RAK Nursing Officer - 2019
Medical & Surgical Nursing
Easy
The nurse should anticipate which immediate treatment for a patient experiencing pulse less ventricular tachycardia?
Appeared in: RAK Nursing Officer - 2019
Explanation
- Pulseless ventricular tachycardia (pVT) is a shockable cardiac arrest rhythm, meaning the heart's electrical activity is chaotic and it is not pumping blood.
- The immediate and highest priority intervention, according to Advanced Cardiac Life Support (ACLS) guidelines, is to deliver an unsynchronized electrical shock, known as defibrillation.
- This electrical current depolarizes the entire myocardium at once, aiming to terminate the chaotic rhythm and allow the heart's natural pacemaker to resume a normal, perfusing rhythm.
- Early defibrillation, combined with high-quality CPR, is the most crucial factor in improving survival outcomes from sudden cardiac arrest.
Why Other Options Were Wrong
- Option B: Transcutaneous pacing delivers electrical impulses to stimulate heart contraction and is used to treat symptomatic bradycardia (a slow heart rate), not a pulseless rapid rhythm like VT.
- Option C: Transvenous pacing is an invasive procedure that also treats symptomatic bradycardia. It is not used in an emergency cardiac arrest situation like pulseless VT.
- Option D: Lidocaine is an antiarrhythmic drug. In the ACLS algorithm for pVT, it is a second-line agent considered only after initial defibrillation attempts and epinephrine have been administered.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Management of Pulseless Ventricular Tachycardia (pVT) in acute care settings.
- Nurses must be able to rapidly identify shockable rhythms like pVT on a monitor, immediately initiate high-quality CPR, and facilitate rapid defibrillation. This is a core competency for nurses in all settings, especially acute and critical care.
- The 'chain of survival' in cardiac arrest depends on early recognition, early CPR, and early defibrillation. A nurse's prompt and correct actions are vital to patient outcomes.
- What if? If the patient had ventricular tachycardia with a pulse but was unstable (e.g., hypotensive, altered mental status, chest pain), the correct immediate treatment would be synchronized cardioversion, not unsynchronized defibrillation. The synchronization avoids delivering the shock on the vulnerable T-wave, which could precipitate ventricular fibrillation.
How to Approach the Question
- First, analyze the question to identify the critical patient state: the patient is 'pulseless' and has 'ventricular tachycardia'.
- Recognize that 'pulseless' + 'VT' equals cardiac arrest.
- Recall the two main pathways in the cardiac arrest algorithm: shockable rhythms (VF/pVT) and non-shockable rhythms (Asystole/PEA).
- Remember that the absolute, immediate priority for any shockable rhythm is defibrillation (an electrical shock).
- Evaluate the options based on this priority. Pacing is for slow heart rates. Medications are secondary interventions. This process of elimination leaves electrical counter shock as the only correct initial action.
Concept Tested & Keywords
- Concept Tested: Management of Pulseless Ventricular Tachycardia (pVT)
- Stem keywords: pulseless ventricular tachycardia, immediate treatment
- Lead-in keywords: anticipate
- Clinical cues: The term 'pulseless' is the critical cue, indicating the patient is in cardiac arrest and requires immediate life-saving intervention, not just arrhythmia management.
Question ID
QC6ERrfpkUsEMl6mMvWWiM
Reference Book
E6 Medicine Davidson Principles Practice 24e p. 502-504
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 642-644
E6 Medicine Harrison 22e Part 1 p. 2013-2015
Practise the full RAK Nursing Officer - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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