Nokea
The client has returned to the floor with a transthoracic pacemaker ready to be connected. The nurse knows that a transthoracic pacemaker is a temporary pacemaker used in what situation?
- A. Transthoracic pacemakers are used in a client who has had open heart surgery.
- B. Transthoracic pacemakers are used when a client has an MI.
- C. Transthoracic pacemakers are used after a coronary bypass graft surgery.
- D. Transthoracic pacemakers are used for tachyarrhythmias.
Correct Answer: A
Rationale: The leads of a transthoracic pacemaker are inserted during open heart surgery. They extend from the chest incision. If the client requires cardiac pacing during postoperative recovery, the leads are connected to a temporary pacing unit.
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The nurse is caring for a client with an arrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the arrhythmia to be which of the following?
- A. Peripheral vascular disease
- B. Ischemic heart disease
- C. Aortic stenosis
- D. Atherosclerotic heart disease
Correct Answer: B
Rationale: The nurse realizes that the most common cause of arrhythmias is ischemic heart disease. When the heart does not obtain sufficient blood to meet demands, the heart works harder to circulate body fluids and becomes inefficient in the process. Problems with the peripheral vessels, narrowing of the aorta and plaque build-up in the vessels may be a component of the disease process but not the best answer.
The nurse enters the client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?
- A. IV lidocaine
- B. Chemical cardioversion
- C. Immediate defibrillation
- D. Electric cardioversion
Correct Answer: C
Rationale: Defibrillation is used during pulseless ventricular tachycardia and ventricular fibrillation.
The nursing student is taking a pre-nursing pharmacology class. Today, the nursing student is learning about antiarrhythmic drugs. What drug is a potassium channel blocker?
- A. Amiodarone
- B. Lidocaine
- C. Flecainide
- D. Isoproterenol
Correct Answer: A
Rationale: Potassium channel blockers include amiodarone and bretylium tosylate. Lidocaine and flecainide are sodium channel blockers. Isoproterenol is a beta-blocker.
The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor of the client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record?
- A. Bigeminy
- B. Couplets
- C. Multifocal PVCs
- D. R-on-T phenomenon
Correct Answer: A
Rationale: The nurse is correct to note bigeminy on the permanent record when every other beat is a PVC. Couplets are two PVCs in a row. Multifocal PVCs originate from more than one location. R-on-T phenomenon occurs when the R wave falls on the T wave.
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.