The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patient's heart?
A)
P wave
B)
T wave
C)
U
... [Show More] wave
D)
QRS complex
Ans: T wave
Feedback:
The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG?
A)
P wave
B)
T wave
C)
QRS complex
D)
U wave
Ans: QRS complex
Feedback:
The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
A)
PP interval and RR interval are irregular.
B)
PP interval is equal to RR interval.
C)
Fewer QRS complexes than P waves
D)
PR interval is constant.
Ans: Fewer QRS complexes than P waves
Feedback:
In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis.
The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient?
A)
Maintain a resting heart rate below 70 bpm.
B)
Maintain adequate control of chest pain.
C)
Maintain adequate cardiac output.
D)
Maintain normal cardiac structure.
Ans: Maintain adequate cardiac output.
Feedback:
For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
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The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do?
A)
Maintain firm contact between paddles and patient skin.
B)
Apply a layer of water as a conducting agent.
C)
Call "all clear" once before discharging the defibrillator.
D)
Ensure the defibrillator is in the sync mode.
Ans: Maintain firm contact between paddles and patient skin.
Feedback:
When defibrillating an adult patient, the nurse should maintain good contact between the paddles and the patient's skin to prevent arcing, apply an appropriate conducting agent (not water) between the skin and the paddles, and ensure the defibrillator is in the nonsync mode. "Clear" should be called three times before discharging the paddles.
A patient who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response?
A)
"To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia"
B)
"To detect and treat bradycardia, which is an excessively slow heart rate"
C)
"To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently"
D)
"To shock your heart if you have a heart attack at home"
Ans: "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia"
Feedback:
The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia.
The nurse is caring for a patient who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment?
A)
Assessing the patient's activity level
B)
Facilitating transthoracic echocardiography
C)
Vigilant monitoring of the patient's ECG
D)
Close monitoring of the patient's peripheral perfusion
Ans: Vigilant monitoring of the patient's ECG
Feedback:
After a permanent electronic device (pacemaker or ICD) is inserted, the patient's heart rate and rhythm are monitored by ECG. This is a priority over peripheral circulation and activity. Echocardiography is not indicated.
During a patient's care conference, the team is discussing whether the patient is a candidate for cardiac conduction surgery. What would be the most important criterion for a patient to have this surgery?
A)
Angina pectoris not responsive to other treatments
B)
Decreased activity tolerance related to decreased cardiac output
C)
Atrial and ventricular tachycardias not responsive to other treatments
D)
Ventricular fibrillation not responsive to other treatments
Ans: Atrial and ventricular tachycardias not responsive to other treatments
Feedback:
Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing. Angina, reduced activity tolerance, and ventricular fibrillation are not criteria.
A nurse is caring for a patient who is exhibiting ventricular tachycardia (VT). Because the patient is pulseless, the nurse should prepare for what intervention?
A)
Defibrillation
B)
ECG monitoring
C)
Implantation of a cardioverter defibrillator
D)
Angioplasty
Ans: Defibrillation
Feedback:
Any type of VT in a patient who is unconscious and without a pulse is treated in the same manner as ventricular fibrillation: Immediate defibrillation is the action of choice. ECG monitoring is appropriate, but this is an assessment, not an intervention, and will not resolve the problem. An ICD and angioplasty do not address the dysrhythmia.
A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the main goal of treatment is what?
treatment is what?
A)
Decrease SA node conduction
B)
Control ventricular heart rate
C)
Improve oxygenation
D)
Maintain anticoagulation
Ans: Control ventricular heart rate
Feedback:
Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. This is a priority because it directly affects cardiac output. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice, followed by anticoagulation with heparin and then Coumadin.
The nurse and the other members of the team are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated unsuccessfully and the patient remains in VF. According to national standards, the nurse should anticipate the administration of what medication? "type answer"
treatment is what?
A)
administer Epinephrine 1 mg IV push
B)
Control ventricular heart rate
C)
Improve oxygenation
D)
Maintain anticoagulation
Ans: Epinephrine 1 mg IV push
Feedback:
Epinephrine should be administered as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and licocaine are given if ventricular dysrhythmia persists.
The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient?
A)
Start lifting the arm above the shoulder right away to prevent chest wall adhesion.
B)
Avoid cooking with a microwave oven.
C)
Avoid exposure to high-voltage electrical generators.
D)
Avoid walking through store and library antitheft devices.
Ans: Avoid exposure to high-voltage electrical generators.
Feedback:
High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function.
A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine?
A)
Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
B)
Administer atropine as a continuous infusion until symptoms resolve.
C)
Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours.
D)
Administer atropine 1.0 mg sublingually.
Ans: Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
Feedback:
Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement?
A)
Clean the skin with providone-iodine solution.
B)
Ensure that the area for electrode placement is dry.
C)
Apply tincture of benzoin to the electrode sites and wait for it to become "tacky."
D)
Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
Ans: Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
Feedback:
An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. Disinfecting the skin is unnecessary and conduction gel is used.
The nurse is caring for a patient who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment?
A)
Cardiac monitoring
B)
Monitoring the implanted device signal
C)
Pain assessment
D)
Monitoring the patient's level of consciousness (LOC)
Ans: Cardiac monitoring
Feedback:
Following catheter ablation therapy, the patient is closely monitored to ensure the dysrhythmia does not reemerge. This is a priority over monitoring of LOC and pain, although these are valid and important assessments. Ablation does not involve the implantation of a device.
The ED nurse is caring for a patient who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform?
A)
Place gel pads over the apex and posterior chest for better conduction.
B)
Ensure no one is touching the patient at the time shock is delivered.
C)
Continue to ventilate the patient via endotracheal tube during the procedure.
D)
Allow at least 3 minutes between shocks.
Ans: Ensure no one is touching the patient at the time shock is delivered.
Feedback:
In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads, or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patient's skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation.
A group of nurses are participating in orientation to a telemetry unit. What should the staff educator tell this class about ST segments?
A)
They are the part of an ECG that reflects systole.
B)
They are the part of an ECG used to calculate ventricular rate and rhythm.
C)
They are the part of an ECG that reflects the time from ventricular depolarization through repolarization.
D)
They are the part of an ECG that represents early ventricular repolarization.
Ans: They are the part of an ECG that represents early ventricular repolarization.
Feedback:
ST segment is the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave. The part of an ECG that reflects repolarization of the ventricles is the T wave. The part of an ECG used to calculate ventricular rate and rhythm is the RR interval. The part of an ECG that reflects the time from ventricular depolarization through repolarization is the QT interval. [Show Less]