Nokea
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.
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A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?
- A. Asystole
- B. Premature ventricular contraction
- C. Atrial flutter
- D. Ventricular fibrillation
Correct Answer: C
Rationale: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.
The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?
- A. A suction machine
- B. A defibrillator
- C. Cardioversion equipment
- D. An ECG machine
Correct Answer: B
Rationale: The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular arrhythmias are at a high risk for fatal heart arrhythmia and death. A suction machine is used to remove respiratory secretions. Cardioversion is used in a planned setting for atrial arrhythmias. An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed.
Which diagnostic study best evaluates different medications' ability to restore normal heart rhythm?
- A. Elective electrical cardioversion
- B. Electrocardiogram (ECG)
- C. Electrophysiology study
- D. Echocardiogram
Correct Answer: C
Rationale: An electrophysiology study is a procedure that enables the physician to examine the electrical activity of the heart, produce actual arrhythmias, and determine the best method for care. Cardioversion uses synchronized electricity to change the rhythm pattern. Electrocardiogram and echocardiograms provide diagnostic information.
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.
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.