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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.
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Which of the following actions by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs?
- A. The nurse assists the patient to do active range-of-motion exercises for all extremities.
- B. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet.
- C. The nurse gives atenolol to the patient without consulting first with the health care provider.
- D. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.
Correct Answer: A
Rationale: The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.
When analyzing the waveforms of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon assessing which of the following findings?
- A. T wave of 0.16 second
- B. P-R interval of 0.18 second
- C. Q-T interval of 0.34 second
- D. QRS interval of 0.14 second
Correct Answer: D
Rationale: Because the normal QRS interval is 0.04-0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval, Q-T interval, and T-wave interval are within the normal range.
The nurse is caring for a patient whose cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which of the following actions should the nurse take first?
- A. Defibrillate at maximum energy.
- B. Give O2 per bag-valve-mask.
- C. Give epinephrine (Adrenalin) IV.
- D. Prepare for endotracheal intubation.
Correct Answer: A
Rationale: The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, the other actions may be appropriate.
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 notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How should the nurse document the rhythm?
- A. Ventricular couplets
- B. Ventricular bigeminy
- C. Ventricular R-on-T phenomenon
- D. Ventricular multifocal contractions
Correct Answer: B
Rationale: Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as couplets. There is no indication that the premature ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.