Pharm Farm
A patient is in cardiac arrest. The monitor shows ventricular fibrillation, and the patient remains pulseless after an initial defibrillation attempt.
What medication should the nurse anticipate giving next?
Epinephrine
The patient is given atropine. What heart rhythm is most likely being treated?
Sinus bradycardia
A patient in the ICU is being treated for sepsis. The patient's BP is 118/72, HR 102, and SpO₂ is 96%. The nurse notices the patient's urine output has decreased to 15 mL/hr over the last 2 hours and the patient is becoming restless.
What should the nurse do next?
Reassess the patient and notify the provider of the decreased urine output and change in mental status. These can be early signs of decreased organ perfusion even before hypotension develops.
A patient remains in ventricular fibrillation despite high-quality CPR and multiple defibrillation attempts.
Which antiarrhythmic medication should the nurse anticipate?
Amiodarone
The patient has a regular narrow-complex tachycardia. Vagal maneuvers are unsuccessful, so the patient is given adenosine.
What heart rhythm is most likely being treated?
Supraventricular tachycardia (SVT)
A mechanically ventilated patient suddenly becomes agitated. The SpO₂ falls from 97% to 85%, and the high-pressure alarm sounds.
The nurse notices the patient is biting the endotracheal tube.
What should the nurse do first?
Assess the patient's airway and immediately address the obstruction, while calling for assistance and providing appropriate oxygenation/ventilatory support. The biting may be causing increased airway resistance and the high-pressure alarm.
A patient has a heart rate of 34/min, BP of 78/46, altered mental status, and cool, clammy skin. The rhythm is symptomatic bradycardia.
Which medication should the nurse anticipate first?
Atropine, while preparing for pacing if the patient does not respond or remains unstable
The patient is pulseless and the monitor shows a chaotic, irregular waveform with no identifiable QRS complexes. The patient receives epinephrine and is defibrillated.
What heart rhythm is this?
Ventricular fibrillation
A patient with sepsis has received IV fluids. The patient's BP is now 82/48, HR 124, and urine output is 10 mL/hr. Lactate is 5.2 mmol/L.
What should the nurse anticipate next?
Vasopressor therapy, typically norepinephrine, to support blood pressure and organ perfusion after appropriate fluid resuscitation.
A patient suddenly develops a regular narrow-complex tachycardia at 190/min. The patient is alert and has a BP of 118/74. Vagal maneuvers are unsuccessful.
Which medication would the nurse anticipate?
Adenosine
The patient remains in a shockable rhythm after defibrillation and epinephrine. Amiodarone is administered as an antiarrhythmic.
What heart rhythm is most likely present?
Pulseless ventricular tachycardia
A patient with septic shock is receiving norepinephrine through a central line. Suddenly, the patient's BP drops from 104/62 to 72/40.
The nurse notices:
What should the nurse do FIRST?
Immediately assess the IV/central-line system and restore the vasopressor infusion as quickly and safely as possible while calling for assistance.
The sudden hypotension occurred at the same time the norepinephrine stopped, so the nurse needs to recognize that the patient may be losing their vasopressor support. This is a great critical-care question because the priority isn't simply "give more fluids"—the nurse has to identify the cause of the sudden deterioration.
A patient with a prolonged QT develops torsades de pointes and becomes pulseless.
Which medication should the nurse anticipate?
Magnesium sulfate.
The patient develops a rapid, polymorphic ventricular rhythm with a prolonged QT interval. The patient is treated with IV magnesium sulfate.
What heart rhythm is this?
Torsades de pointes
A 68-year-old patient with septic shock is mechanically ventilated and receiving norepinephrine through a central line. Over the past hour, the nurse notices the patient is becoming increasingly confused.
Current assessment:
The patient has already received 30 mL/kg of IV crystalloid. The norepinephrine infusion is running, and the pump shows no alarms.
The nurse notices the patient's extremities are cool and mottled, and the arterial line waveform appears dampened.
❓ Question
What should the nurse do NEXT?
Immediately reassess the patient's hemodynamic status and verify the arterial-line reading and vasopressor delivery while urgently escalating the patient's ongoing shock.
The patient has signs of persistent tissue hypoperfusion despite initial fluid resuscitation and vasopressor therapy: worsening mental status, oliguria, elevated lactate, prolonged capillary refill, mottling, and hypotension.
The dampened arterial waveform is an important clue—the displayed BP may be inaccurate. The nurse should assess the arterial-line system for kinks, air, loose connections, or other problems and compare the pressure with another reliable measurement.
At the same time, the patient needs immediate critical-care reassessment for refractory septic shock, including evaluation of vasopressor requirements, cardiac function, fluid responsiveness, oxygen delivery, and possible additional hemodynamic support.