Adult Critical Care Specialty (ACCS) Practice Exam

What crucial immediate intervention should be taken for a patient with a heart rate of 130 and low blood pressure?

1. Fluid challenge

2. Rate-limiting medication

3. Positioning the patient supine

4. Reducing oxygen delivery

The correct answer is: Fluid challenge

For a patient presenting with a heart rate of 130 beats per minute and low blood pressure, the most critical immediate intervention is a fluid challenge. This approach is fundamental in addressing potential hypovolemia, which can be a significant cause of low blood pressure and tachycardia. By administering intravenous fluids, you aim to increase the intravascular volume, thereby helping to improve cardiac output and blood pressure. The rationale behind this intervention lies in the principle that low blood pressure may indicate inadequate perfusion and volume status. A fluid challenge provides the necessary volume that can support circulation, especially in cases of shock or dehydration. Positioning the patient supine can be beneficial for maintaining venous return but is not as directly effective as delivering fluids. Rate-limiting medications, while important in the overall management of tachyarrhythmias, should not be the first step when there is evidence of low blood pressure, as they may further decrease cardiac output. Reducing oxygen delivery is counterintuitive, as maintaining adequate oxygenation is critical in any patient facing cardiovascular instability. Overall, initiating a fluid challenge provides immediate support to stabilize blood pressure and heart rate, making it the most appropriate initial intervention in this scenario.