Nokea
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first?
- A. Sustained asystole
- B. Supraventricular tachycardia
- C. Atrial fibrillation
- D. Ventricular fibrillation
Correct Answer: D
Rationale: Ventricular fibrillation is called the rhythm of a dying heart. It is the rhythm that needs attention first because there is no cardiac output, and it is an indication for CPR and immediate defibrillation. Sustained asystole either is from death, or the client is off of the cardiac monitor. Supraventricular tachycardia and atrial fibrillation are monitored and reported to the physician but not addressed first.
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The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation?
- A. It is a scheduled procedure 1 to 10 days in advance.
- B. The client is sedated before the procedure.
- C. It is used to eliminate ventricular arrhythmias.
- D. It uses less electrical energy than cardioversion.
Correct Answer: C
Rationale: The only treatment for a life-threatening ventricular arrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion.
The client has just been admitted with bradycardia and scheduled for the insertion of a pacemaker. The nurse notifies the physician that the client's heart rate has dropped into the 40 beats/minute range. The physician orders a temporary pacemaker. The nurse knows that there are different types of temporary pacemakers. What types of temporary pacemakers are there? Select all that apply.
- A. Transatrial
- B. Transcutaneous
- C. Transvenous
- D. Transthoracic
- E. Transabdominal
Correct Answer: B,C,D
Rationale: The three types of temporary pacemakers are transcutaneous, transvenous, and transthoracic. Transatrial and transabdominal are not types of temporary pacemakers.
The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button?
- A. Placing gel on the chest
- B. Checking the ECG rhythm
- C. Shouting, 'All clear'
- D. Stating, 'Charging'
Correct Answer: C
Rationale: Preceding pressing the discharge button, the nurse shouts 'All clear' to ensure that no one is in contact with the client. The other options are correct but not the nursing action immediately preceding.
The nurse knows that a pacemaker is the treatment of choice for what cardiac arrhythmia?
- A. Supraventricular tachycardia
- B. Atrial flutter
- C. Ventricular fibrillation
- D. Complete heart block
Correct Answer: D
Rationale: Pacemaker insertion is the treatment for complete heart block. Treatments for supraventricular tachycardia are: Valsalva maneuver, unilateral carotid massage, immersion of face in ice water, administration of IV adenosine, cardioversion, and radiofrequency ablation. Cardioversion and drug therapy are used for the treatment of atrial flutter. Treatment for ventricular fibrillation is defibrillation preceded by or followed with epinephrine.
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.