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The nurse is caring for a patient who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurses assessment?
- A. Assessing the patients activity level
- B. Facilitating transthoracic echocardiography
- C. Vigilant monitoring of the patients ECG
- D. Close monitoring of the patients peripheral perfusion
Correct Answer: C
Rationale: After a permanent electronic device (pacemaker or ICD) is inserted, the patients heart rate and rhythm are monitored by ECG. This is a priority over peripheral circulation and activity. Echocardiography is not indicated.
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The nurse is caring for a patient who has just undergone catheter ablation therapy. The nurse in the stepdown unit should prioritize what assessment?
- A. Cardiac monitoring
- B. Monitoring the implanted device signal
- C. Pain assessment
- D. Monitoring the patients level of consciousness (LOC)
Correct Answer: A
Rationale: Following catheter ablation therapy, the patient is closely monitored to ensure the dysrhythmia does not reemerge. This is a priority over monitoring of LOC and pain, although these are valid and important assessments. Ablation does not involve the implantation of a device.
The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient?
- A. Start lifting the arm above the shoulder right away to prevent chest wall adhesion.
- B. Avoid cooking with a microwave oven.
- C. Avoid exposure to high-voltage electrical generators.
- D. Avoid walking through store and library antitheft devices.
Correct Answer: C
Rationale: High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function.
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG?
- A. P wave
- B. T wave
- C. QRS complex
- D. U wave
Correct Answer: C
Rationale: The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.
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.
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.