Nokea
The nurse is providing instruction to a patient on the management of a new implantable cardioverter-defibrillator (ICD). Which of the following patient statements indicate that the teaching has been effective?
- A. It will be 6 weeks before I can take a bath or return to my usual activities.
- B. I will notify the airlines when I make a reservation that I have a pacemaker.
- C. I won't lift the arm on the pacemaker side up very high until I see the doctor.
- D. I must avoid cooking with a microwave oven or being near a microwave in use.
Correct Answer: C
Rationale: The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period.
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The nurse is caring for a patient who was admitted with a myocardial infarction and experiences a 50-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next?
- A. Notify the health care provider.
- B. Perform synchronized cardioversion.
- C. Administer the PRN IV lidocaine.
- D. Document the rhythm and monitor the patient.
Correct Answer: C
Rationale: The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes and accelerate repolarization. The nurse should notify the health care provider after the medications are administered. Defibrillation is not indicated given that the patient is currently in a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.
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.
The nurse is caring for a patient who has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the P-R interval is 0.24 seconds. Which of the following actions should the nurse implement?
- A. Notify the patient's health care provider immediately.
- B. Administer atropine per agency bradycardia protocol.
- C. Prepare the patient for temporary pacemaker insertion.
- D. Document the finding and continue to monitor the patient.
Correct Answer: D
Rationale: First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.
The nurse is analyzing an electrocardiogram rhythm strip of a patient with a regular cardiac rhythm and finds there are 25 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as beats per minute.
Correct Answer: 60
Rationale: There are 1500 small blocks in a minute, and the nurse will divide 1500 by 25 to calculate the heart rate, resulting in 60 beats per minute.
The nurse is caring for a patient who has a ST segment change that indicates an acute inferior wall myocardial infarction. Which of the following leads is best for monitoring the patient?
- A. I
- B. II
- C. V6
- D. MCL1
Correct Answer: B
Rationale: Lead II reflects the inferior area of the heart that is experiencing the ST segment changes and will best reflect any electrocardiographic changes that indicate further damage to the myocardium. The other leads do not reflect the inferior part of the myocardial wall and will not provide data about further ischemic changes.