Class 07- Perfusion- Dysrhythmias NCLEX

Class 07- Perfusion- Dysrhythmias NCLEX MurseRN Save Fundamentals Evolve 15 terms whitneyjweston Preview ATI Pharmacology Made Easy 5.0 ~ ...28 terms zain_amro4Preview NUR 223 Ch32 TPN 27 terms jkdellPreview UMC S 26 terms edo The following are indications for 12-lead ECG monitoring. (Select all that apply.) Evaluation of syncope Evaluation of metabolic disorders Evaluation of allergies Evaluation of pacemakers Evaluation of metabolic disorders Evaluation of syncope Evaluation of pacemakers Evaluation of metabolic disorders 12-Lead ECG monitoring is used for suspected acute coronary syndromes including myocardial infarction, evaluation of implanted defibrillators and pacemakers, disorders of the cardiac rhythm, evaluation of syncope, evaluation of metabolic disorders, effects and side effects of pharmacotherapy and evaluation of primary and secondary cardiomyopathic processes. An allergy to the adhesive is not an indication but a problem that needs to be addressed by using a different type of adhesive.

REF: p. 706

Proper skin preparation before ECG electrode placement is important for what reason?To make sure the adhesive sticks to the skin To reduce signal noise to improve recording To reduce skin breakdown when removing the electrodes To reduce the risk of infection To reduce signal noise to improve recording Proper skin preparation before ECG electrodes are placed decreases skin impedance and signal noise, thereby producing a clean, accurate recording.

Alarm fatigue is a serious problem in hospitals and occurs when? (Select all that apply.) Select all that apply.Nurses become desensitized to alarms.Nurses are exposed to an excessive number of alarms.Alarms are used incorrectly.Alarms limits are not used.Patients become tired of alarms.Nurses become desensitized to alarms.Nurses are exposed to an excessive number of alarms.Alarms are used incorrectly.Alarm fatigue develops when a person is exposed to an excessive number of alarms which can happen when patients without a need for alarms are monitored add to the burden. This situation can result in sensory overload, which may cause the person to become desensitized to the alarms. Consequently, the response to alarms may be delayed, or alarms may be missed altogether.

REF: p. 710

The nurse is applying a 12-lead ECG. Put the following steps in the correct order.1. Place patient in supine position.2. Apply chest leads.3. Apply extremity leads.4. Determine the indications for obtaining the ECG.5. Check the ECG machine for messages.6. Press button to obtain 12 lead.

1, 2, 3, 4, 6, 5

2, 1, 3, 4, 6, 5

4, 1, 2, 3, 5, 6

3, 2, 1, 4, 5, 6

4, 1, 2, 3, 5, 6

The steps are as documented.The nurse correctly delegates to the nursing assistive personnel (NAP) when she/he delegates the following: (Select all that apply.) Select all that apply.Obtain a 12-lead ECG on the patient.Deliver the 12-lead ECG to the health care provider.Tell me if the patient is having PVCs.Report to me any patient complaints of chest pain.Place the ECG leads in the correct place on the patient.Obtain a 12-lead ECG on the patient.Deliver the 12-lead ECG to the health care provider.Report to me any patient complaints of chest pain.Place the ECG leads in the correct place on the patient.The skill of obtaining an ECG can be delegated to nursing assistive personnel (NAP). The NAP is also instructed to deliver the report to the health care provider and to report any changes in patient conduction. The NAP cannot interpret the ECG.

When computing a heart rate from the electrocardiography (ECG) tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. What does the nurse calculate the patient’s heart rate to be?60 beats/min 75 beats/min 100 beats/min 150 beats/min 100 beats/min

Rationale:

Because each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15, in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100).Cardioversion is attempted for a patient with atrial flutter and a rapid ventricular response. After delivering 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take immediately?Administer 250 mL of 0.9% saline solution IV by rapid bolus.Assess the apical pulse, blood pressure, and bilateral neck vein distention.Turn the synchronizer switch to the “off” position and recharge the device.Ask the patient if there is any chest pain or discomfort and administer morphine sulfate.Turn the synchronizer switch to the “off” position and recharge the device.

Rationale:

Ventricular fibrillation produces no effective cardiac contractions or cardiac output. If during synchronized cardioversion the patient becomes pulseless or the rhythm deteriorates to ventricular fibrillation, the nurse should turn the synchronizer switch off and initiate defibrillation. Fluids, additional assessment, or treatment of pain alone will not restore an effective heart rhythm.The nurse determines there is artifact on the patient’s telemetry monitor. Which factor should the nurse assess for that could correct this issue?Disabled automaticity Electrodes in the wrong lead Too much hair under the electrodes Stimulation of the vagus nerve fibers Too much hair under the electrodes

Rationale:

Artifact is caused by muscle activity, electrical interference, or insecure leads and electrodes that could be caused by excessive chest wall hair.Disabled automaticity would cause an atrial dysrhythmia. Electrodes in the wrong lead will measure electricity in a different plane of the heart and may have a different wave form than expected. Stimulation of the vagus nerve fibers causes a decrease in heart rate, not artifact.The nurse performs discharge teaching for a patient with an implantable cardioverter-defibrillator (ICD). Which statement by the patient indicates that further teaching is needed?“The device may set off the metal detectors in an airport.” “My family needs to keep up to date on how to perform CPR.” “I should not stand next to antitheft devices at the exit of stores.” “I can expect redness and swelling of the incision site for a few days.” “I can expect redness and swelling of the incision site for a few days.”

Rationale:

Patients should be taught to report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever to their primary care providers immediately. Teach patients to inform TSA airport security of the presence of the ICD because it may set off metal detectors. If a handheld screening wand is used, it should not be placed directly over the ICD. Teach patients to avoid standing near antitheft devices in doorways of stores and public buildings and to walk through them at a normal pace. Caregivers should learn cardiopulmonary resuscitation.

Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the electrocardiogram

(ECG)?

The length of time it takes to depolarize the atrium.The length of time it takes for the atria to depolarize and repolarize.The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers.The length of time it takes for the electrical impulse to travel from the sinoatrial (SA) node to the atrioventricular (AV) node.The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers.

Rationale:

The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers in order for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium, causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and is not usually measured.The patient has atrial fibrillation with a rapid ventricular response. What electrical treatment option does the nurse prepare the patient for?Defibrillation Synchronized cardioversion Automatic external defibrillator (AED) Implantable cardioverter-defibrillator (ICD) Synchronized cardioversion

Rationale:

Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response).Defibrillation or AEDs are the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia (VT). An ICD is used with patients who have survived sudden cardiac death, have spontaneous sustained VT, and are at high risk for future life-threatening dysrhythmias.The nurse observes a flat line on the patient’s monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer?Lidocaine or amiodarone Digoxin and procainamide Epinephrine or vasopressin β-Adrenergic blockers and dopamine Epinephrine or vasopressin

Rationale:

Normally, the patient in asystole cannot be successfully resuscitated. However, administration of epinephrine or vasopressin may prompt the return of depolarization and ventricular contraction. Lidocaine and amiodarone are used for ventricular tachycardia or ventricular fibrillation.Digoxin and procainamide are used for ventricular rate control. β-Adrenergic blockers are used to slow heart rate, and dopamine is used to increase heart rate.