Nokea
A young adult patient arrives at the student health centre at the end of the quarter complaining that, 'My heart is skipping beats.' An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What of the following actions should the nurse take first?
- A. Have the patient transported to the hospital emergency department (ED).
- B. Administer O2 at 2-3 L/minute using nasal prongs.
- C. Ask the patient about any history of coronary artery disease.
- D. Question the patient about current stress level and coffee use.
Correct Answer: D
Rationale: In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.
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Which of the following actions should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg?
- A. Turn the synchronizer switch to the 'off' position.
- B. Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position.
- C. Set the defibrillator/cardioverter energy to 300 J.
- D. Administer a sedative before cardioversion is implemented.
Correct Answer: D
Rationale: When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). CPR is not indicated for this patient.
The nurse is caring for a patient who was admitted with a myocardial infarction and experiences a 50-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next?
- A. Notify the health care provider.
- B. Perform synchronized cardioversion.
- C. Administer the PRN IV lidocaine.
- D. Document the rhythm and monitor the patient.
Correct Answer: C
Rationale: The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes and accelerate repolarization. The nurse should notify the health care provider after the medications are administered. Defibrillation is not indicated given that the patient is currently in a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.
The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which of the following methods is best to use?
- A. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes
- B. Count the number of large squares in the R-R interval and divide by 100.
- C. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
- D. Calculate the number of small squares between one QRS complex and the next and divide into 1500.
Correct Answer: C
Rationale: This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer.
The nurse is caring for a patient in the emergency department who has symptoms of a 'racing' heart and nervousness. The nurse places the patient on a cardiac monitor and obtains the following electrocardiogram tracing. Which of the following actions should the nurse take next?
- A. Get ready to perform electrical cardioversion.
- B. Have the patient perform the Valsalva manoeuvre.
- C. Obtain the patient's blood pressure and oxygen saturation.
- D. Prepare to give β-blocker medication to slow the heart rate.
Correct Answer: C
Rationale: The patient has sinus tachycardia, which may have multiple etiologies such as pain, dehydration, anxiety, and myocardial ischemia; further assessment is needed before determining the treatment. Vagal stimulation or β-blockade may be used after further assessment of the patient. Electrical cardioversion is used for some tachydysrhythmias, but would not be used for sinus tachycardia.
The nurse is providing instruction to a patient on the management of a new implantable cardioverter-defibrillator (ICD). Which of the following patient statements indicate that the teaching has been effective?
- A. It will be 6 weeks before I can take a bath or return to my usual activities.
- B. I will notify the airlines when I make a reservation that I have a pacemaker.
- C. I won't lift the arm on the pacemaker side up very high until I see the doctor.
- D. I must avoid cooking with a microwave oven or being near a microwave in use.
Correct Answer: C
Rationale: The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period.