Nokea
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.
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A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient?
- A. Chest pain
- B. Bleeding at the implantation site
- C. Malignant hyperthermia
- D. Bradycardia
Correct Answer: B
Rationale: Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.
A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine?
- A. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
- B. Administer atropine as a continuous infusion until symptoms resolve.
- C. Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours.
- D. Administer atropine 1.0 mg sublingually.
Correct Answer: A
Rationale: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.
The nurse is caring for a patient who is in the recovery room following the implantation of an ICD. The patient has developed ventricular tachycardia (VT). What should the nurse assess and document?
- A. ECG to compare time of onset of VT and onset of devices shock
- B. ECG so physician can see what type of dysrhythmia the patient has
- C. Patients level of consciousness (LOC) at the time of the dysrhythmia
- D. Patients activity at time of dysrhythmia
Correct Answer: A
Rationale: If the patient has an ICD implanted and develops VT or ventricular fibrillation, the ECG should be recorded to note the time between the onset of the dysrhythmia and the onset of the devices shock or antitachycardia pacing. This is a priority over LOC or activity at the time of onset.
During a patients care conference, the team is discussing whether the patient is a candidate for cardiac conduction surgery. What would be the most important criterion for a patient to have this surgery?
- A. Angina pectoris not responsive to other treatments
- B. Decreased activity tolerance related to decreased cardiac output
- C. Atrial and ventricular tachycardias not responsive to other treatments
- D. Ventricular fibrillation not responsive to other treatments
Correct Answer: C
Rationale: Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing. Angina, reduced activity tolerance, and ventricular fibrillation are not criteria.
The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient?
- A. Maintain a resting heart rate below 70 bpm.
- B. Maintain adequate control of chest pain.
- C. Maintain adequate cardiac output.
- D. Maintain normal cardiac structure.
Correct Answer: C
Rationale: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.