Correct answer—D. Rationales: According to the standards of the American Heart Association, the client should be defibrillated, then given epinephrine. Clients in ventricular fibrillation can’t be cardioverted using the synchronization mode. Although amiodarone may be used in the treatment of ventricular fibrillation, they aren’t considered first-ine pharmacologic agents.

Nursing process step: Intervention

Correct answer—D. Rationales: Hypercalcemia can occur after massive blood transfusion because of the presence of the preservative EDTA. Hypernatremia and hyperchloremic acidosis can also occur.

Nursing process step: Assessment

Correct answer—C. Rationales: These agents should be removed or wiped off before defibrillation because electrical arcing can occur when topical medications are present. Defibrillation has no effect on administration or deactivation of topical nitroglycerin. Nitroglycerin in combination with defibrillation doesn’t cause reflex tachycardia.

Nursing process step: Intervention

Correct answer—B. Rationales: Organophosphate insecticides (cholinesterase inhibitors) bind to prevent the breakdown of acetylcholine, resulting in pulmonary edema and excessive oral secretions. Atropine (an anticholinergic agent) promotes drying of pulmonary secretions and is considered an end point in treatment. Flumazenil is used in the treatment of barbiturate overdose; naltrexone is used in the treatment of opioid toxicity; and activated charcoal is used to facilitate binding of the ingested toxic substance and to promote excretion of the substance through the GI tract.

Nursing process step: Intervention

Correct answer—A. Rationales: Medication administration by way of an ET tube requires momentary cessation of cardiopulmonary resuscitation, followed by hyperventilation to nebulize the medication. Needles should never be placed in the ET tube. Resuming normal ventilations doesn’t propel the drug into the lungs or clear the tube of any remaining drug. Flushing the tube with sterile water places excess fluid in the lungs, further compromising the client’s oxygenation.

Nursing process step: Implementation

Correct answer—D. Rationales: Elective cardioversion should be avoided in the presence of digoxin toxicity because there’s a likelihood of arrhythmogenesis. Cardioversion can be safely used with methemoglobinemia, cyanide toxicity, and hypermagnesemia.

Nursing process step: Analysis

Correct answer—A. Rationales: The asthma client may not exhibit wheezing as air movement significantly decreases, but any problems in airway and breathing are considered life-threatening and should be seen immediately. In most cases, a sickle cell anemia client is considered stable but urgent; this client would be seen second. The 12-year-old with a foot laceration would most likely be seen third and the closed fracture fourth. Closed fractures and lacerations are considered stable and nonurgent as long as no neurovascular compromise is noted.

Nursing process step: Assessment

Correct answer—B. Rationales: Airway and breathing are always the first priority of assessment and intervention. Because the client is unresponsive, supplemental oxygen is the first priority. Next comes synchronized cardioversion, which is the treatment of choice in clients with symptomatic narrow complex tachycardia. Asynchronized cardioversion is indicated in pulseless ventricular tachycardia or ventricular fibrillation.

Nursing process step: Intervention

Correct answer—B. Rationales: Transmissibility of malignant cells is possible with heart valve, saphenous vein, and bone donation because of the vascularity of these tissues. The cornea isn’t vascular, thus eliminating the possibility of disease transmission.

Nursing process step: Analysis

Correct answer—C. Rationales: Isoproterenol is the drug of choice in the treatment of symptomatic bradycardia after heart transplantation because of its potent beta-adrenergic effect in clients without intact vagal innervation. In cardiac transplantation, the vagus nerve isn’t attached to the transplanted heart. Adenosine slows electrical conduction through the atrioventricular node and is used to treat symptomatic supraventricular tachycardia. Atropine is an anticholinergic agent used in the treatment of symptomatic bradycardia in clients with intact vagal innervation. Epinephrine is a potent sympathomimetic agent that mimics the sympathetic nervous system.

Nursing process step: Intervention

Correct answer—B. Rationales: Using the formula: systolic blood pressure = 80 + age in years × 2, the estimated normal blood pressure for a 3-year-old child is 80 (3×2) = 86.

Nursing process step: Assessment

Correct answer—C. Rationales: According to the Centers for Disease Control and Prevention, motor vehicle collisions are the number one cause of pediatric deaths, followed by homicide, suicide, drowning, pedestrian injuries, fires, and burns.

Nursing process step: Evaluation

Correct answer—C. Rationales: Succinylcholine is an ultra-short-acting depolarizing agent used for rapid-sequence intubation and may cause bradycardia, especially in children. Atropine is the drug of choice in treating succinylcho-line-induced bradycardia. Lidocaine is used in adults only. Epinephrine bolus and isoproterenol aren’t used in rapid-sequence intubation because of their profound cardiac effects.

Nursing process step: Intervention

Correct answer—D. Rationales: The following agents can be safely administered by intraosseous infusion: blood, bretylium, calcium, chloride, colloids, crystalloids, dobutamine, dopamine, epinephrine, glucose, and sodium bicarbonate.

Isoproterenol, which doesn’t fall into any of the above categories, can’t be administered by the intraosseous route.

Nursing process step: Intervention

Correct answer—B. Rationales: Children have a circulating blood volume of 80 mL/kg. Therefore, a 20-kg child has a circulating blood volume of 1,600 mL.

Nursing process step: Analysis

Correct answer—B. Rationales: Gender hasn’t been identified as a risk factor in upper GI bleeding. Cigarette smoking, use of nonsteroidal anti-inflammatory drugs, and H. pylori infection have been implicated as major risk factors.

Nursing process step: Assessment

Correct answer—B. Rationales: After permanent interruption of cerebral circulation (brain death), the client frequently experiences pulmonary edema, diabetes insipidus, or neurogenic shock. Loss of thermoregulatory mechanisms results in hypothermia.

Nursing process step: Assessment

Correct answer—B. Rationales: Forensic examination of a client after death is common when the cause of death is suspected of being unnatural. Homicide or suspected homicide, death after traumatic injury, and poisoning may be attributed to malicious acts or product failure involving others. Further investigation is required in these cases. Unwitnessed cardiac arrest isn’t considered unnatural.

Nursing process step: Analysis

Correct answer—A. Rationales: Maintaining urine output above 100 mL/hour in a potential organ donor ensures adequate perfusion of the renal glomeruli. Systolic blood pressure should be maintained above 100 mm Hg. Central venous pressure should be maintained within normal limits to prevent neurogenic pulmonary edema. HCT should be maintained above 30% to ensure adequate intravascular fluid volume. Oxygen and carbon dioxide levels are maintained within normal limits to ensure organ and tissue oxygenation.

Nursing process step: Intervention

Correct answer—C. Rationales: Because of sympathetic nervous system influences resulting in peripheral vasoconstriction, the central carotid pulse is the most reliable site in assessing pulse quality in the hemodynamically unstable adult. Radial, dorsalis pedis, and popliteal pulses are generally palpable in clients with a systolic pressure greater than 80 mm Hg. Femoral pulses are palpable in clients with a systolic pressure greater than 70 mm Hg, and carotid pulses are palpable in clients with a systolic pressure greater than 60 mm Hg.

Nursing process step: Assessment

Correct answer—D. Rationales: Chronic neuropathy, commonly seen in a client with diabetes mellitus, interferes with the transmission of pain impulses. A client with diabetes who has myocardial ischemia may be pain free. Careful history combined with subjective findings should be used in diagnosing cardiac emergencies in a client with diabetes. The use of aspartame, sulfonylurea agents, or insulin doesn’t interfere with pain impulse transmission to the brain.