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The nurse is caring for a patient who develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and symptoms of feeling faint. Which of the following actions should the nurse take?
- A. Continue to monitor the rhythm and BP
- B. Apply the transcutaneous pacemaker (TCP).
- C. Have the patient perform the Valsalva manoeuvre.
- D. Give the scheduled dose of diltiazem.
Correct Answer: B
Rationale: The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva manoeuvre will further decrease the rate.
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Which of the following actions should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg?
- A. Turn the synchronizer switch to the 'off' position.
- B. Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position.
- C. Set the defibrillator/cardioverter energy to 300 J.
- D. Administer a sedative before cardioversion is implemented.
Correct Answer: D
Rationale: When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). CPR is not indicated for this patient.
The nurse is caring for a patient whose cardiac monitor shows sinus tachycardia, rate 102, and is apneic with no pulses palpable by the nurse. Which of the following actions should the nurse do first?
- A. Start CPR.
- B. Defibrillate.
- C. Administer atropine per hospital protocol.
- D. Give 100% oxygen per nonbreather mask.
Correct Answer: A
Rationale: The patient's clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.
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.
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 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.