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The nurse is caring for a patient who has had a biventricular pacemaker implanted. When planning the patients care, the nurse should recognize what goal of this intervention?
- A. Resynchronization
- B. Defibrillation
- C. Angioplasty
- D. Ablation
Correct Answer: A
Rationale: Biventricular (both ventricles) pacing, also called resynchronization therapy, may be used to treat advanced heart failure that does not respond to medication. This type of pacing therapy is not called defibrillation, angioplasty, or ablation therapy.
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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.
Following cardiac resuscitation, a patient has been placed in a state of mild hypothermia before being transferred to the cardiac intensive care unit. The nurses assessment reveals that the patient is experiencing neuromuscular paralysis. How should the nurse best respond?
- A. Administer hypertonic IV solution.
- B. Administer a bolus of warmed normal saline.
- C. Reassess the patient in 15 minutes.
- D. Document this as an expected assessment finding.
Correct Answer: D
Rationale: The nurse caring for a patient with hypothermia (passive or induced) needs to monitor for appropriate level of cooling, sedation, and neuromuscular paralysis to prevent seizures; myoclonus; and shivering. Neuromuscular paralysis is an expected finding and does not necessitate further interventions.
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.
A patient calls his cardiologists office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the patient to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what?
- A. Infection
- B. Failure to capture
- C. Premature battery depletion
- D. Oversensing of dysrhythmias
Correct Answer: D
Rationale: Inappropriate delivery of ICD therapy, usually due to oversensing of atrial and sinus tachycardias with a rapid ventricular rate response, is the most frequent complication of ICD. Infections, failure to capture, and premature battery failure are less common.
A cardiac care nurse is aware of factors that result in positive chronotropy. These factors would affect a patients cardiac function in what way?
- A. Exacerbating an existing dysrhythmia
- B. Initiating a new dysrhythmia
- C. Resolving ventricular tachycardia
- D. Increasing the heart rate
Correct Answer: D
Rationale: Stimulation of the sympathetic system increases heart rate. This phenomenon is known as positive chronotropy. It does not influence dysrhythmias.