Nokea
The nurse administers IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block. Which of the following findings indicate that the medication has been effective?
- A. Increase in the patient's heart rate
- B. Decrease in premature contractions
- C. Increase in peripheral pulse volume
- D. Decrease in ventricular ectopic beats
Correct Answer: A
Rationale: Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The patient does not have ventricular ectopy or premature contractions.
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The nurse is caring for a patient who has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the P-R interval is 0.24 seconds. Which of the following actions should the nurse implement?
- A. Notify the patient's health care provider immediately.
- B. Administer atropine per agency bradycardia protocol.
- C. Prepare the patient for temporary pacemaker insertion.
- D. Document the finding and continue to monitor the patient.
Correct Answer: D
Rationale: First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.
The nurse is caring for a patient whose cardiac monitor shows sinus rhythm, rate 60-70. The P-R interval is 0.18 seconds at 1:00 A.M., 0.20 seconds at 2:30 P.M., and 0.23 seconds at 4:00 P.M. Which of the following actions should the nurse take at this time?
- A. Prepare for possible temporary pacemaker insertion.
- B. Administer atropine sulphate 1 mg IV per agency protocol.
- C. Document the patient's rhythm and assess the patient's response to the rhythm.
- D. Hold the dose of metoprolol and call the health care provider.
Correct Answer: D
Rationale: The patient has progressive first-degree atrioventricular (AV) block, and the β-blocker should be held until discussing the medication with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic, and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic.
The nurse has received change-of-shift report about the following patients on the telemetry unit. Which of the following patients should the nurse see first?
- A. A patient with atrial fibrillation, rate 88, who has a new order for warfarin
- B. A patient with type 1 second-degree atrioventricular (AV) block, rate 60, who is dizzy when ambulating
- C. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago
- D. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone due
Correct Answer: D
Rationale: The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.
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 caring for a patient with dilated cardiomyopathy who has an atrial fibrillation that has been unresponsive to drug therapy for several days. Which of the following actions should the nurse anticipate?
- A. Electrical cardioversion
- B. IV adenosine
- C. Anticoagulant therapy with warfarin
- D. Insertion of an implantable cardioverter-defibrillator
Correct Answer: C
Rationale: Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion; this is done to prevent embolization of clots from the atria. Adenosine is not used to treat atrial fibrillation. Cardioversion may be done after several weeks of warfarin therapy. ICDs are used for patients with recurrent ventricular fibrillation.