# An adult collapses on the medical-surgical unit and is found pulseless with monitor showing wide-complex VT. Which actions should the nurse and team perform? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375078&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

An adult collapses on the medical-surgical unit and is found pulseless with monitor showing wide-complex VT. Which actions should the nurse and team perform? Select all that apply.

1

Give amiodarone 300 mg IV bolus after the third defibrillation if VT/VF persists

2

Defibrillate at 200 J biphasic as soon as the defibrillator is available

3

Administer IV epinephrine 1 mg every 3 to 5 minutes after second shock

4

Begin uninterrupted high-quality CPR with rate 100-120 and depth 2 inches

5

Perform synchronized cardioversion at 100 J for the wide-complex tachycardia

## Explanation

Pulseless VT and VF require immediate high-quality CPR with minimal interruption (rate 100-120, depth 2-2.4 inches, full recoil). Defibrillation is the most important intervention — every minute of delay reduces survival by 7-10 percent. After the second shock, epinephrine 1 mg IV every 3-5 minutes. Amiodarone 300 mg IV bolus is given after the third shock for refractory VT/VF (lidocaine 1-1.5 mg/kg is alternative). Atropine is NOT used in pulseless VT/VF — it is for symptomatic bradycardia. Address Hs (hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypothermia) and Ts (toxins, tamponade, tension PTX, thrombosis pulmonary/coronary).

## In-depth explanation

Quality CPR metrics: rate 100-120, depth 2 inches, full recoil, minimize interruptions, ETCO2 over 10 mmHg suggests adequate compression.

## Clinical scenario

Witnessed arrest. CPR initiated within 30 seconds. AED arriving.

## Key concepts

- **pulseless VT** — Wide-complex tachycardia without palpable pulse; shockable rhythm.
- **amiodarone** — Class III antiarrhythmic; first-line antiarrhythmic in cardiac arrest after defibrillation.
- **Hs and Ts** — Mnemonic for reversible causes of cardiac arrest.

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