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A patient calls his cardiologists office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the patient to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what?
- A. Infection
- B. Failure to capture
- C. Premature battery depletion
- D. Oversensing of dysrhythmias
Correct Answer: D
Rationale: Inappropriate delivery of ICD therapy, usually due to oversensing of atrial and sinus tachycardias with a rapid ventricular rate response, is the most frequent complication of ICD. Infections, failure to capture, and premature battery failure are less common.
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A patient who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurses best response?
- A. To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia
- B. To detect and treat bradycardia, which is an excessively slow heart rate
- C. To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently
- D. To shock your heart if you have a heart attack at home
Correct Answer: A
Rationale: The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia.
A patient is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurses responsibility in the care of the patients pacemaker?
- A. Monitoring for pacemaker malfunction or battery failure
- B. Determining when it is appropriate to remove the pacemaker
- C. Making necessary changes to the pacemaker settings
- D. Selecting alternatives to future pacemaker use
Correct Answer: A
Rationale: Monitoring for pacemaker malfunctioning and battery failure is a nursing responsibility. The other listed actions are physician responsibilities.
The staff educator is teaching a CPR class. Which of the following aspects of defibrillation should the educator stress to the class?
- A. Apply the paddles directly to the patients skin.
- B. Use a conducting medium between the paddles and the skin.
- C. Always use a petroleum-based gel between the paddles and the skin.
- D. Any available liquid can be used between the paddles and the skin.
Correct Answer: B
Rationale: Use multifunction conductor pads or paddles with a conducting medium between the paddles and the skin (the conducting medium is available as a sheet, gel, or paste). Do not use gels or pastes with poor electrical conductivity.
A patient has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this patients care, what nursing diagnosis is most appropriate?
- A. Acute pain
- B. Risk for unilateral neglect
- C. Risk for activity intolerance
- D. Risk for fluid volume excess
Correct Answer: C
Rationale: Sinus bradycardia causes decreased cardiac output that is likely to cause activity intolerance. It does not typically cause pain, fluid imbalances, or neglect of a unilateral nature.
When planning the care of a patient with an implanted pacemaker, what assessment should the nurse prioritize?
- A. Core body temperature
- B. Heart rate and rhythm
- C. Blood pressure
- D. Oxygen saturation level
Correct Answer: B
Rationale: For patients with pacemakers, close monitoring of the heart rate and rhythm is a priority, even though each of the other listed vital signs must be assessed.