Health Management II Exam 1

Indications for antiplatelet drugs

- ischemic stroke - angina (stable & unstable) - coronary stenting - acute mi (chew 325 mg aspirin) - prevention of mi, 81 mg/day

What does acute alcohol toxicity cause?

- CNS depression, respiratory failure, F&E imbalances

Meds for Benzo Overdose

- IV flumazenil (Romazicon): reversal agennt, risk of seizures, and benzo withdrawal sxs - Activated charcoal: used for barbituates and other sedatives/hypnotics

Second-Degree AV Block Type II (Mobitz II heart block)

- P wave is nonconducted without progressive PR lengthening; usually occurs when a block in one of the bundle branches is present - Rate and Rhythm: atrial (usually normal and regular); ventricular (slower and regular or irregular) - P wave: more P waves than QRS complexes - PR interval: normal or prolonged but consistent for every QRS - QRS complex: widened QRS, preceded by >/ 2 P waves with nonconducted QRS complex - Clinical associations: rheumatic heart disease, cad, anterior mi, drug toxicity - Treatment: transcutaneous pacing or insertion of temporary pacemaker may be needed before permanent pacemaker

QRS Complex

- Q wave: first negative/downward deflection after the P waves, short and narrow, not present in several leads (<0.03 seconds) - R wave: first positive/upward deflection in the QRS complex - S wave: first negative/downward deflection after the R wave

Sinus Tachycardia

- Rate and Rhythm: 101-180 beats/min and regular - P wave: normal - PR interval: normal - QRS complex: normal - Clinical associations: exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, mi, hf, hyperthyroidism, anxiety, fear, drugs - Treatment: depends on the cause; pain management, iv beta blockers, adenosine, ccbs; synchronized cardioversion

Ventricular Tachycardia

- Rate and Rhythm: 150-250 beats/min and regular or irregular - P wave: not usually visible - PR interval: not measurable - QRS complex: wide and distorted - a run of 3 or more PVCs - ectopic focus or foci fire repeatedly and the ventricle takes control as the pacemaker - QRS configuration determines type: monomorphic, polymorphic, torsades de pointes - Clinical associations: mi, cad, electrolyte imbalance, cardiomyopathy, drug toxicity, cns disorder - Treatment: IV procainamide, lidocaine, amiodarone (monomorphic, clinically stable); IV magnesium, isoproteremnol, phenytoin, antitachycardia pacing (polymorphic); cardioversion

Accelerated Idioventricular Rhythm

- Rate and Rhythm: 40-100 beats/min and regular - P wave: not usually visible - PR interval: not measurable - QRS complex: wide and distorted - can develop when the SA node or AV node rate becomes less than that of a ventricular ectopic pacemaker - Clinical associations: acute mi and reperfusion of the myocardium after thrombolytic therapy or percutaneous coronary interventions - Treatment: temporary pacing;

Sinus Bradycardia

- Rate and Rhythm: < 60 beats/min and regular - P wave: normal - PR interval: normal - QRS complex: normal - Clinical associations: carotid sinus massage, valsalva manuever, hypothermia, increased iop, vagal stimulation, hypothyroidism, increased icp, inferior mi - Treatment: IV atropine; if ineffective, transcutaneous pacing or dopamine or epinephrine infusion; may need permanent pacemaker - symptomatic: d/t inadequate perfusion -> fatigue, dizziness, chest pain, syncope

Ventricular Fibrillation

- Rate and Rhythm: not measurable and irregular - P wave: absent - PR interval: not measurable - QRS complex: not measurable - severe derangement of the heart rhythm characterized on ecg by irregular waveforms of varying shapes and amplitude; firing of multiple ectopic foci in the ventricle - Clinical associations: acute mi, myocardial ischemia, hf, cardiomyopathy, electric shock, hyperkalemia, hypoxemia, acidosis, drug toxicity - Treatment: immediate cpr and acls with use of defibrillation and drug therpay (epinephrine, amiodarone)

Intrinsic Rates of the Conduction System

- SA node and atria: 60-100 times/min - AV node and bundle of His: 40-60 times/min - Bundle branches and Purkinje fibers: 20-40 times/min

Pleural Effusion

- abnormal collection of fluid in the pleural space - it is a sign of disease - accumulation d/t increased pulmonary capillary pressure, decreased oncotic pressure, increased pleural membrane permeability, or obstruction of lymphatic flow - sxs: dyspnea, cough, occasional sharp non-radiating chest pain that is worse on inhalatiojn - decreased movement of the chest of affected side, decreased breath sounds over affected area

Dysrhythmias

- abnormal heart rhythms

Hemothorax

- accumulation of blood in the pleural space from injury to the chest wall, diaphragm, lung, blood vessels or mediastinum - usually as a result of trauma - sxs: dyspnea, decreased or absent breath sounds, dullness to percussion, decreased hgb, shock - interventions: chest tube insertion with chest drainage system; autotransfusion of collected blood; treatment of hypovolemia as needed with iv fluid; pack rbcs

Paroxysmal Supraventricular Tachycardia (PSVT)

- also known as supraventricular tachycardia (SVT) or atrial tachycardia - dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His - Rate and Rhythm: 151-220 beats/min; regular or slightly irregular - P wave: abnormal shape, may be hidden in the preceding T wave - PR interval: shortened or normal - QRS complex: usually normal - Clinical associations: overexertion, emotional stress, deep inspiration, stimulants, rheumatic heart disease, digitalis toxicity, cad, cor pulmonale - Treatment: vagal stimulation (valsalva, carotid massage, coughing); IV adenosine; beta blockers, ccbs; synchronized cardioversion (if clinically unstable)

Thrombolytic drugs

- alteplase tissue plasminogen activator; tenecteplase & reteplase - clotblusters - remove thrombi that have already formed - uses: acute mi, pulmonary embolism, ischemic stroke

Heparins

- anticoagulants - inactivate thrombin and factor Xa in the coagulation cascade - low molecular wt heparins: enoxaparin (lovenox) & dalteparin (fragmin); sq - uses: evolving stroke, massive dvt & pe, acute mi - antidote: protamine sulfate

The 5 As (want to quit)

- ask - advise - assess - assist - arrange

Thoracentesis

- aspiration of intrapleural fluid for diagnostic and therapeutic purposes - needle is inserted into the intercostal space - fluid is aspirated with a syringe or tubing is connected to the needle to allow fluid to drain into a sterile container

Drugs that inhibit platelet aggregation

- aspirin - clopidogrel (plavix) - ticlopidine (ticlid) - (antiplatelet drugs) - most effective when use to prevent arterial thrombosis

Atrial Flutter

- atrial tachydysrhythmias identified by recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in the right atrium, or less often, the left atrium - Rate and Rhythm: atrial (200-350 beats/min and regular); ventricular (> or < 100 beats/min; may be regular and irregular) - P wave: flutter waves (saw-tooth pattern); more flutter waves than QRS complexes; may occur in 2:1, 3:1, 4:1 pattern; atrial flutter waves represent atrial depolarization followed by repol - PR interval: variable and not measurable - QRS complex: usually normal - Clinical associations: cad, htn, mitral valve disorders, pulmonary embolus, chronic lung disease, cor pulmonale, cardiomyopathym hyperthyroidism, drugs - Treatment: ccbs, beta blockers; electrical cardioversion; antidysrhythmic drugs (ibutilide, amiodarone, flecainide)

Pulmonary Embolism

- blockage of 1 or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue - the embolus travels with blood flow through ever-smaller blood vessels until it lodges and obstructs perfusion of the alveoli - most PEs arise from dvt in the deep veins of the legs - sxs: depends on type, size, extent of emboli; dyspnea, moderate hypoxemia, tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, accentuation of pulmonic heart sound, tachycardia, syncope - dx: D- dimer (lab that measures amount of cross-linked fibrin fragments, which result from clot degradation); CT scan to view pulmonary blood vessels

Pneumothorax

- caused by air entering the pleural cavity - partial or complete lung collapse - collection of air in the pleural space which can cause the lung to collapse caused by trauma or pathology in visceral or parietal pleura - open pneumothorax: air entering through an opening in the chest wall; outside air rushes in due to disruption of the chest wall and parietal pleura - closed pneumothorax: no external wound; lung air rushes out due to disruption of the visceral pleura - breath sounds absent over affected area - sxs: dyspnea, decreased movement of involved chest wall, decreased or absent breath sounds on the affected side, hyperreasonance to percussion - interventions: chest tube insertion with chest drainage system

Banana Bag

- common rehydrating solution for alcohol use disorder - contains saline 1L (or dextrose in water solution); thiamine 100 mg; folic acid 1 mg; multivitamin; magnesium sulfate

Third-Degree AV Block

- complete heart block - form of AV dissociation in which no impulses from the atria are conducted to the ventricles - Rate and Rhythm: atrial (regular but may appear irregular due to P waves hidden in the QRS complex); ventricular (20-60 beats/min and regular) - P wave: normal, but no connection with QRS complex - PR interval: inconsistent - QRS complex: normal or widened, no relationship with P wave - Clinical associations: severe heart disease, cardiomyopathy, systemic diseases, drugs - Treatment: temporary transcutaneous pacemaker

Premature Ventricular Contractions (PVC)

- contraction coming from an ectopic focus in the ventricles - premature occurence of a QRS complex - wide and distorted in shape compared with QRS complex coming down the normal conduction - Rate and Rhythm: underlying rhythm can be any rate, regular or irregular; occur at variable rates - P wave: not usually visible, hidden in the PVC - PR interval: not measurable - QRS complex: not measurable - unifocal (same shape) or multifocal (arise from different foci; different shape) - Clinical associations: stimulants, electrolyte imbalances, hypoxia, exercise, fever, emotional stress, mi, mitral valve prolapse, hf, cad - Treatment: beta blockers, lidocaine, amiodarone

Premature Atrial Contraction (PAC)

- contraction starting from the ectopic focus in the atrium sooner than the next expected sinus beat - ectopic signal starts in the left or right atrium and travels across the atria by an abnormal pathway - irregular rhythm - P wave: abnormal shape; different shape that of a P wave originating in the SA node or may be hidden in the preceding T wave - PR interval: normal; may be shorter or longer than the PR interval coming from the SA node - QRS complex: normal; if 0.12 sec or more, there is abnormal conduction through the ventricles - Clinical associations: emotional stress, physical fatigue, caffeine, tobacco, alcohol, hypoxia, electrolyte imbalance, hyperthyroidism, copd, cad, valvular disease - Treatment: depends of sxs; caffeine, sympathomimetic drugs, beta blockers; vagal manuevers; synchronized cardioversion (if clinically unstable)

Direct Thrombin Inhibitors

- dabigatran (pradaxa) & apixaban (eliquis) - uses: afib, vte prevention

Opioid Withdrawal Treatment

- for GI distress: loperamide, ondansetron - long-acting: methadone, buprenorphine

Second-Degree AV Block Type I (Mobitz 1, Wenckebach heart block)

- gradual lengthening of PR interval - AV conduction time is increasingly prolonged until an atrial impulse is nonconducted and a QRS complex is blocked; most often occurs in the AV node - Rate and Rhythm: atrial (normal and regular); ventricular (slower and irregular); ventricular may be slower bc of nonconducted or blocked QRS complexes - P wave: normal - PR interval: progressive lengthening - QRS complex: normal width with pattern of one nonconduced/blocked QRS complex - Clinical association: drugs, cad - Treatment: atropine, temporary pacemaker

ECG

- graphic tracing of the electrical impulses produced in the heart

Common Causes of Dysrhythmias

- heart conditions: accessory pathways, cardiomyopathy, conduction defects, heart failure, myocardial ischemia, infarction, valve disease - other: acid-base imbalance; alcohol; caffeine; tobacco; connective tissue disorders; drowning; drug effects; electric shock; electrolyte imbalances; emotional crisis; herbal supplements; hypoxia; metabolic conditions; sepsis, shock; toxins

Hypotonic Fluids

- less solutes than intracellular fluid - ex: .45NS, 2.5D5W, .33NS - fluid shifts into cells - used for cellular hydration - watch for decreased BP d/t decrease blood volume - do not give: low BP, increased ICP, stroke, neuro pt, liver, trauma, surgery, burns

QT Interval

- measured from beginning of QRS complex to the end of the T wave - represents time taken for entire electrical depolarization and repolarization of the ventricles - normal duration: 0.34 to 0.43 seconds

ST Segment

- measured from the S wave of the QRS complex to the beginning of the T wave - represents the time between ventricular depolarization and repolarization (diastole) - should be isoelectric (flat) - normal duration: 0.12 seconds

PR Interval

- measured from the beginning of the P wave to the beginning of the QRS complex - represents time taken for impulse to spread through the atria, AV node, and bundle of His, bundle branches, and Purkinje fibers to a point immediately before ventricular contraction - normal duration: 0.12-0.20 seconds

QRS Interval

- measured from the beginning to the end of QRS complex - represents time taken for depolarization/contraction of both ventricles (systole) - normal duration: < 0.12 seconds

Interventions for acute alcohol toxicity

- monitor vs - IVF & electrolytes: IV thiamine, magnesium, multivit, glucose solutions

Hypertonic Fluids

- more solutes than intracellular fluid - ex: D5 1/2, D5NS, D5LR - fluid shifts out of cells - used for hypovolemia, vascular expansion, increased uop, 3rd spacing, dka - do not give: renal or cardiac pts; dehydration

What does nicotine do to the body?

- most common sud - CNS stimulant, withdrawal (person feels tired), irritable, anxious, craving more nicotine

Meds for Opioid Overdose

- naloxone (Narcan)

What to give if pt hospitalized for nicotine use?

- nicotine replacement products: reduce cravings and withdrawal; otc- skin patches, lozenges, gum; prescription- inhalers, nasal spray - non-nicotine meds: vareniciline (Chantix)- ease withdrawal sxs, block receptors making smoking less enjoyable; bupropion (Zyban)- reduces urge to smoke, reduces some w/d sxs, prevents wt gain

Tidaling

- normal fluctuation of water within the water-seal chamber - reflects intrapleural pressure changes during inspiration and expiration - if stops, may indicate an occluded chest tube

Telemetry Monitoring

- observation of a patient's HR and rhythm at a site distant from the patient

Arterial Blood Gases

- obtained to determine oxygenation status and acid-base balance - includes measurement of PaO2 (80-100 mmHg), PaCO2(35-45 mmHg), pH (7.35-7.45), HCO3- (22-26 mEq/L), and SaO2 (>95%)

Spontaneous Pneumothorax

- occurs due to rupture of small blebs (air-filled sacs) on the surface of the lung

Naltrexone

- opioid antagonist - for opioid dependency who want to completely abstain from opioid therapy and not suited for opioid agonist therapies

Heparin-Induced Thrombocytopenia (HIT)

- potential fatal immune-mediated disorder- develop antibodies to heparin-platelet protein complexes leading to thrombocytopenia and increase thrombus risk

What are the main objectives of IVF therapy?

- provide usual maintenance fluids - replace abnormal fluid losses - correct existing electrolyte imbalances

The 5 Rs (unwilling to quit)

- relevance - risks - rewards - roadblocks - repetition

P Wave

- represents time for the passage of the electrical impulse through the atrium causing atrial depolarization; should be upright - normal duration: 0.06-0.12 seconds

T Wave

- represents time for ventricular repolarization - should be upright - normal duration: 0.16 seconds

Normal Sinus Rhythm

- rhythm that starts in the SA node at a rate of 60 to 100 beats/min and follows the normal conduction pathway - normal P wave, PR interval, & QRS complex

Factor Xa Inhibitors

- rivaroxaban (xarelto) - uses: afib, vte (venous thromboembolism) prevention

Isotonic Fluids

- same tonicity as intracellular fluids - ex: NS, LR, D5W - no fluid shifts - used for fluid and lyte replacement - watch for fluid overload, edema, diluted lab values - do not give: volume overload pts

CIWA-Ar

- scale used to score categories and provide medications for alcohol - each category score 0-7 - agitation, anxiety, auditory disturbances, headache, clouding of sensorium, paroxysmal sweats, tactile disturbances, tremor, visual disturbances

Pulseless Electrical Activity (PEA)

- situation in which organized electrical activity is seen on the ecg, but there is no mechanical heart activity and the patient has no pulse - most common dysrhythmia seen after defibrillation - causes: hypovolemia, hypoxia, metabolic acidosis, hyperkalemia, hypokalemia, etc - treatment: cpr followed by drug therapy (epi) and intubation

ESI-5

- stable abcs/vitals - no life or organ threat - could be delayed to see physician - low resource intensity; examination only - ex: cold sxs; minor burn; recheck wound; prescription refill

ESI-4

- stable abcs/vitals - no life threat or organ threat - could be delayed to see physician - low resource intensity; once simple diagnostic study (xr) or simple procedure (sutures) - ex: closed extremity trauma; simple laceration; cystitis

ESI-3

- stable abcs/vitals - unlikely but possible life threat or organ threat - should be seen by physician within up to an hour - medium to high resource intensity; multiple diagnostic studies (multiple labs, xrys) or brief observation; complex procedure (ivf, iv meds) - ex: abd pain or gynecologic disorders unless in severe distress; hip fracture in older pt

Junctional Dysrhythmias

- start in the area of the AV node to the bundle of His - SA node does not fire or signal is blocked - Rate and Rhythm: 40-180 beats/min; regular - P wave: abnormal in shape and inverted; may be hidden in the QRS complex - PR interval: less than 0.12 second when the p wave precedes the QRS complex; shortened if present - QRS complex: usually normal - Clinical associations: cad, hf, cariomyopathy, electrolyte imbalances, inferior mi, rheumatic heart disease, drugs - Treatment: atropine; beta blockers, ccbs, amiodarone

Acute Marijuana Toxicity

- sxs: acute psychotic episodes, dysrhythmias, mi - treatment: dronabinol (Marinol)- control n/v & appetite stimulant; nabilone (Cesamet)- control n/v in chemo tx

Sinus Arrhythmias

- the conduction pathway is the same as that in the sinus rhythm, but SA node fires irregularly

Synchronized Cardioversion

- the passage of an electric current through the heart during a specific part of the cardiac cycle to terminate certain kinds of dysrhythmias - synchronized circuit in the defibrillator delivers a shock on the R wave of the QRS complex of the ECG - if pt awake- sedation with midazolam or fentanyl - uses: ventricular tachydysrhythmias (VT w/pulse); supraventricular tachydysrhythmias (atrial flutter with rapid ventricular response)

ESI-2

- threatened abcs/vitals - likely, but not always obvious life threat or organ threat - should be seen within 10 minutes by physician - high resource intensity; multiple, often complex diagnostic studies; frequent consultation; continuous monitoring - ex: chest pain probably from ischemia; multiple trauma unless responsive

Why might a patient need IV albumin?

- to replace plasma proteins that provide oncotic pressure to keep fluids in the intravascular space

Asystole

- total absence of ventricular electrical activity - occasionally, P waves are seen - pt's are unresponsive, apneic, pulseless - treatment: cpr w/acls measures; definitive drug therapy with epi and intubation

Atrial Fibrillation

- total disorganization of atrial electrical activity because of multiple ectopic foci - may be paroxysmal or persistent - Rate and Rhythm: atrial (350-600 beats/min and irregular); ventricular (> or < 100 beats/min and irregular) - P wave: fibrillatory waves - PR interval: not measurable - QRS complex: usually normal - Clinical association: underlying heart disease, thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte problems, stress, heart surgery - Treatment: ccbs (diltiazem); beta blockers; amiodarone, digoxin; electrical cardioversion

First-Degree AV Block

- type of AV block in which every impulse is conducted to the ventricles, but the time of the AV conduction is prolonged; after the impulse moves through the AV node, ventricles usually respond normal - Rate and Rhythm: normal and regular - P wave: normal - PR interval: >0.20 seconds; prolonged - QRS complex: normal - Clinical associations: increasing age, mi, cad, rheumatic fever, hyperthyroidism, electrolyte imbalances, vagal stimulation, drugs

ESI-1

- unstable vitals/abcs - obvious life threat or organ threat - should be seen by physician immediately - high resource intensity; staff at bedside continuously; often mobilization of team response - ex: cardiac arrest; intubated trauma pt; overdose with bradypnea; severe respiratory distress

COWS scale

- used to assess and monitor sxs of opiate withdrawal - mild: 5-12 - moderate: 13-24 - moderately severe: 25-36 - severe withdrawal: > 36 - resting pulse rate: measured after pt is sitting or lying for one minute (0,1,2,4) - sweating: over past 1/2 hr not accounted for by room temp or pt activity (0-4) - restlessness: observation during assessment (0,1,3,5) - pupil size (0,1,2,5) - bone or joint aches: if pt was having pain previously, only the additional component attributed to opiate withdrawal is scored (0,1,2,4) - runny nose or tearing: not accounted for by cold symptoms or allergies (0,1,2,4) - GI upset: over last 1/2 hr (0,1,2,3,5) - tremor: observation of outstretched hands (0,1,2,4) - yawning: during assessment (0,1,2,4) - anxiety or irritability: (0,1,2,4) - gooseflesh skin: (0,3,5)

Chest Drainage Unit

- used to collect fluid, air, and/or blood from the chest cavity - first compartment: collection chamber; receives fluid and air from the pleural space; the drained fluid stays in this chamber while expelled air vents to the second compartment - second compartment: water-seal chamber; contains 2 cm of water, which acts as a one-way valve; incoming air enters from the collection chamber and bubbles up through the water to precent backflow of air into the patient - third compartment: suction control chamber; applies suction to the chest drainage unit; there is a water and dry suction control; the water suction control chamber uses a column of water to control the amount of suction from the wall regulator - suction control chamber requires a connection to the wall suction source that is dialed up higher than the prescribed suction for the suction to work - water suction: uses water in the suction control chamber to control water suction pressure - dry suction: controls wall suction by using a regulator control dial

What interventions are used to decrease the rate of SVT?

- vagal manuever (bearing down to stimulate pns) - IV diltiazem (rate control) - IV adenosine (stop heart so SA node can take over) - ablation (prevention)

Warfarin

- vit k antagonist - suppresses 4 clotting factors that are dependent on vit k for synthesis - uses: long term prevention of vte, pe, prevention of thrombosis in ppl with prosthetic heart valves and afib - reversal agents: vit k, fresh frozen plasma (ffp), prothrombin complex concentrates - pccs: replace deficient clotting factors and corrects inr; pooled plasma products that contain factors I, IX, and X with variable amounts of factor VII and proteins C and S

A patient with supraventricular tachycardia with a rate of 170 bpm is being prepared for cardioversion. The patient is alert with a bp of 110/66 mmHg. What action should the nurse perform when preparing the pt? A. Turn the synchronizer switch to the "off" position B. Give a sedative before cardioversion is implemented C. Set the defibrillator/cardioverter energy to 360 joules D. Provide assisted ventilations with a bag-valve-mask device

B

The nurse observes no P waves on a patients monitor strip. There are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 seconds (narrow), but they occur irregularly with a rate of 120 beats/min. What does the nurse determine the rhythm to be? A. Sinus tachycardia B. Atrial fibrillation C. Ventricular fibrillation D. Ventricular tachycardia

B

The patient has atrial fibrillation with a rapid ventricular response. What electrical treatment option does the nurse prepare the patient for? A. Defibrillation B. Synchronized cardioversion C. Automatic external defibrillator D. Implantable cardioverter-defibrillator

B

A patient reporting dizziness and sob is admitted with a dysrhythmias. Which medication, if ordered, requires the nurse to carefully monitor the pt for asystole? A. Digoxin B. Adenosine C. Metoprolol D. Atropine Sulfate

B - IV adenosine is the first drug of choice to concert SVT to a normal sinus rhythm; the nurse should monitor a pt's ecg continuously bc a brief period of asystole after adenosine administration is common and expected

What interventions are appropriate to treat symptomatic bradycardia? SATA A. Metoprolol B. Atropine C. Defibrillation D. Cardioversion E. Implanted pacemaker

B & E

A patient in the coronary care unit develops ventricular fibrillation. What is the first action the nurse should take? A. Perform defibrillation B. Initiate cpr C. Prepare for synchronized cardioversion D. Administer IV antidysrhythmic drugs per protocol

B (then defibrillate)

A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? A. Obtain a 12-lead ECG B. Notify the hcp of the change in the rhythm C. Give supplemental O2 at 2 to 3 L/min via nasal cannula D. Assess the patient's vital signs including O sats

C

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? A. Lidocaine or amiodarone B. Digoxin and procainamide C. Epinephrine or vasopressin D. B-adrenergic blockers and dopamine

C

The nurse observes ventricular tachycardia on the patient's monitor. What evaluation made by the nurse led to this interpretation? A. Unmeasurable rate and rhythm B. Rate 150 beats/min; inverted P wave C. Rates 200 beats/min; P wave not visible D. Rate 125 beats/min; normal QRS complex

C

The cardiac rhythm is sinus bradycardia with 6 to 8 PVCs per minute. What characteristic of PVCs does the nurse recognize? A. An irregular rhythm B. An inverted T wave C. A wide, distorted QRS complex D. An increasingly long PR interval

C - B (after ischemia or mi) - D (heart block)

The nurse is monitoring the ecg of several patients on a cardiac telemetry unit. The patients are directly visible to the nurse and all the patients are observed to be sitting up and talking with visitors. Which patient's rhythm would require the nurse to take immediate action? A. A 62 yr old man with a fever and sinus tachycardia with a rate of 110 beats/min B. A 72 yr old woman with atrial fibrillation with 60 to 80 QRS complexes per minute C. A 52 yr old man with premature ventricular contractions at a rate of 12 per minute D. A 42 yr old woman with first degree AV block and sinus bradycardia at a rate of 56 beats/min

C - frequent pvcs may reduce cardiac output and precipitate angina and heart failure, depending on their frequency; bc pvcs in cad or acute mi indicate ventricular irritability, pts physiologic response must be monitored

Cardioversion is attempted for a patient with atrial flutter and rapid ventricular response. After delivering 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take immediately? A. Administer 250 mL of 0.9% saline solution IV by rapid bolus B. Assess the apical pulse, blood pressure, and bilateral neck vein distention C. Turn the synchronizer switch to the "off" position and recharge the device D. Ask the patient if there is any chest pain or discomfort and administer morphine sulfate

C - v fib produces no effective cardiac contractions or co; if during synchronized cardioversion the pt becomes pulseless or the rhythm deteriorates to v fib, the nurse should turn the synchronizer switch off and initiate defibrillation

A patient has a junctional escape rhythm on the cardiac monitor. What hr will the nurse expect the patient to have? A. 15 to 20 B. 20 to 40 C. 40 to 60 D. 60 to 100

C (coming from AV node)

A patient develops third-degree heart block and reports feeling chest pressure and sob. Which instructions should the nurse provide to the patient before initiating emergency transcutaneous pacing? A. The device will convert your heart rate and rhythm back to normal B. The device uses overdrive pacing to slow the heart to a normal rate C. The device is inserted through a large vein and threaded into your heart D. The device delivers a current through your skin that can be uncomfortable

D

A patient on telemetry has multifocal premature ventricular contractions. Which lab result is most important for the nurse to communicate to the hcp? A. Blood glucose 243 mg/dL B. Serum chloride 92 mEq/L C. Serum sodium 134 mEq/L D. Serum potassium 2.9 mEq/L

D

A patient's cardiac rhythm is sinus bradycardia with a hr of 34 bpm. If the bradycardia is symptomatic, what would the nurse expect the pt to exhibit? A. Palpitations B. Hypertension C. Warm, flushed skin D. Shortness of breath

D

The nurse obtains a rhythm strip on a client and makes the following analysis: No visible P waves, PR interval not measurable, ventricular rate 162, RR interval regular, QRS complex wide and distorted, QRS duration 0.18 seconds. How will the nurse interpret the patient's cardiac rhythm? A. Atrial flutter B. Sinus tachycardia C. Ventricular fibrillation D. Ventricular tachycardia

D - if pt has a pulse -> synchronized cardioversion - if pt does not have a pulse -> cpr

The nurse is analyzing the rhythm of a patient's ECG. What finding will need further investigation? A. ST segment is on the isoelectric line B. PR interval of 0.18 seconds C. QT interval of 0.38 seconds D. QRS interval of 0.18 seconds

D (< 0.12 seconds)

Cardioversion

restoration of a normal heart rhythm by electric shock