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The nurse is caring for a patient who has had an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. How should the nurse best respond?
- A. Recognize that the view of the electrical current changes in relation to the lead placement.
- B. Recognize that the electrophysiological conduction of the heart differs with lead placement.
- C. Inform the technician that the ECG equipment has malfunctioned.
- D. Inform the physician that the patient is experiencing a new onset of dysrhythmia.
Correct Answer: A
Rationale: Each lead offers a different reference point to view the electrical activity of the heart. The lead displays the configuration of electrical activity of the heart. Differences between leads are not necessarily attributable to equipment malfunction or dysrhythmias.
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During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructors best response?
- A. Cardioversion is done on a beating heart; defibrillation is not.
- B. The difference is the timing of the delivery of the electric current.
- C. Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not.
- D. Cardioversion is always attempted before defibrillation because it has fewer risks.
Correct Answer: B
Rationale: One major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current is synchronized with the patients electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized. Both can be done on a beating heart (i.e., in a dysrhythmia). Cardioversion is not necessarily attempted first.
During a patients care conference, the team is discussing whether the patient is a candidate for cardiac conduction surgery. What would be the most important criterion for a patient to have this surgery?
- A. Angina pectoris not responsive to other treatments
- B. Decreased activity tolerance related to decreased cardiac output
- C. Atrial and ventricular tachycardias not responsive to other treatments
- D. Ventricular fibrillation not responsive to other treatments
Correct Answer: C
Rationale: Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing. Angina, reduced activity tolerance, and ventricular fibrillation are not criteria.
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 writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient?
- A. Maintain a resting heart rate below 70 bpm.
- B. Maintain adequate control of chest pain.
- C. Maintain adequate cardiac output.
- D. Maintain normal cardiac structure.
Correct Answer: C
Rationale: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
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.