Nokea
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.
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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 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.
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.
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated?
- A. The registered nurse stating to administer digoxin
- B. The registered nurse administering atropine sulfate intravenously
- C. The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute
- D. The registered nurse stating to administer all medications except those which are cardiotonics
Correct Answer: B
Rationale: The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.
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.