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The nurse is instructing on home care after placement of an implanted cardioverter defibrillator (ICD). Which statement, made by the client, needs clarification by the nurse?
- A. I need to notify my cardiologist if I feel frequent kicks to the chest.
- B. I can continue to work with my power tools.
- C. I need to stay away from microwaves.
- D. I should opt for a hand search at the airport instead of metal detector scan.
Correct Answer: C
Rationale: Similar to hand tools, microwaves have shields or are grounded, making them safe for clients with ICDs. There is no restriction from microwave use. All of the other options are correct.
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The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor of the client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record?
- A. Bigeminy
- B. Couplets
- C. Multifocal PVCs
- D. R-on-T phenomenon
Correct Answer: A
Rationale: The nurse is correct to note bigeminy on the permanent record when every other beat is a PVC. Couplets are two PVCs in a row. Multifocal PVCs originate from more than one location. R-on-T phenomenon occurs when the R wave falls on the T wave.
Which of the following does the nurse recognize as the therapeutic goal of radiofrequency catheter ablation for a client with cardiac arrhythmias?
- A. Reperfusion of ischemic heart tissue
- B. Dilation of arterial blood vessels
- C. Destruction of errant tissue
- D. Stimulation of the impulse center
Correct Answer: C
Rationale: The therapeutic goal of radiofrequency catheter ablation is to destroy errant tissue, in hopes of allowing impulse conduction to travel over appropriate pathways. The goal does not include dilation of blood vessels or reperfusion of heart tissue. There is no stimulation of the heart.
The client has returned to the floor with a transthoracic pacemaker ready to be connected. The nurse knows that a transthoracic pacemaker is a temporary pacemaker used in what situation?
- A. Transthoracic pacemakers are used in a client who has had open heart surgery.
- B. Transthoracic pacemakers are used when a client has an MI.
- C. Transthoracic pacemakers are used after a coronary bypass graft surgery.
- D. Transthoracic pacemakers are used for tachyarrhythmias.
Correct Answer: A
Rationale: The leads of a transthoracic pacemaker are inserted during open heart surgery. They extend from the chest incision. If the client requires cardiac pacing during postoperative recovery, the leads are connected to a temporary pacing unit.
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?
- A. Diuretic
- B. Anticoagulant
- C. Antihypertensive
- D. Potassium supplement
Correct Answer: B
Rationale: Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation. The other options may be prescribed but not expected in most situations.
The client has just been diagnosed with a arrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm?
- A. Heart rate between 60 and 150 beats/minute.
- B. Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 second.
- C. The ventricles depolarize in 0.5 second or less.
- D. The sinoatrial (SA) node initiates the impulse.
Correct Answer: D
Rationale: The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats/minute, the SA node initiates the impulse, the impulse travels to the AV node in 0.12 to 0.2 second, the ventricles depolarize in 0.12 seconds or less, and each impulse occurs regularly.