An unresponsive patient is found to have pulseless electrical activity. CPR is initiated and epinephrine is administered. After resuscitation efforts, the patient develops jugular venous distension, hypotension Which condition should the nurse suspect as the underlying reversible cause?

1. A

   Massive pulmonary embolism

2. B

   Tension pneumothorax

3. C

   Cardiac tamponade

4. D

   Acute myocardial infarction

Appeared in: NORCET-11 Prelims

Explanation

• Cardiac tamponade is a reversible cause of PEA and is included in the '5 Ts' mnemonic.
• Classic signs are jugular venous distension and hypotension due to impaired cardiac filling.
• Immediate intervention (pericardiocentesis) is required to relieve pressure and restore cardiac output.

Why Other Options Were Wrong

• Option A: Massive pulmonary embolism can cause PEA and hypotension, but JVD is less prominent and usually accompanied by severe hypoxia and right heart strain symptoms.
• Option B: Tension pneumothorax is a cause of PEA and can cause JVD and hypotension, but is usually associated with absent breath sounds and tracheal deviation.
• Option D: Acute myocardial infarction can cause cardiac arrest, but does not typically present with JVD and hypotension post-CPR unless complicated by tamponade or massive infarct.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Recognition of reversible causes of pulseless electrical activity (PEA) with post-resuscitation JVD and hypotension in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Nurses must rapidly identify signs of obstructive shock (JVD, hypotension) after cardiac arrest to initiate life-saving interventions.
• Cardiac tamponade requires urgent pericardiocentesis to relieve pressure and restore cardiac output.
• What if? If the patient had absent breath sounds and tracheal deviation, tension pneumothorax would be suspected and immediate needle decompression would be indicated.

How to Approach the Question

• Identify the clinical context: PEA after resuscitation with new JVD and hypotension.
• Recall the '5 Ts' of reversible PEA causes: Tamponade, Tension pneumothorax, Thrombosis (pulmonary/coronary), Toxins, Trauma.
• Match the clinical findings (JVD, hypotension) to the most likely cause.
• Rule out other options by comparing their classic presentations.
• Select the answer that best fits the unique combination of findings.

Concept Tested & Keywords

• Concept Tested: Recognition of reversible causes of pulseless electrical activity (PEA) with post-resuscitation JVD and hypotension
• Stem keywords: unresponsive patient, pulseless electrical activity, CPR, epinephrine, jugular venous distension, hypotension
• Lead-in keywords: should the nurse suspect
• Clinical cues: JVD and hypotension after CPR suggest obstructive shock

Question ID

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Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 45-47