The patient's heart rate is 165 beats per minute and his cardiac monitor shows a rapid rate with narrow QRS complexes; the waves cannot be seen, but the rhythm is regular. The patient is symptomatic, so the nurse prepares the patient for:

administration of beta-blockers.

transcutaneous pacemaker insertion.

emergent cardioversion.

administration of atropine.

Answer and Explanation

The Correct Answer is C

A. Beta-blockers, such as metoprolol or esmolol, are commonly used to slow the ventricular rate in certain tachyarrhythmias like atrial fibrillation or atrial flutter, especially when the patient is hemodynamically stable. However, in this scenario, the patient is symptomatic with a very high heart rate (165 bpm), which may indicate compromised cardiac output. Symptoms may include hypotension, chest pain, shortness of breath, or altered mental status. In unstable patients, beta-blockers are too slow to reverse the hemodynamic instability, making emergent cardioversion the appropriate first-line treatment.

B. Pacemakers are indicated for bradycardia or high-grade heart block, not tachyarrhythmias. Using a pacemaker in a patient with supraventricular tachycardia (SVT) or other narrow complex tachycardias would not correct the rapid heart rate and may worsen patient condition.

C. This patient demonstrates narrow complex tachycardia (likely SVT) that is regular and rapid, with symptoms indicating hemodynamic instability. According to ACLS (Advanced Cardiac Life Support) guidelines, synchronized electrical cardioversion is indicated for unstable tachyarrhythmias to restore sinus rhythm promptly. Synchronized cardioversion ensures the electrical shock is delivered during the R wave to avoid inducing ventricular fibrillation. Emergent cardioversion is prioritized over medications when a patient is unstable because it immediately restores cardiac output and perfusion.

D. Atropine is an anticholinergic drug used primarily for bradycardia to increase heart rate by blocking vagal stimulation. Administering atropine to a patient with tachycardia would be inappropriate and could further increase heart rate, worsening myocardial oxygen demand and precipitating ischemia or hemodynamic collapse.

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

Explanation

A. Cardiogenic shock results from severe pump failure and presents with signs of both left- and right-sided heart failure. Left-sided failure leads to pulmonary congestion, manifested by crackles and dyspnea, while right-sided failure causes systemic venous congestion, including JVD and peripheral edema. Hypotension and poor perfusion develop as shock progresses. Early recognition of these signs allows prompt intervention.

B. Tracheal deviation is not associated with cardiogenic shock; it indicates tension pneumothorax or large pleural effusion. Hypertension alone is not typical of cardiogenic shock, which usually presents with hypotension and low cardiac output.

C. While diuretics and ARBs are part of chronic heart failure management, they are not first-line treatments for acute cardiogenic shock. Insulin is unrelated unless the patient has diabetes. Acute shock management requires hemodynamic support rather than standard outpatient medications.

D. IV vasodilators, such as nitroprusside or nitroglycerin, reduce preload and afterload, improving cardiac output and tissue perfusion in cardiogenic shock. Careful monitoring is needed to prevent hypotension.

E. Positive inotropes, like dobutamine or milrinone, increase myocardial contractility, improving cardiac output in cardiogenic shock. They are often used in combination with vasodilators or mechanical support for optimal hemodynamic stabilization.

F. Mechanical support devices, such as intra-aortic balloon pumps (IABP) or ventricular assist devices (VADs), can be used in refractory cardiogenic shock to improve perfusion, reduce cardiac workload, and stabilize the patient until recovery or definitive therapy.

A. Begin cardiopulmonary resuscitation and advanced life support. B. treat the patient with intravenous amiodarone or lidocaine. C. ignore the rhythm since it is benign. D. provide electrical cardioversion per physician protocol

Correct Answer is A

Explanation

A. Pulseless ventricular tachycardia is a life-threatening cardiac arrest rhythm. The immediate priority is high-quality CPR and activation of the advanced cardiac life support (ACLS) protocol, including defibrillation as soon as possible. Early initiation of CPR and defibrillation significantly improves survival rates.

B. While antiarrhythmic medications like amiodarone or lidocaine may be used during ACLS, they are secondary interventions. The immediate priority for pulseless VT is CPR and defibrillation, not medication administration first.

C. Pulseless VT is not benign; it is a medical emergency. Ignoring it would result in death within minutes due to lack of cardiac output.

D. Synchronized cardioversion is used for unstable VT with a pulse, not for pulseless VT. In pulseless VT, unsynchronized defibrillation is required, and CPR should be initiated immediately.

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The patient's heart rate is 165 beats per minute and his cardiac monitor shows a rapid rate with narrow QRS complexes; the waves cannot be seen, but the rhythm is regular. The patient is symptomatic, so the nurse prepares the patient for:

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Naxlex Comprehensive Predictor Exams

One of the complications we might see of heart failure is cardiogenic shock. What kinds of signs and symptoms might you see and how do we treat? (Select all that apply)

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

Explanation

The nurse notices ventricular tachycardia on the heart monitor. When the patient is assessed, the patient is found to be unresponsive with no pulse. The nurse should:

Correct Answer is A

Explanation

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