NUM 3110: Comprehensive Emergency Nursing Prep
with Detailed Rationales
Course Code: NUM 3110
Course Name: Comprehensive Emergency Nursing
Topic: Advanced Cardiac Life Support (ACLS), Arrhythmia Management, and
Post-Resuscitation Care
Academic Year: 2026/2027
Question 1
A patient is brought to the emergency department in cardiac arrest. The monitor
reveals ventricular fibrillation (VF). Which action should the emergency nurse
perform first?
A. Administering an intravenous bolus of amiodarone
B. Delivering an immediate unsynchronized shock (defibrillation)
C. Preparing the patient for emergency endotracheal intubation
D. Performing a 12-lead electrocardiogram (ECG)
CORRECT ANSWER: B
RATIONALE: Ventricular fibrillation (VF) is a lethal, shockable cardiac
rhythm characterized by chaotic ventricular electrical activity without mechanical
contraction. The definitive treatment for VF is immediate defibrillation to
depolarize the myocardium simultaneously, allowing the heart's natural pacemaker
to resume a functional rhythm. While chest compressions must be ongoing until
the defibrillator is ready, delivering the shock takes precedence. Amiodarone is an
antiarrhythmic administered after subsequent shocks and epinephrine. Intubation
and a 12-lead ECG are secondary measures that must never delay immediate
defibrillation.
Question 2
The emergency team is resuscitating an adult patient in cardiac arrest with a non-
shockable rhythm. According to ACLS guidelines, what is the standard initial dose
and frequency of Epinephrine?
A. 1 mg IV/IO every 1 to 2 minutes
,B. 1 mg IV/IO every 3 to 5 minutes
C. 5 mg IV/IO every 5 to 10 minutes
D. 0.5 mg IV/IO given as a continuous one-time infusion
CORRECT ANSWER: B
RATIONALE: For adult cardiac arrest, the standard dose of Epinephrine is 1
mg administered intravenously or intraosseously (IV/IO) every 3 to 5 minutes.
Epinephrine acts as a potent vasoconstrictor via alpha-1 receptors, increasing
myocardial and cerebral perfusion pressure during chest compressions. Giving it
every 1 to 2 minutes increases the risk of toxicity and post-resuscitation
tachycardia, while a 5 mg dose or a single 0.5 mg dose deviates from standard
ACLS guidelines.
Question 3
A patient in the resuscitation bay exhibits severe symptomatic bradycardia with a
heart rate of 34 beats per minute, severe chest pain, and a blood pressure of 78/42
mmHg. Which medication is the first-line drug choice?
A. Amiodarone
B. Atropine sulfate
C. Epinephrine infusion
D. Adenosine
CORRECT ANSWER: B
RATIONALE: Atropine sulfate is the first-line medication for symptomatic
bradycardia. It is an anticholinergic drug that blocks vagal effects on the
sinoatrial (SA) and atrioventricular (AV) nodes, increasing the heart rate. The
initial dose is 1 mg IV, repeatable every 3 to 5 minutes up to a maximum dose of 3
mg. Amiodarone is used for tachyarrhythmias. An epinephrine infusion can be
used if atropine fails, but it is not first-line. Adenosine is used to slow down
narrow-complex supraventricular tachycardias.
Question 4
A patient presents to the ED with a regular, narrow-complex supraventricular
tachycardia (SVT) at a rate of 180 beats per minute. The patient is
hemodynamically stable but complains of severe palpitations. Which medication
,should the nurse anticipate administering rapidly via IV push?
A. Digoxin
B. Adenosine
C. Metoprolol
D. Lidocaine
CORRECT ANSWER: B
RATIONALE: Adenosine is the drug of choice for stable, regular, narrow-
complex supraventricular tachycardia (SVT). It works by slowing electrical
conduction through the AV node, effectively interrupting reentry pathways to
restore sinus rhythm. Due to its short half-life (less than 10 seconds), it must be
administered as a rapid IV push followed immediately by a rapid normal saline
flush. Digoxin has a very slow onset. Metoprolol can be used later for rate control
but is not the first-line rapid conversion agent. Lidocaine is an antiarrhythmic
utilized for ventricular arrhythmias, not supraventricular tachydysrhythmias.
Question 5
The nurse is assisting with the resuscitation of a patient in refractory ventricular
fibrillation. After delivering three shocks and administering the first dose of
epinephrine, the provider orders an antiarrhythmic medication. Which agent
should the nurse prepare first?
A. Magnesium sulfate
B. Amiodarone
C. Atropine
D. Calcium chloride
CORRECT ANSWER: B
RATIONALE: Amiodarone is the primary antiarrhythmic medication
recommended by ACLS guidelines for shock-refractory ventricular
fibrillation or pulseless ventricular tachycardia. The initial bolus dose in cardiac
arrest is 300 mg IV/IO, followed by a second dose of 150 mg if the rhythm
persists. Magnesium sulfate is only indicated first if the patient exhibits Torsades
de Pointes. Atropine is completely contraindicated in tachyarrhythmias and cardiac
arrest rhythms. Calcium chloride is only indicated for hyperkalemia,
hypocalcemia, or calcium channel blocker overdose.
, Question 6
A patient develops an unstable, rapid ventricular tachycardia with a pulse. The
patient is confused, hypotensive (BP 82/44 mmHg), and has a capillary refill of 5
seconds. Which intervention should the nurse anticipate?
A. Unsynchronized high-energy defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers
D. Administration of oral beta-blockers
CORRECT ANSWER: B
RATIONALE: When an adult patient presents with an unstable
tachyarrhythmia with a pulse (e.g., ventricular tachycardia, rapid atrial
fibrillation, or SVT causing hypotension and altered mental status), the treatment
of choice is synchronized cardioversion. The machine delivers a shock timed
precisely with the R-wave of the QRS complex to prevent inducing ventricular
fibrillation. Unsynchronized defibrillation is reserved for pulseless patients. Vagal
maneuvers and oral medications are inappropriate for a hemodynamically unstable
patient requiring immediate conversion.
Question 7
During a cardiac arrest resuscitation, the team notes a flat line on the cardiac
monitor. The nurse confirms the rhythm in two contiguous leads and diagnoses
asystole. Which intervention is strictly contraindicated for this rhythm?
A. High-quality chest compressions
B. Electrical defibrillation
C. Intravenous epinephrine administration
D. Identifying and treating reversible causes (H's and T's)
CORRECT ANSWER: B
RATIONALE: Defibrillation is strictly contraindicated in asystole.
Defibrillation is used to depolarize a chaotic electrical rhythm (like VF or pulseless
VT) to let a viable pacemaker resume control. In asystole, there is no electrical
activity present; shocking a flatline causes myocardial injury and decreases the
chance of achieving return of spontaneous circulation (ROSC). Management must
with Detailed Rationales
Course Code: NUM 3110
Course Name: Comprehensive Emergency Nursing
Topic: Advanced Cardiac Life Support (ACLS), Arrhythmia Management, and
Post-Resuscitation Care
Academic Year: 2026/2027
Question 1
A patient is brought to the emergency department in cardiac arrest. The monitor
reveals ventricular fibrillation (VF). Which action should the emergency nurse
perform first?
A. Administering an intravenous bolus of amiodarone
B. Delivering an immediate unsynchronized shock (defibrillation)
C. Preparing the patient for emergency endotracheal intubation
D. Performing a 12-lead electrocardiogram (ECG)
CORRECT ANSWER: B
RATIONALE: Ventricular fibrillation (VF) is a lethal, shockable cardiac
rhythm characterized by chaotic ventricular electrical activity without mechanical
contraction. The definitive treatment for VF is immediate defibrillation to
depolarize the myocardium simultaneously, allowing the heart's natural pacemaker
to resume a functional rhythm. While chest compressions must be ongoing until
the defibrillator is ready, delivering the shock takes precedence. Amiodarone is an
antiarrhythmic administered after subsequent shocks and epinephrine. Intubation
and a 12-lead ECG are secondary measures that must never delay immediate
defibrillation.
Question 2
The emergency team is resuscitating an adult patient in cardiac arrest with a non-
shockable rhythm. According to ACLS guidelines, what is the standard initial dose
and frequency of Epinephrine?
A. 1 mg IV/IO every 1 to 2 minutes
,B. 1 mg IV/IO every 3 to 5 minutes
C. 5 mg IV/IO every 5 to 10 minutes
D. 0.5 mg IV/IO given as a continuous one-time infusion
CORRECT ANSWER: B
RATIONALE: For adult cardiac arrest, the standard dose of Epinephrine is 1
mg administered intravenously or intraosseously (IV/IO) every 3 to 5 minutes.
Epinephrine acts as a potent vasoconstrictor via alpha-1 receptors, increasing
myocardial and cerebral perfusion pressure during chest compressions. Giving it
every 1 to 2 minutes increases the risk of toxicity and post-resuscitation
tachycardia, while a 5 mg dose or a single 0.5 mg dose deviates from standard
ACLS guidelines.
Question 3
A patient in the resuscitation bay exhibits severe symptomatic bradycardia with a
heart rate of 34 beats per minute, severe chest pain, and a blood pressure of 78/42
mmHg. Which medication is the first-line drug choice?
A. Amiodarone
B. Atropine sulfate
C. Epinephrine infusion
D. Adenosine
CORRECT ANSWER: B
RATIONALE: Atropine sulfate is the first-line medication for symptomatic
bradycardia. It is an anticholinergic drug that blocks vagal effects on the
sinoatrial (SA) and atrioventricular (AV) nodes, increasing the heart rate. The
initial dose is 1 mg IV, repeatable every 3 to 5 minutes up to a maximum dose of 3
mg. Amiodarone is used for tachyarrhythmias. An epinephrine infusion can be
used if atropine fails, but it is not first-line. Adenosine is used to slow down
narrow-complex supraventricular tachycardias.
Question 4
A patient presents to the ED with a regular, narrow-complex supraventricular
tachycardia (SVT) at a rate of 180 beats per minute. The patient is
hemodynamically stable but complains of severe palpitations. Which medication
,should the nurse anticipate administering rapidly via IV push?
A. Digoxin
B. Adenosine
C. Metoprolol
D. Lidocaine
CORRECT ANSWER: B
RATIONALE: Adenosine is the drug of choice for stable, regular, narrow-
complex supraventricular tachycardia (SVT). It works by slowing electrical
conduction through the AV node, effectively interrupting reentry pathways to
restore sinus rhythm. Due to its short half-life (less than 10 seconds), it must be
administered as a rapid IV push followed immediately by a rapid normal saline
flush. Digoxin has a very slow onset. Metoprolol can be used later for rate control
but is not the first-line rapid conversion agent. Lidocaine is an antiarrhythmic
utilized for ventricular arrhythmias, not supraventricular tachydysrhythmias.
Question 5
The nurse is assisting with the resuscitation of a patient in refractory ventricular
fibrillation. After delivering three shocks and administering the first dose of
epinephrine, the provider orders an antiarrhythmic medication. Which agent
should the nurse prepare first?
A. Magnesium sulfate
B. Amiodarone
C. Atropine
D. Calcium chloride
CORRECT ANSWER: B
RATIONALE: Amiodarone is the primary antiarrhythmic medication
recommended by ACLS guidelines for shock-refractory ventricular
fibrillation or pulseless ventricular tachycardia. The initial bolus dose in cardiac
arrest is 300 mg IV/IO, followed by a second dose of 150 mg if the rhythm
persists. Magnesium sulfate is only indicated first if the patient exhibits Torsades
de Pointes. Atropine is completely contraindicated in tachyarrhythmias and cardiac
arrest rhythms. Calcium chloride is only indicated for hyperkalemia,
hypocalcemia, or calcium channel blocker overdose.
, Question 6
A patient develops an unstable, rapid ventricular tachycardia with a pulse. The
patient is confused, hypotensive (BP 82/44 mmHg), and has a capillary refill of 5
seconds. Which intervention should the nurse anticipate?
A. Unsynchronized high-energy defibrillation
B. Synchronized cardioversion
C. Vagal maneuvers
D. Administration of oral beta-blockers
CORRECT ANSWER: B
RATIONALE: When an adult patient presents with an unstable
tachyarrhythmia with a pulse (e.g., ventricular tachycardia, rapid atrial
fibrillation, or SVT causing hypotension and altered mental status), the treatment
of choice is synchronized cardioversion. The machine delivers a shock timed
precisely with the R-wave of the QRS complex to prevent inducing ventricular
fibrillation. Unsynchronized defibrillation is reserved for pulseless patients. Vagal
maneuvers and oral medications are inappropriate for a hemodynamically unstable
patient requiring immediate conversion.
Question 7
During a cardiac arrest resuscitation, the team notes a flat line on the cardiac
monitor. The nurse confirms the rhythm in two contiguous leads and diagnoses
asystole. Which intervention is strictly contraindicated for this rhythm?
A. High-quality chest compressions
B. Electrical defibrillation
C. Intravenous epinephrine administration
D. Identifying and treating reversible causes (H's and T's)
CORRECT ANSWER: B
RATIONALE: Defibrillation is strictly contraindicated in asystole.
Defibrillation is used to depolarize a chaotic electrical rhythm (like VF or pulseless
VT) to let a viable pacemaker resume control. In asystole, there is no electrical
activity present; shocking a flatline causes myocardial injury and decreases the
chance of achieving return of spontaneous circulation (ROSC). Management must
