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Which of the following actions by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs?
- A. The nurse assists the patient to do active range-of-motion exercises for all extremities.
- B. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet.
- C. The nurse gives atenolol to the patient without consulting first with the health care provider.
- D. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.
Correct Answer: A
Rationale: The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.
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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.
The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How should the nurse document the rhythm?
- A. Ventricular couplets
- B. Ventricular bigeminy
- C. Ventricular R-on-T phenomenon
- D. Ventricular multifocal contractions
Correct Answer: B
Rationale: Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as couplets. There is no indication that the premature ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.
The nurse is caring for a patient who is on the telemetry unit and develops atrial flutter, rate 150, with associated dyspnea and diaphoresis, with an oxygen saturation of 94%. Which of the following actions that are included in the hospital dysrhythmia protocol should the nurse take first?
- A. Obtain a 12-lead electrocardiogram (ECG).
- B. Give O2 via nasal cannula at 3-4 L/minute.
- C. Take the patient's blood pressure and respiratory rate.
- D. Notify the health care provider of the change in rhythm.
Correct Answer: B
Rationale: Since this patient has dyspnea in association with the new rhythm, the nurse's initial actions should be to ensure a patent airway and oxygen administration. The other actions also are important and should be implemented rapidly.
The nurse has received change-of-shift report about the following patients on the telemetry unit. Which of the following patients should the nurse see first?
- A. A patient with atrial fibrillation, rate 88, who has a new order for warfarin
- B. A patient with type 1 second-degree atrioventricular (AV) block, rate 60, who is dizzy when ambulating
- C. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago
- D. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone due
Correct Answer: D
Rationale: The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.
When analyzing the waveforms of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon assessing which of the following findings?
- A. T wave of 0.16 second
- B. P-R interval of 0.18 second
- C. Q-T interval of 0.34 second
- D. QRS interval of 0.14 second
Correct Answer: D
Rationale: Because the normal QRS interval is 0.04-0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval, Q-T interval, and T-wave interval are within the normal range.