Nokea
Which of the following actions should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg?
- A. Turn the synchronizer switch to the 'off' position.
- B. Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position.
- C. Set the defibrillator/cardioverter energy to 300 J.
- D. Administer a sedative before cardioversion is implemented.
Correct Answer: D
Rationale: When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). CPR is not indicated for this patient.
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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 is caring for a young adult patient who had a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54 mm Hg, and the student denies any health problems. Which of the following actions by the nurse is best?
- A. Allow the student to participate on the swim team.
- B. Refer the student to a cardiologist for further assessment.
- C. Obtain more detailed information about the student's health history.
- D. Tell the student to stop swimming immediately if any dyspnea occurs.
Correct Answer: A
Rationale: In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the health history. Dyspnea during an aerobic activity such as swimming is normal.
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.
Which of the following laboratory results for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?
- A. Blood glucose 12.8 mmol/L
- B. Serum chloride 90 mmol/L
- C. Serum sodium 133 mmol/L
- D. Serum potassium 2.8 mmol/L
Correct Answer: D
Rationale: Electrolyte imbalances increase the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation; the health care provider will need to prescribe a potassium infusion to correct this hypokalemia. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the patient's PVCs and do not require immediate correction.
The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis. P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. Which of the following cardiac rhythms should the nurse interpret from these findings?
- A. Atrial fibrillation
- B. Sinus tachycardia
- C. Ventricular fibrillation
- D. Ventricular tachycardia
Correct Answer: D
Rationale: The absence of P waves, wide QRS, rate >150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.