A patient with an Implantable Cardioverter-Defibrillator (ICD) reports experiencing multiple shock episodes while at home. He is now in the emergency department, fully conscious, oriented, but anxious. What is the next best step?

1. A

   Reassure the patient that this is a normal occurrence.

2. B

   Immediately deactivate the ICD.

3. C

   Attach the patient to an ECG monitor and assess vital signs.

4. D

   Administer a sedative and discharge the patient if symptoms improve

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

• The question asks for the 'next best step', which in an emergency setting always prioritizes assessment before intervention.
• Attaching an ECG monitor and assessing vital signs are the core components of a primary survey (ABC - Circulation assessment).
• This action provides the essential data needed to understand the patient's current cardiac rhythm and hemodynamic stability.
• The results of the ECG and vital signs will determine if the ICD shocks were appropriate (for a life-threatening rhythm) or inappropriate (due to a non-lethal rhythm or device malfunction), which guides all further treatment.

Why Other Options Were Wrong

• Option A: Multiple ICD shocks are not a 'normal occurrence'. This provides false reassurance and minimizes a potentially life-threatening situation known as an electrical storm.
• Option B: Deactivating the ICD without a full assessment and a backup plan is extremely dangerous. The device is the patient's protection against fatal arrhythmias.
• Option D: This addresses the patient's anxiety but completely ignores the underlying, potentially fatal cardiac cause of the shocks. Discharging the patient would be negligent.

Related Visual

• Visual 1: Image - A patient in an emergency department bed connected to a cardiac monitor, showing the placement of ECG leads and a vital signs display.
• Visual 2: Diagram - An illustration showing the placement of an ICD and its leads within the heart.
• Visual 3: ECG Strip - An example of Ventricular Tachycardia (VT), which is a common reason for an appropriate ICD shock.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Emergency management of a patient with an Implantable Cardioverter-Defibrillator (ICD) after receiving multiple shocks in acute care settings.
• The nurse's primary role in this scenario is rapid and accurate assessment. Recognizing that multiple ICD shocks are an emergency is critical for patient safety.
• Nurses must be prepared to provide immediate psychological support, as receiving shocks is a terrifying experience for patients, increasing anxiety and myocardial oxygen demand.
• What if the patient was found unconscious? The 'next best step' would change to initiating the ACLS protocol: check for a pulse, and if absent, begin chest compressions and call for a defibrillator, as the patient is in cardiac arrest despite the ICD.

How to Approach the Question

• First, identify the question type: This is a clinical priority question asking for the 'next best step' in an emergency.
• Analyze the patient's situation: The patient has a known cardiac device (ICD) and has experienced a critical event (multiple shocks). They are currently conscious but anxious.
• Apply the nursing process (ADPIE). The first and most critical step is always Assessment.
• Evaluate the options based on the 'Assessment first' principle. Which option represents the most crucial assessment?
• Option C (ECG and vitals) is a pure assessment step. Options A, B, and D are interventions or communications.
• Eliminate the incorrect options by identifying their risks: A (false reassurance), B (dangerous intervention), D (unsafe discharge). This confirms that the assessment step (C) is the correct priority.

Concept Tested & Keywords

• Concept Tested: Emergency management of a patient with an Implantable Cardioverter-Defibrillator (ICD) after receiving multiple shocks.
• Stem keywords: Implantable Cardioverter-Defibrillator (ICD), multiple shock episodes, emergency department, conscious, anxious
• Lead-in keywords: next best step
• Clinical cues: Patient is conscious and oriented, indicating current hemodynamic stability but the situation is urgent.
• Clinical cues: Patient is anxious, highlighting the need for both physiological assessment and psychological support.

Question ID

Qv5tZ5_TlLmkkjU_P04WbY

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