# Drag each rhythm-and-circulation cluster to the immediate response pathway it requires. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395516&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question Drag each rhythm-and-circulation cluster to the immediate response pathway it requires. **1.** Chaotic waveform without identifiable QRS complexes; the client is unresponsive and pulseless Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate **2.** Wide regular ventricular rhythm at 220/min with no pulse Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate **3.** Organized narrow-complex electrical activity at 70/min but no palpable pulse Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate **4.** Near-flat tracing confirmed in two leads with no pulse Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate **5.** Regular narrow-complex tachycardia at 190/min with a pulse, hypotension, chest pain, and altered mentation Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate **6.** Monomorphic wide-complex tachycardia with a pulse and signs of shock Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate **7.** Irregularly irregular narrow-complex rhythm with a pulse, blood pressure 128/74 mm Hg, and no ischemic symptoms Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate **8.** New irregularly irregular rhythm with stable perfusion requiring 12-lead confirmation and cause evaluation Select a category Shockable cardiac arrest: CPR and prompt defibrillation Unstable tachyarrhythmia with a pulse: synchronized pathway Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes Perfusing stable atrial fibrillation: assess and treat the cause or rate ## Explanation Pulseless ventricular fibrillation and pulseless ventricular tachycardia require CPR and prompt defibrillation. Pulseless electrical activity and asystole are nonshockable arrest rhythms requiring CPR, epinephrine, and evaluation of reversible causes. Unstable tachyarrhythmia with a pulse requires immediate expert escalation and synchronized cardioversion when indicated. A perfusing, stable atrial fibrillation pattern requires focused assessment, 12-lead confirmation, cause evaluation, and prescribed rate or rhythm management rather than arrest treatment. ## In-depth explanation Quick answer Pulse first: shock VF/pVT arrest; do not shock PEA/asystole; synchronize an unstable tachycardia with a pulse; assess and treat stable atrial fibrillation. Clinical judgment The same monitor rate can lead to different actions depending on pulse and perfusion. Confirm responsiveness and pulse rapidly, start high-quality CPR for arrest, and do not delay indicated defibrillation. NCLEX decision rule Treat the client and circulation state, not a monitor label in isolation.References 1AHA 2025 Adult Advanced Life Support 2AHA 2025 Adult Basic Life Support ## Clinical scenario Rhythm plus perfusion The monitor findings have been confirmed and artifact has been excluded. Classify the whole clinical state, including whether a pulse is present, rather than naming the rhythm alone. ## Key concepts - **Shockable Rhythm** — A cardiac-arrest rhythm for which unsynchronized defibrillation is indicated, such as ventricular fibrillation or pulseless ventricular tachycardia. - **Pulseless Electrical Activity** — Organized electrical activity without a palpable pulse or effective mechanical circulation. - **Synchronized Cardioversion** — A shock timed to the QRS complex for selected unstable tachyarrhythmias when a pulse is present. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 68-year-old client is admitted to the emergency department with suspected sepsis from a …](https://mymerci.kr/pages/nclex_q.php?qn_id=363987&lang=en) - [A nurse is caring for an adult client in the emergency department who is suspected to have…](https://mymerci.kr/pages/nclex_q.php?qn_id=363993&lang=en) - [A nurse is teaching a 72-year-old client with chronic heart failure (reduced ejection frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=366202&lang=en) - [A nurse is caring for an adult client admitted with diabetic ketoacidosis. 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