Nokea
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?
- A. Asystole
- B. Premature ventricular contraction
- C. Atrial flutter
- D. Ventricular fibrillation
Correct Answer: C
Rationale: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.
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Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion?
- A. Atropine
- B. Digoxin
- C. Enalapril
- D. Diazepam
Correct Answer: D
Rationale: Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as diazepam.
The nurse is caring for a client on the cardiac unit. The licensed practical nurse on the previous shift reported the following vital signs/assessment information: temperature, 100.6?°F; pulse, 56 beats/minute; respirations 24 breaths/minute; blood pressure, 116/60 mm Hg; pulse oximetry reading, 92%; and with 2+ edema noted in the lower extremities. Prior to 9 AM antiarrhythmic medication administration, which of the following will the nurse reassess?
- A. Temperature
- B. Pulse
- C. Blood pressure
- D. Edema
Correct Answer: B
Rationale: Of the vital signs noted, the pulse rate is found to be abnormal, below 60 beats/minute. Before administering an antiarrhythmic medication, which often slows the heart rate further, the pulse rate would be reassessed, and a rate of 60 beats/minute would need to be obtained.
The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation?
- A. It is a scheduled procedure 1 to 10 days in advance.
- B. The client is sedated before the procedure.
- C. It is used to eliminate ventricular arrhythmias.
- D. It uses less electrical energy than cardioversion.
Correct Answer: C
Rationale: The only treatment for a life-threatening ventricular arrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion.
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first?
- A. Sustained asystole
- B. Supraventricular tachycardia
- C. Atrial fibrillation
- D. Ventricular fibrillation
Correct Answer: D
Rationale: Ventricular fibrillation is called the rhythm of a dying heart. It is the rhythm that needs attention first because there is no cardiac output, and it is an indication for CPR and immediate defibrillation. Sustained asystole either is from death, or the client is off of the cardiac monitor. Supraventricular tachycardia and atrial fibrillation are monitored and reported to the physician but not addressed first.
The nurse reports to the cardiac nurse practitioner that the client is consistently exhibiting a normal sinus rhythm. What characteristic(s) has the nurse noted to determine the rhythm is normal? Select all that apply.
- A. Heart rate 106 beats/minute
- B. Upright P wave before each QRS complex
- C. Each impulse occurs regularly.
- D. Impulse travels to the SA node from the AV node.
- E. Wave ends with a T wave
- F. Ventricles depolarize in the QRS complex.
Correct Answer: B,C,E,F
Rationale: Characteristics of normal sinus rhythm include a regular impulse originating in the SA node and with impulses continuing to the AV node. There is a P wave initially with depolarization at the QRS complex and ending with a T wave. Normal heart rate is between 60 to 100 beats/minute.