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During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructors best response?
- A. Cardioversion is done on a beating heart; defibrillation is not.
- B. The difference is the timing of the delivery of the electric current.
- C. Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not.
- D. Cardioversion is always attempted before defibrillation because it has fewer risks.
Correct Answer: B
Rationale: One major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current is synchronized with the patients electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized. Both can be done on a beating heart (i.e., in a dysrhythmia). Cardioversion is not necessarily attempted first.
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A patient is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the patients care?
- A. Ablate the area causing the dysrhythmia.
- B. Freeze hypersensitive cells.
- C. Diagnose the dysrhythmia.
- D. Determine the nursing plan of care.
Correct Answer: C
Rationale: A patient may undergo an EP study in which electrodes are placed inside the heart to obtain an intracardiac ECG. This is used not only to diagnose the dysrhythmia but also to determine the most effective treatment plan. However, because an EP study is invasive, it is performed in the hospital and may require that the patient be admitted.
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement?
- A. Clean the skin with providone-iodine solution.
- B. Ensure that the area for electrode placement is dry.
- C. Apply tincture of benzoin to the electrode sites and wait for it to become tacky.
- D. Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
Correct Answer: D
Rationale: An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. Disinfecting the skin is unnecessary and conduction gel is used.
The nurse is caring for a patient who has just undergone catheter ablation therapy. The nurse in the stepdown unit should prioritize what assessment?
- A. Cardiac monitoring
- B. Monitoring the implanted device signal
- C. Pain assessment
- D. Monitoring the patients level of consciousness (LOC)
Correct Answer: A
Rationale: Following catheter ablation therapy, the patient is closely monitored to ensure the dysrhythmia does not reemerge. This is a priority over monitoring of LOC and pain, although these are valid and important assessments. Ablation does not involve the implantation of a device.
The nurse and the other members of the team are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated unsuccessfully and the patient remains in VF. According to national standards, the nurse should anticipate the administration of what medication?
- A. Epinephrine 1 mg IV push
- B. Lidocaine 100 mg IV push
- C. Amiodarone 300 mg IV push
- D. Sodium bicarbonate 1 amp IV push
Correct Answer: A
Rationale: Epinephrine should be administered as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and lidocaine are given if ventricular dysrhythmia persists.
The nurse is providing care to a patient who has just undergone an electrophysiologic (EP) study. The patient states that she is nervous about things going wrong during the procedure. What is the nurses best response?
- A. This is basically a risk-free procedure.
- B. Thousands of patients undergo EP every year.
- C. Remember that this is a step that will bring you closer to enjoying good health.
- D. The whole team will be monitoring you very closely for the entire procedure.
Correct Answer: D
Rationale: Patients who are to undergo an EP study may be anxious about the procedure and its outcome. A detailed discussion involving the patient, the family, and the electrophysiologist usually occurs to ensure that the patient can give informed consent and to reduce the patients anxiety about the procedure. It is inaccurate to state that EP is risk-free and stating that it is common does not necessarily relieve the patients anxiety. Characterizing EP as a step toward good health does not directly address the patients anxiety.