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A nurse is providing health education to a patient scheduled for cryoablation therapy. The nurse should describe what aspect of this treatment?
- A. Peeling away the area of endocardium responsible for the dysrhythmia
- B. Using electrical shocks directly to the endocardium to eliminate the source of dysrhythmia
- C. Using high-frequency sound waves to eliminate the source of dysrhythmia
- D. Using a cooled probe to eliminate the source of dysrhythmia
Correct Answer: D
Rationale: Cryoablation therapy involves using a cooled probe to create a small scar on the endocardium to eliminate the source of the dysrhythmias. Endocardium resection involves peeling away a specified area of the endocardium. Electrical ablation involves using shocks to eliminate the area causing the dysrhythmias. Radio frequency ablation uses high-frequency sound waves to destroy the area causing the dysrhythmias.
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The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient?
- A. Maintain a resting heart rate below 70 bpm.
- B. Maintain adequate control of chest pain.
- C. Maintain adequate cardiac output.
- D. Maintain normal cardiac structure.
Correct Answer: C
Rationale: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
The nurse is caring for a patient with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the patients most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best respond to this finding?
- A. Recognize that the procedure was unsuccessful.
- B. Recognize this as a therapeutic goal of the procedure.
- C. Liaise with the care team in preparation for repeating the maze procedure.
- D. Prepare the patient for pacemaker implantation.
Correct Answer: B
Rationale: The maze procedure is an open heart surgical procedure for refractory atrial fibrillation. Small transmural incisions are made throughout the atria. The resulting formation of scar tissue prevents reentry conduction of the electrical impulse. Consequently, scar formation would constitute a successful procedure. There is no indication for repeating the procedure or implanting a pacemaker.
A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine?
- A. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
- B. Administer atropine as a continuous infusion until symptoms resolve.
- C. Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours.
- D. Administer atropine 1.0 mg sublingually.
Correct Answer: A
Rationale: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.
The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do?
- A. Maintain firm contact between paddles and patient skin.
- B. Apply a layer of water as a conducting agent.
- C. Call all clear once before discharging the defibrillator.
- D. Ensure the defibrillator is in the sync mode.
Correct Answer: A
Rationale: When defibrillating an adult patient, the nurse should maintain good contact between the paddles and the patients skin to prevent arcing, apply an appropriate conducting agent (not water) between the skin and the paddles, and ensure the defibrillator is in the nonsync mode. Clear should be called three times before discharging the paddles.
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
- A. PP interval and RR interval are irregular.
- B. PP interval is equal to RR interval.
- C. Fewer QRS complexes than P waves
- D. PR interval is constant.
Correct Answer: C
Rationale: In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis.