Nokea
Which of the following information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response?
- A. The pacemaker prevents or minimizes ventricular irritability.
- B. The pacemaker paces the atria at rates up to 500 impulses/minute.
- C. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur.
- D. The pacemaker stimulates a heartbeat if the patient's heart rate drops too low.
Correct Answer: D
Rationale: The permanent pacemaker will discharge when the ventricular rate drops below the set rate. The pacemaker will not decrease ventricular irritability or discharge if the patient develops ventricular fibrillation. Since the patient has a slow ventricular rate, overdrive pacing will not be used.
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The nurse is caring for a patient who has been experiencing dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic tracing. Which of the following cardiac rhythms should the nurse identify?
- A. Sinus rhythm with premature ventricular contractions (PVCs)
- B. Junctional escape rhythm
- C. Third-degree atrioventricular (AV) block
- D. Sinus rhythm with premature atrial contractions (PACs)
Correct Answer: C
Rationale: The inconsistency between the atrial and ventricular rates and the variable P-R interval indicate that the rhythm is third-degree AV block. Sinus rhythm with PACs or PVCs will have a normal rate and consistent P-R intervals with occasional PACs or PVCs. A junctional escape rhythm will not have P waves.
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.
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.
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.
The nurse is caring for a patient in the emergency department who has symptoms of a 'racing' heart and nervousness. The nurse places the patient on a cardiac monitor and obtains the following electrocardiogram tracing. Which of the following actions should the nurse take next?
- A. Get ready to perform electrical cardioversion.
- B. Have the patient perform the Valsalva manoeuvre.
- C. Obtain the patient's blood pressure and oxygen saturation.
- D. Prepare to give β-blocker medication to slow the heart rate.
Correct Answer: C
Rationale: The patient has sinus tachycardia, which may have multiple etiologies such as pain, dehydration, anxiety, and myocardial ischemia; further assessment is needed before determining the treatment. Vagal stimulation or β-blockade may be used after further assessment of the patient. Electrical cardioversion is used for some tachydysrhythmias, but would not be used for sinus tachycardia.