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The nurse is caring for a patient on telemetry. The patients ECG shows a shortened PR interval, slurring of the initial QRS deflection, and prolonged QRS duration. What does this ECG show?
- A. Sinus bradycardia
- B. Myocardial infarction
- C. Lupus-like syndrome
- D. Wolf-Parkinson-White (WPW) syndrome
Correct Answer: D
Rationale: In WPW syndrome there is a shortened PR interval, slurring (called a delta wave) of the initial QRS deflection, and prolonged QRS duration. These characteristics are not typical of the other listed cardiac anomalies.
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The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patients heart?
- A. P wave
- B. T wave
- C. U wave
- D. QRS complex
Correct Answer: B
Rationale: The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do?
- A. Maintain firm contact between paddles and patient skin.
- B. Apply a layer of water as a conducting agent.
- C. Call all clear once before discharging the defibrillator.
- D. Ensure the defibrillator is in the sync mode.
Correct Answer: A
Rationale: When defibrillating an adult patient, the nurse should maintain good contact between the paddles and the patients skin to prevent arcing, apply an appropriate conducting agent (not water) between the skin and the paddles, and ensure the defibrillator is in the nonsync mode. Clear should be called three times before discharging the paddles.
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.
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.
The nurse is caring for a patient with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the patients most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best respond to this finding?
- A. Recognize that the procedure was unsuccessful.
- B. Recognize this as a therapeutic goal of the procedure.
- C. Liaise with the care team in preparation for repeating the maze procedure.
- D. Prepare the patient for pacemaker implantation.
Correct Answer: B
Rationale: The maze procedure is an open heart surgical procedure for refractory atrial fibrillation. Small transmural incisions are made throughout the atria. The resulting formation of scar tissue prevents reentry conduction of the electrical impulse. Consequently, scar formation would constitute a successful procedure. There is no indication for repeating the procedure or implanting a pacemaker.