1You are called to the patient's bedside because she is experiencing the sensation of fluttering in her

chest. You perform an initial assessment and find that the 22-year-old woman is communicative and in
no acute distress. The rhythm monitor on the defibrillator reveals a regular, narrow complex heart rate
of 150 beats per minute. Your initial evaluation should include which of the following?

A Check blood pressure

B Check mental status

C Check for signs of heart failure

D All of the above

RATIONALE

All of these are important assessments in a person with stable tachycardia.

2She denies chest pain or shortness of breath. Her lungs are clear to auscultation, has no jugular venous
distention and no edema. A 12-lead ECG confirms a regular, narrow-complex tachyarrhythmia. Her
blood pressure is 130/85 mmHg. What is your next action?

A Give IV adenosine

B Carotid massage

C Oral beta-blocker

D Synchronized cardioversion

RATIONALE

A vagal maneuver such as carotid massage should be tried first in a person with stable tachycardia.

3The vagal maneuver did not lower the patient's heart rate. What is your next action?

A Massage both carotids simultaneously

B Adenosine 6 mg bolus IV once

C Adenosine 12 mg bolus IV once

D Synchronized cardioversion

RATIONALE
The first dosage of IV adenosine for supraventricular tachycardia is 6 mg. Never massage both carotid
arteries simultaneously.

4The adenosine did not lower the patient's heart rate. What is your next action?

A Amiodarone 150 mg bolus once

B Adenosine 6 mg bolus IV once

C Adenosine 12 mg bolus IV once

D Synchronized cardioversion

RATIONALE

If adenosine 6 mg fails to convert the patient’s supraventricular tachycardia to a sinus rhythm, the
subsequent dosage of IV adenosine should be increased to 12 mg.

5The patient is visibly anxious and now states that she is having chest pain. She describes the pain as a
pressure in her chest. When asked about her pain, she appeared confused. Her systolic blood pressure is
now 100/70. What is your next action?

A Administer a second 12 mg IV dose of adenosine intravenously

B Amiodarone 150 mg IV bolus once

C Procainamide 150 mg IV bolus once

D Cardioversion

RATIONALE

This tachyarrhythmia is now causing cardiovascular instability. It is appropriate to move to cardioversion

as therapy.

6You determine that the woman's tachycardia is causing rate-related symptoms and decide to provide
cardioversion. The rhythm is still narrow and regular. After administering light sedation, you provide an
initial dose of energy from the defibrillation through externally placed pads. What dose of energy should
you initially deliver?

A 50-100 Joules, synchronized

B 120-200 Joules biphasic, synchronized

C 200 Joules monophasic, synchronized

D Process to defibrillation, not synchronized

ATIONALE

The first energy level to apply to treat SVT is 50-100 Joules. This should be synchronized to the person’s
cardiac cycle. A defibrillation or unsynchronized shock is not appropriate.

7You deliver the energy and the patient immediately loses consciousness. You cannot find a pulse after
trying for ten seconds. The heart monitor still shows a tachyarrhythmia. What is your next action?

A Amiodarone 150 mg IV over 10 minutes

B Procainamide 20-50 mg/minute

C Defibrillate

D Sotalol 100 mg IV over 5 minutes

ATIONALE

The patient has pulseless ventricular tachycardia or ventricular fibrillation. Thus, the first and best
intervention is to provide a defibrillation or unsynchronized shock.

8You administer a defibrillation dose (200 J biphasic) to the patient. What is your next action?

A Immediately check the rhythm to see if another shock is needed

B Start high-quality CPR immediately

C Immediately check for a pulse

D Deliver a second defibrillation at a higher dose

RATIONALE

Provide chest compressions as part of CPR immediately after providing a shock. This should continue for
two minutes without interruption.
9After two minutes of CPR, the patient still has no pulse and the rhythm is now ventricular fibrillation.
What is your next action?

A Deliver a second defibrillation at a higher dose

B Deliver a second defibrillation at the same dose

C Adenosine 12 mg bolus IV once

D Abort the resuscitation

RATIONALE

For biphasic energy, 200 J is already the maximum dosage level. Subsequent shocks should be delivered
at this same energy. It is too soon to abort the resuscitation in this woman (and probably too soon for
any patient). She is a young and otherwise healthy woman who has a relatively high likelihood of
regaining spontaneous circulation.

10You administer the second defibrillation and resume high-quality CPR. You also administer which of
the following?

A Adenosine 12 mg bolus IV once

B Atropine 1 mg IV bolus

C Lidocaine 1 mg IV bolus

D Epinephrine 1 mg IV bolus

RATIONALE

Epinephrine 1 mg is the treatment of choice for adult cardiac arrest. In the pulseless ventricular
tachycardia/ventricular fibrillation algorithm, now is the proper time to administer it.