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The nurse is caring for a patient who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output?
- A. Increased blood pressure
- B. Bounding peripheral pulses
- C. Changes in level of consciousness
- D. Skin flushing
Correct Answer: C
Rationale: The nurse conducts a physical assessment to confirm the data obtained from the history and to observe for signs of diminished cardiac output (CO) during the dysrhythmic event, especially changes in level of consciousness. Blood pressure tends to decrease with lowered CO and bounding peripheral pulses are inconsistent with this problem. Pallor, not skin flushing, is expected.
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A patient is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurses responsibility in the care of the patients pacemaker?
- A. Monitoring for pacemaker malfunction or battery failure
- B. Determining when it is appropriate to remove the pacemaker
- C. Making necessary changes to the pacemaker settings
- D. Selecting alternatives to future pacemaker use
Correct Answer: A
Rationale: Monitoring for pacemaker malfunctioning and battery failure is a nursing responsibility. The other listed actions are physician responsibilities.
The ED nurse is caring for a patient who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform?
- A. Place gel pads over the apex and posterior chest for better conduction.
- B. Ensure no one is touching the patient at the time shock is delivered.
- C. Continue to ventilate the patient via endotracheal tube during the procedure.
- D. Allow at least 3 minutes between shocks.
Correct Answer: B
Rationale: In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patients skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation.
The nurse is providing care to a patient who has just undergone an electrophysiologic (EP) study. The patient states that she is nervous about things going wrong during the procedure. What is the nurses best response?
- A. This is basically a risk-free procedure.
- B. Thousands of patients undergo EP every year.
- C. Remember that this is a step that will bring you closer to enjoying good health.
- D. The whole team will be monitoring you very closely for the entire procedure.
Correct Answer: D
Rationale: Patients who are to undergo an EP study may be anxious about the procedure and its outcome. A detailed discussion involving the patient, the family, and the electrophysiologist usually occurs to ensure that the patient can give informed consent and to reduce the patients anxiety about the procedure. It is inaccurate to state that EP is risk-free and stating that it is common does not necessarily relieve the patients anxiety. Characterizing EP as a step toward good health does not directly address the patients anxiety.
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.
The staff educator is teaching a CPR class. Which of the following aspects of defibrillation should the educator stress to the class?
- A. Apply the paddles directly to the patients skin.
- B. Use a conducting medium between the paddles and the skin.
- C. Always use a petroleum-based gel between the paddles and the skin.
- D. Any available liquid can be used between the paddles and the skin.
Correct Answer: B
Rationale: Use multifunction conductor pads or paddles with a conducting medium between the paddles and the skin (the conducting medium is available as a sheet, gel, or paste). Do not use gels or pastes with poor electrical conductivity.