A several-second sinus pause or asystole immediately after the push is expected, but report a sustained pause or new dangerous rhythm.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client in stable monomorphic ventricular tachycardia with a pulse is prescribed an antiarrhythmic. Which medication does the nurse anticipate administering?
Answer: B. Amiodarone is a first-line antiarrhythmic for stable ventricular tachycardia with a pulse. Atropine is used for symptomatic bradycardia, adenosine is for stable narrow-complex supraventricular tachycardia, and digoxin is not used to acutely terminate VT.
Question 2 of 3
A client has stable, narrow-complex supraventricular tachycardia (SVT) at a rate of 180 that did not respond to vagal maneuvers. Which medication does the nurse prepare to give as a rapid IV push?
Answer: B. Adenosine is the drug of choice for stable narrow-complex SVT after vagal maneuvers fail. It must be given as a rapid IV push followed by a rapid saline flush because of its very short half-life. The client should be warned about a brief period of asystole or flushing. Amiodarone and digoxin are not the first-line acute push agents here, and atropine treats bradycardia.
Question 3 of 3
A client with symptomatic bradycardia (heart rate 38, blood pressure 80/50, dizziness) is being treated. Which medication does the nurse anticipate administering first?
Answer: A. Atropine 1 mg IV is the first-line drug for symptomatic bradycardia; it blocks vagal tone to increase heart rate. If atropine is ineffective, transcutaneous pacing or dopamine/epinephrine infusions are next. Adenosine and beta blockers would worsen bradycardia.
Keep the streak going with more questions like these, each with a full rationale.
What is adenosine?
It briefly slows conduction through the AV node, momentarily interrupting the reentry circuit. Because its half-life is only a few seconds, it must be given by rapid IV push.
Key points to remember
- First-line drug for converting stable narrow-complex PSVT to sinus rhythm.
- Extremely short half-life (about 10 seconds) requires very rapid IV push followed by an immediate saline flush.
- A brief period of asystole or pause of a few seconds after administration is expected as the rhythm converts.
- Given as close to the IV insertion site as possible, ideally an antecubital or central line, with a rapid flush.
- Common transient effects include flushing, chest pressure, dyspnea, and a feeling of impending doom lasting seconds.
- Effects are blunted by caffeine and theophylline and enhanced by dipyridamole and carbamazepine.
Nursing priorities
- Administer by rapid IV push over 1-2 seconds immediately followed by a 20 mL saline flush.
- Have the patient on continuous ECG monitoring and run a rhythm strip during administration.
- Ensure emergency equipment and a defibrillator are available before giving the drug.
- Warn the patient about transient flushing, chest tightness, and shortness of breath before pushing.
Patient teaching
- You may feel brief chest tightness, flushing, or shortness of breath for a few seconds; this passes quickly.
- Tell the team if you have asthma, as the medication can rarely trigger wheezing.
Red flags: report now
- A several-second sinus pause or asystole immediately after the push is expected, but report a sustained pause or new dangerous rhythm.
- Avoid in asthma or reactive airway disease due to the risk of severe bronchospasm; give only if no alternative, with bronchodilators and airway support ready.
- Report failure to convert or recurrence of the tachydysrhythmia.
References
Clinical references for this topic
