Nokea
The nurse is caring for a patient with dilated cardiomyopathy who has an atrial fibrillation that has been unresponsive to drug therapy for several days. Which of the following actions should the nurse anticipate?
- A. Electrical cardioversion
- B. IV adenosine
- C. Anticoagulant therapy with warfarin
- D. Insertion of an implantable cardioverter-defibrillator
Correct Answer: C
Rationale: Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion; this is done to prevent embolization of clots from the atria. Adenosine is not used to treat atrial fibrillation. Cardioversion may be done after several weeks of warfarin therapy. ICDs are used for patients with recurrent ventricular fibrillation.
You may also like to solve these questions
The nurse is caring for a patient who has been experiencing dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic tracing. Which of the following cardiac rhythms should the nurse identify?
- A. Sinus rhythm with premature ventricular contractions (PVCs)
- B. Junctional escape rhythm
- C. Third-degree atrioventricular (AV) block
- D. Sinus rhythm with premature atrial contractions (PACs)
Correct Answer: C
Rationale: The inconsistency between the atrial and ventricular rates and the variable P-R interval indicate that the rhythm is third-degree AV block. Sinus rhythm with PACs or PVCs will have a normal rate and consistent P-R intervals with occasional PACs or PVCs. A junctional escape rhythm will not have P waves.
The nurse is caring for a young adult patient who had a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54 mm Hg, and the student denies any health problems. Which of the following actions by the nurse is best?
- A. Allow the student to participate on the swim team.
- B. Refer the student to a cardiologist for further assessment.
- C. Obtain more detailed information about the student's health history.
- D. Tell the student to stop swimming immediately if any dyspnea occurs.
Correct Answer: A
Rationale: In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the health history. Dyspnea during an aerobic activity such as swimming is normal.
The nurse needs to estimate quickly the heart rate for a patient with a regular heart rhythm. Which of the following methods is best to use?
- A. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes
- B. Count the number of large squares in the R-R interval and divide by 100.
- C. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
- D. Calculate the number of small squares between one QRS complex and the next and divide into 1500.
Correct Answer: C
Rationale: This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer.
The nurse is caring for a patient who is on the telemetry unit and develops atrial flutter, rate 150, with associated dyspnea and diaphoresis, with an oxygen saturation of 94%. Which of the following actions that are included in the hospital dysrhythmia protocol should the nurse take first?
- A. Obtain a 12-lead electrocardiogram (ECG).
- B. Give O2 via nasal cannula at 3-4 L/minute.
- C. Take the patient's blood pressure and respiratory rate.
- D. Notify the health care provider of the change in rhythm.
Correct Answer: B
Rationale: Since this patient has dyspnea in association with the new rhythm, the nurse's initial actions should be to ensure a patent airway and oxygen administration. The other actions also are important and should be implemented rapidly.
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.