephrine, and further action is needed to prevent deterioration.

C. Suggest that the client's medication be changed to norepinephrine: Norepinephrine is another vasopressor that has less of a beta-1 adrenergic effect compared to epinephrine. It is primarily used for hypotension and septic shock, not as a direct substitute for epinephrine post-cardiac arrest. Changing to another vasopressor without indication is not the best initial step.

D. Ask the physician if the dose can be decreased: A heart rate of 120 bpm may indicate that the epinephrine dose is too high, causing sympathetic overstimulation. Prolonged or excessive tachycardia increases myocardial oxygen demand, which can be detrimental, especially in a post-arrest heart. Decreasing the dose can help prevent arrhythmias or myocardial ischemia, making this the most appropriate and proactive action.

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Correct Answer is B

Explanation

A. Administer amiodarone IV push followed by a continuous infusion: Amiodarone is part of the Advanced Cardiac Life Support (ACLS) algorithm for ventricular fibrillation (VF) or pulseless ventricular tachycardia, but it should only be given after confirming the rhythm and initiating basic life support steps, including pulse check.

B. Establish unresponsiveness and check the carotid pulse: The rhythm strip shows ventricular fibrillation, a life-threatening arrhythmia. However, before initiating advanced interventions such as defibrillation, the nurse must first confirm the client is unresponsive and pulseless, which is the correct initial action according to ACLS protocols.

C. Immediately defibrillate the client using the synchronous mode: Defibrillation is the correct treatment for VF, but it must be done in unsynchronized mode. Additionally, it is not appropriate to defibrillate until pulselessness is confirmed. Synchronized mode is used for rhythms like unstable SVT or atrial fibrillation not VF.

D. Initiate a rapid response call and increase the monitor’s sensitivity: A rapid response team is called for deteriorating patients who are still responsive. If the client is unresponsive and pulseless, a code blue or cardiac arrest protocol should be initiated, not just a rapid response. Monitor sensitivity adjustments are irrelevant in a confirmed life-threatening rhythm.

A. Benign Prostatic Hyperplasia B. Congestive Heart Failure C. Rheumatic Fever D. Coronary Artery Disease

Correct Answer is A

Explanation

A. Benign Prostatic Hyperplasia: Tamsulosin is an alpha-1 adrenergic blocker specifically prescribed to relieve urinary symptoms caused by benign prostatic hyperplasia (BPH). It works by relaxing the smooth muscles in the bladder neck and prostate, improving urine flow and decreasing bladder outlet obstruction.

B. Congestive Heart Failure: Tamsulosin is not indicated for heart failure management. Medications used in heart failure typically include ACE inhibitors, beta blockers, diuretics, and aldosterone antagonists not selective alpha-1 blockers like tamsulosin.

C. Rheumatic Fever: Rheumatic fever is linked to valvular heart disease, not urinary retention or prostate enlargement. Tamsulosin does not have a role in its treatment or management.

D. Coronary Artery Disease: Tamsulosin does not have any therapeutic effect in managing coronary artery disease. CAD is typically managed with medications such as beta blockers, statins, antiplatelets, and nitrates, depending on the clinical scenario.

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The nurse is caring for a client who has been successfully resuscitated following a cardiac arrest and is now on an IV infusion of epinephrine. The cardiac monitor shows a heart rate of 120 beats/minute. What should be the nurse's best action?

Nursing Test Bank

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