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The nurse is providing instruction to a group of new nurses orienting on the unit, highlighting the benefits of the implantable cardioverter defibrillator (ICD). While pointing at a diagram of the heart, at which location would the nurse identify the placement of the electrical lead?
- A. On the right atrium near the SA node
- B. In the right ventricle near the septum
- C. At the left atrium on the anterior wall
- D. On the left ventricle on the posterior wall
Correct Answer: B
Rationale: The nurse is correct to explain that an ICD consists of a generator with a battery and one or two electrical leads that resemble a wire. The generator is placed under the skin, and the lead wire is inserted transvenously through the subclavian or cephalic vein to the apex or septum of the right ventricle. The other options are incorrect.
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The nurse and student nurse are observing a cardioversion procedure. The nurse is correct to tell the student that electrical current will be initiated at which time?
- A. During stimulation of the SA node
- B. During repolarization of the heart
- C. During ventricular depolarization
- D. During the contraction phase
Correct Answer: C
Rationale: The electrical current is initiated at the R wave when ventricular depolarization occurs. The electrical current completely depolarizes the entire myocardium with the goal of restoring the normal pacemaker of the heart.
The nurse is caring for a client with an arrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the arrhythmia to be which of the following?
- A. Peripheral vascular disease
- B. Ischemic heart disease
- C. Aortic stenosis
- D. Atherosclerotic heart disease
Correct Answer: B
Rationale: The nurse realizes that the most common cause of arrhythmias is ischemic heart disease. When the heart does not obtain sufficient blood to meet demands, the heart works harder to circulate body fluids and becomes inefficient in the process. Problems with the peripheral vessels, narrowing of the aorta and plaque build-up in the vessels may be a component of the disease process but not the best answer.
For which client does the nurse anticipate cardioversion as a possible medical treatment?
- A. A new myocardial infarction client
- B. A client with poor kidney perfusion
- C. A client with third-degree heart block
- D. A client with atrial arrhythmias
Correct Answer: D
Rationale: The nurse is correct to identify a client with atrial arrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker.
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.
The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the arrhythmia?
- A. Defibrillation
- B. Maze procedure
- C. Pacemaker implantation
- D. Elective cardioversion
Correct Answer: D
Rationale: Atrial fibrillation is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. Maze procedures are used for clients who are not candidates for cardio diversion; these procedures use scar-forming techniques to eliminate rapid firing of ectopic pacemaker sites, thus restoring the normal conduction pathways in the atria. A Maze procedure might be considered for this client only after determining ineligibility for cardiodiversion. Pacemakers are implanted for bradycardia.