Cardiac Care Part 2
What is the PR interval in Normal Sinus Rhythm?
.12-.20 seconds
What is the PR interval for Sinus Bradycardia?
.12-.20 seconds/normal
How long is one small box on an EKG?
0.04 seconds
Presentation of patient's with Myocardial Infarction
+Crushing chest pain unrelieved with nitrates +Pain radiating to left arm, epigastric, or jaw +SOB +Pale +Diaphoretic +Nausea +Anxiety +Palpitations
How do you determine heart rate on a EKG?
+Determine if its a six-second strip +If it has 30 large boxes it is a six-second strip +1500/number of boxes between R waves=heart rate
How can you tell if a heart rhythm is regular?
if the distance between each R wave is +/- 1-2 small boxes
What is the PR interval in Ventricular Tachycardia?
not measurable
When does CK-MB peak?
10-24 hours
What is the heart rate in Normal Sinus Rhythm?
60-100
The nurse places a client on the cardiac monitor and observes the heart rhythm. Which rhythm requires the most urgent intervention? A) Ventricular tachycardia B) Atrial fibrillation C) Trigeminy D) Bigeminy
A
What is the heart rate for Sinus Bradycardia?
Less than 60
How does a patient in Ventricular Fibrillation present?
Cardiac arrest
What is the heart rate in Ventricular Fibrillation?
No heart rate
Signs of coronary artery disease
chest pain
Interventions for Premature Ventricular Contraction
+Determining underlying rhythm +Determine frequency of PVCs
MONA
+Medication +Oxygen +Nitrates +Aspirin
Patient presentation of Ventricular Tachycardia
+Palpitations +Chest pain +Decreased CO +Hypotensive +LOC changes +Lightheaded +Syncope
Acute coronary syndrome
+STEMI +NSTEMI +Unstable angina
Presentation of Premature Ventricular Contraction
+Skipped heartbeat +Pounding heart
What are the risk factors for coronary artery disease?
+Smoking +High blood pressure +Obesity +Diabetes +Hyperlipidemia +Family history
What is the P:QRS ratio in Normal Sinus Rhythm?
1:1
What is the length of the QRS complex in Premature Ventricular Contractions?
greater than .12 seconds
Causes of Ventricular Tachycardia
+Abnormal potassium or magnesium levles +MI
Treatment of Ventricular Tachycardia
+Amiodarone +Magnesium sulfate +Synchronized cardioversion +CPR +Defibulate +Epinephrine
What is the length of a normal QRS complex?
.06-.12 seconds
When does Troponin I peak?
12 hours
What is the rate for Ventricular Tachycardia?
150-250 bpm
What is the P:QRS ratio for Sinus Bradycardia?
1:1
Is the rhythm regular or irregular in Ventricular Tachycardia?
regular or irregular
A student nurse is explaining preventricular contractions (PVCs) to their client. Which of the following statements by the student nurse would need further teaching by the nurse? A) PVCs originate in the atria B) PVCs are normal C) PVCs originate in the ventricles D) Frequent PVCs can lead to Ventricular tachycardia
C A) Increased filling time of ventricles There is a decreased filling time of the ventricles during a PVC B) Increased filling time of atria There is a decreased filling time of the ventricles during a PVC C) Decreased filling time of ventricles There is a decreased filling time of the ventricles during a PVC. D) Decreased filling time of atria There is a decreased filling time of the ventricles during a PVC
What is angina?
Chest pain associated with lack of blood flow to the heart
Troponin I
Most specific to cardiac damage
In normal Sinus Rhythm is the heart rhythm regular or irregular?
Regular
CK-MB
Specific to cardiac damage in the absence of skeletal muscle damage
What is Myocardial Infarction?
Sudden loss of blood flow to the heart
What is the rate in Premature Ventricular Contractions?
Varriable
Coronary Artery Disease
a buildup of plaque in the main vessels leading to the heart
What is the P:QRS ratio of Sinus Tachycardia?
1:1
When does myoglobin peak?
2 hours
What is the PR interval in Premature Ventricular Contractions?
Not measurable
What is the PR interval in Ventricular Fibrillation?
Not measurable
What is the length of the QRS complex in Ventricular Fibrillation?
Not measurable
The nurse is getting report from the emergency department on a client admitted for unstable angina. The ED nurse states that everything has come back negative and the plan of care is for the client to have a cardiac stress test later today. Which question is a priority question to ask the ED nurse during report? A) Has this client received aspirin? B) When was the last time the client ate or drank? C) Were any of the cardiac enzymes elevated? D) When was the last time the client received pain medication?
B A) Has this client received aspirin? This information can be looked up in the chart, so it is not crucial to ask the nurse this information. B) When was the last time the client ate or drank? A client must be NPO for a cardiac stress test. The most important information to get from the ED nurse before the client is handed off, is when the PO intake occurred. C) Were any of the cardiac enzymes elevated? Results of these tests can be found in the chart. D) When was the last time the client received pain medication? The last time any medication was given is something that can be looked up in the chart.
A new nurse is reviewing a rhythm on a telemetry monitor and believes it might be ventricular fibrillation. Which of the following characteristics is the nurse most likely observing? Select all that apply. A) Normal PR interval B) Irregular rhythm C) Ventricular heart rate of 150-250 bpm D) P:QRS ratio that is not measurable E) Large and tall P waves
B&D A) Normal PR interval This is not a characteristic of V-fib. A normal PR interval would occur in normal sinus rhythm. B) Irregular rhythm This is a characteristic of V-fib. Ventricular fibrillation is an irregular rhythm and the P: QRS ratio is nonmeasurable. C) Ventricular heart rate of 150-250 bpm This is not a characteristic of V-fib. A ventricular heart rate of 150-250 would be present in ventricular tachycardia, not V-fib. D) P:QRS ratio that is not measurable This is a characteristic of V-fib. Ventricular fibrillation is an irregular rhythm and the P: QRS ratio is nonmeasurable. E) Large and tall P waves This is not a characteristic of V-fib. A large P wave can mean right atrial enlargement.
Is the rate regular or irregular in Atrial Fibrillation?
Irregular
Is the rhythm regular or irregular in Ventricular Fibrillation?
Irregular
What is the QRS complex in Ventricular Tachycardia?
greater than .12 seconds
What is the heart rate in Sinus Tachycardia?
greater than 100 bpm
Causes of coronary artery disease
high blood pressure and cholesterol
What do you give instead of morphine and nitrates in an inferior MI?
lots of fluids
Myoglobin
low specificity to infarction. Released with any muscle damage.
ACE inhibitors
lower blood pressure
Beta-adrenoceptors
lower heart rate
What are contraindicated in inferior MI?
morphine and nitrates
What is the PR interval of Sinus Tachycardia?
normal
What is the P:QRS Ratio in Premature Ventricular Contractions?
not measurable
What is the P:QRS ratio in Ventricular Fibrillation?
not measurable
Is the rhythm regular or irregular in Sinus Tachycardia?
regular
Interventions for Ventricular Tachycardia
+Determine if pulse is present +Sustained or unsustained +Determine if monomorphic or polymorphic
Treatment for Premature Ventricular Contraction
+Determine the cause +Antiarrhythmics +Beta-blockers/calcium channel blockers Implantable defibrillator +Ablation
What is the length of the QRS complex in Normal Sinus Rhythm?
.06-.12 seconds
What is the QRS complex for Sinus Bradycardia?
.06-.12 seconds/normal
What is a normal PR interval?
.12-.20 seconds
Interventions for new-onset angina
+Assess pain +Vital signs +12 lead +Nitroglycerin +Oxygen +Asprin +Draw cardiac enzymes
How to treat Ventrical Fibulation
+CPR +Defibrillate +Epinephrine +Amiodarone
Cause of Premature Ventricular Contraction
+Caffeine +Alcohol +Tobacco +Electrolyte imbalances (potassium and magnesium) +Hypoxia +MI
What causes angina?
+Coronary artery disease +Stress +Anemia +Heart failure +Arrhythmias
Non-ST elevation myocardial infarction
+Crushing chest pain +Elevated cardiac enzymes +No ST elevation on EKG +Partial occlusion +Need pharmacological therapy (nitrates/beta-blockers) +Angiography in 24-48 hours
ST-elevation myocardial infarction
+Crushing chest pain +Elevated cardiac enzymes +ST-elevation on 12 lead EKG +Complete occlusion +Thrombolytics +Surgical
A 56-year-old client is suffering from multiple premature ventricular contractions (PVCs) that cause her to feel lightheaded and dizzy. Which drug would most likely be prescribed for the management of PVCs? A) Carvedilol B) Calcium chloride C) Epinephrine D) Aspirin
A A) Carvedilol Carvedilol (Coreg) is a medication that may be given to regulate the heart rate when a patient has frequent premature ventricular contractions that cause symptoms, like dizziness and the feeling of being lightheaded. Carvedilol is a beta blocker that is also used for other cardiac conditions, such as heart failure, high blood pressure and angina. B) Calcium chloride This medication is used to treat hypocalcemia, not PVCs. C) Epinephrine This medication is typically used to treat severe anaphylaxis and is not effective to treat PVCs. D) Aspirin This medication is and NSAID and is also used to treat chest pain and to help prevent blood clotting. Aspirin does not treat PVCs.
A nurse must deliver a shock to a client in ventricular fibrillation by using a biphasic defibrillator. Which describes the amount of energy delivered with the first shock on an adult client? A) 360 joules B) 200 joules C) 120 joules D) 150 joules
C A) 360 joules This energy level is higher than the first shock level of a biphasic defibrillator. B) 200 joules This energy level is higher than the first shock level of a biphasic defibrillator. C) 120 joules When setting the energy level on a defibrillator for an adult client who is in ventricular fibrillation, the initial level with a biphasic defibrillator is 120 joules. The sequence is as follows. Biphasic: 120 - 150 - 200 - 200. Monophasic - start at 200 - 260 joules. Clients tend to have better outcomes when a biphasic defibrillator is used compared to a monophasic defibrillator. D) 150 joules This energy level is too high.
The nurse is admitting a client who states, "When I was pregnant I would get heartburn so bad, I was eating antacids like crazy. I now feel the same way, except I am not pregnant. The antacids aren't helping me and now I have this pain between my shoulder blades." Which part of this statement is most concerning and must be investigated further? A) "I have this pain between my shoulder blades" B) "When I was pregnant I would get heartburn so bad" C) "I was eating antacids like crazy" D) "The antacids aren't helping me"
A A) "I have this pain between my shoulder blades" This female client is showing signs of a myocardial infarction. Women often present with atypical symptoms and will often describe a feeling of acid reflux that is actually a heart attack. This client needs an EKG (ECG) immediately to rule out a STEMI. B) "When I was pregnant I would get heartburn so bad" Heartburn is common during pregnancy. C) "I was eating antacids like crazy" This is a safe substance for pregnant women to consume, so this statement is not concerning. D) "The antacids aren't helping me" This is concerning, but the most concerning statement is the client describing pain between the shoulder blades.
The nurse is caring for a client who is suffering from frequent premature ventricular contractions. Which of the following is true of this condition? Select all that apply. A) It arises from one or more atrial ectopic foci B) It may decrease the efficiency of the heart's pumping action C) The client may experience an irregular heartbeat D) The client is usually hypertensive E) It is commonly caused by a myocardial infarction
B,C&E A) It arises from one or more atrial ectopic foci A PVC originates in ventricular foci, not atrial foci. B) It may decrease the efficiency of the heart's pumping action The client with frequent premature ventricular contractions may have a decrease in the efficiency of the heart's pumping action, as it can reduce cardiac output. C) The client may experience an irregular heartbeat A PVC is an irregular heartbeat, and the client will be able to feel the irregularity. D) The client is usually hypertensive A client with PVC's is usually normotensive. E) It is commonly caused by a myocardial infarction It is commonly caused by myocardial infarction, and the client is usually normotensive.
The nurse is caring for a client who has suddenly gone into ventricular fibrillation. Which of the following is true about this condition? Select all that apply. A) The blood pressure is usually normal B) The client will feel an irregular heartbeat C) It is the most severe of all dysrhythmias D) It can be caused by a myocardial infarction E) Blood flow must be restored or there will be death in 1-5 minutes
C,D&E A) The blood pressure is usually normal Blood pressure in a client with ventricular fibrillation rapidly drops to zero, because the heart is not pumping blood. B) The client will feel an irregular heartbeat A pulse is not present during ventricular fibrillation. C) It is the most severe of all dysrhythmias Ventricular fibrillation is the most severe of all dysrhythmias and can be caused by a myocardial infarction. D) It can be caused by a myocardial infarction Ventricular fibrillation can be caused by a previous myocardial infarction. E) Blood flow must be restored or there will be death in 1-5 minutes The client is unconscious with no blood pressure and blood flow must be restored or death will occur in 1-5 minutes.
A nurse observes Ventricular Tachycardia on telemetry monitor. Which of the following is the first action the nurse must implement? A) Start CPR B) Prepare for defibrillation C) Obtain a 12 lead EKG D) Check the client's pulse
D A) Start CPR The nurse must check the pulse first to determine if a pulse is present. B) Prepare for defibrillation The nurse must check the pulse first to determine if a pulse is present. C) Obtain a 12 lead EKG The nurse must check the pulse first to determine if a pulse is present. D) Check the client's pulse This client is in ventricular tachycardia. The nurse must check the pulse first to verify it is present and determine the beats per minute, as well as assess the client's level of consciousness.
What is the length of the QRS complex in Atrial Fibrillation?
Normal
What is the length of the QRS complex in Sinus Tachycardia?
Normal
What is the rate in Atrial Fibrillation?
Normal to high
What is the P:QRS ratio in Atrial Fibrillation?
Not measurable
The nurse is caring for a client who was just administered an antianginal agent in the form of a nitrate. The nurse knows that this helps angina by which of the following mechanisms? A) Reducing venous tone, decreasing cardiac workload B) Decreasing heart rate C) Dilates capillaries in the messentary D) Increase arterial pressure
A A) Reducing venous tone, decreasing cardiac workload Nitrates reduce venous tone, decreasing cardiac workload and reducing myocardial oxygen consumption. B) Decreasing heart rate Nitroglycerin does not have this effect on the heart. C) Dilates capillaries in the messentary Dilating mesenteric capillaries would not relieve chest pain. D) Increase arterial pressure Nitroglycerin decreases arterial pressure by vasodilation rather than increasing arterial pressure.
Is the rate regular or irregular in Premature Ventricular Contractions?
regular or irregular
The nurse is caring for a client who presents to the emergency department with angina. Which of the following is the first action the nurse will take? A) Administer nitroglycerin 0.4 mg sublingual B) Give 2L oxygen per nasal cannula C) Administer 2 mg morphine IV D) Administer 4 baby aspirin at 81 mg each
A A) Administer nitroglycerin 0.4 mg sublingual The first action the nurse will take out of the four choices is to administer a 0.4 mg sublingual nitroglycerin tab. B) Give 2L oxygen per nasal cannula This is the third thing the nurse would do, provided that the client's oxygen level is below 94%. If the client's oxygen level is above 94%, they do not need oxygen. C) Administer 2 mg morphine IV This is the last action the nurse would take, and it is only given if chest pain is unrelieved by nitroglycerin and aspirin. D) Administer 4 baby aspirin at 81 mg each This is the second action the nurse will take.
The nurse is caring for a telemetry client. Upon entering the room, the nurse notices a few premature ventricular contractions on the cardiac monitor. As the nurse begins an assessment, the client goes into ventricular tachycardia on the monitor. Which of the following nursing actions is most appropriate? A) Check a pulse B) Call the provider C) Call a code blue D) Call for help
A A) Check a pulse The first step for a client in ventricular tachycardia is to check a pulse. If there isn't a pulse, then using the ACLS algorithm, the client would be treated with defibrillation. B) Call the provider When a client goes into ventricular tachycardia, this is a medical emergency. The nurse would check a pulse to make sure the client matches the monitor, then call a code blue, which gets the code blue team to the bedside quickly. There will be a provider on the code blue team. C) Call a code blue First the nurse checks a pulse, because V-tach with a pulse is handled differently than pulseless V-tach. D) Call for help Once the nurse determines the client's pulse status, the nurse will call a code and help will arrive.
Which of the following is the first medication given for a client in ventricular fibrillation? A) Epinephrine B) Atropine C) Bretyllium D) Lidocaine
A A) Epinephrine This is the first medication given for ventricular fibrillation, which is a medical emergency. The order of care for ventricular fibrillation is CPR, then defibrillation, then epinephrine, then amiodarone. B) Atropine This is given for bradycardia. C) Bretyllium This used to be given for ventricular fibrillation but has been dropped from the ACLS algorithm. D) Lidocaine This used to be given for ventricular fibrillation if amiodarone was not effective, but has been dropped from the ACLS algorithm.
The client presents to the emergency department complaining of chest pain for the past 2 hours. The client is breathing, alert, and oriented. What is the first action the nurse should take? A) Get an EKG B) Start an IV C) Call the provider D) Get vital signs
A A) Get an EKG The priority intervention for the nurse is to get an EKG started to verify whether the client is having a myocardial infarction. B) Start an IV The IV is a huge priority, but getting the EKG started is the first action. C) Call the provider When a client arrives with chest pain, an EKG is obtained, IV started, vital signs taken and oxygen administered if needed. All these actions can be done without orders from the provider. D) Get vital signs An EKG must be initiated, then IV start and vital signs quickly after.
A nurse is caring for a client in the ICU who has a history of cardiac dysrhythmias. The client goes into a state of ventricular tachycardia and the nurse is unable to find a pulse. The code team arrives and delivers a shock of defibrillation to the client at 360 Joules. Which step would the nurse perform next? A) Immediately resume chest compressions B) Assess the client's pulse C) Provide two manual breaths with a bag and mask D) Administer 1 mL of IV epinephrine
A A) Immediately resume chest compressions A client who is in ventricular fibrillation or pulseless ventricular tachycardia has a shockable rhythm and the healthcare staff can perform defibrillation. Immediately after providing the first shock to the client, the team should restart chest compressions without stopping to check a pulse. The nurse should perform CPR for 2 minutes before stopping to assess the client's heart rhythm. B) Assess the client's pulse Chest compressions immediately before and after delivering a shock give the best outcomes. C) Provide two manual breaths with a bag and mask Chest compressions take priority over providing bag-mask ventilations. D) Administer 1 mL of IV epinephrine Epinephrine is given into an IV or IO line. Chest compressions should not be stopped for epinephrine administration.
The student nurse is discussing ventricular fibrillation with their nursing instructor. The student nurse needs further teaching after which of the following statements about ventricular fibrillation (V-fib) is made? A) Not a shockable rhythm B) When a client is in cardiac arrest C) Shock immediately D) Requires CPR
A A) Not a shockable rhythm This statement requires further teaching, ventricular fibrillation is a shockable rhythm. B) When a client is in cardiac arrest C) Shock immediately D) Requires CPR
The nurse is assessing a client who is coughing so hard that his chest hurts. The client is holding his chest and asking for pain medications. What is the priority for this client? A) Obtain orders for an EKG (ECG) B) Give the client water C) Get the client cough syrup D) Give the client pain medications
A A) Obtain orders for an EKG (ECG) Because the client is clutching his chest and asking for pain medications, the nurse should talk to the provider about an order for an EKG. The pain may be from coughing, but the nurse should not assume that the heart is fine if the client is demonstrating these symptoms. B) Give the client water First the nurse will assess the client's cardiac status, then address the client's pain. Water and cough syrup are a low priority. C) Get the client cough syrup This is a low priority, because the client's cardiac status and pain will be addressed first. D) Give the client pain medications The nurse needs to initiate a conversation with the provider about an EKG first, and pain medication would be next.
A student nurse is explaining preventricular contractions (PVCs) to their client. Which of the following statements by the student nurse would need further teaching by the nurse? A) PVCs originate in the atria B) PVCs are normal C) PVCs originate in the ventricles D) Frequent PVCs can lead to Ventricular tachycardia
A A) PVCs originate in the atria This statement needs further teaching because premature ventricular contractions are caused from an abnormal electrical stimulus in the ventricles not the atria. B) PVCs are normal This is a true statement regarding PVCs. C) PVCs originate in the ventricles This is a true statement regarding PVCs. D) Frequent PVCs can lead to Ventricular tachycardia This is a true statement regarding PVCs.
A new nurse notices what appears to be ventricular fibrillation (V-fib) on the monitor and quickly enters the client's room to find the client sitting on the side of the bed talking. After the nurse checks the pulse and determines the client has a regular pulse of 85 beats per minute the nurse should do which of the following next? A) Reposition the leads and recheck the rhythm B) Call a code C) Start CPR D) Defibrillate the client
A A) Reposition the leads and recheck the rhythm It may be an artifact, after determining the client is stable with a pulse, leads should be repositioned and the rhythm rechecked. B) Call a code The client has a pulse and is stable. C) Start CPR The client has a pulse and is stable. D) Defibrillate the client The client has a pulse and is stable.
A student nurse is explaining ventricular tachycardia to a group of students. The nurse is correct in stating which of the following? A) There are multiple disorganized firing in the ventricles B) There are multiple disorganized firing in the atria C) The ventricles are contracting too slow to produce an adequate cardiac output D) The atria are contracting too slow to produce an adequate cardiac output
A A) There are multiple disorganized firing in the ventricles The extra electrical impulses are initiated in the ventricles and begin firing at a rapid rate - causing ventricular tachycardia. B) There are multiple disorganized firing in the atria This would cause an atrial arrhythmia such as atrial flutter or atrial fibrillation. C) The ventricles are contracting too slow to produce an adequate cardiac output Ventricular tachycardia is a fast rhythm (usually >150 bpm), not too slow. There could be an impact on cardiac output, but not because the ventricles are contracting too slowly. D) The atria are contracting too slow to produce an adequate cardiac output Ventricular tachycardia involves rapid firing from the ventricles, it is NOT a slow atrial rhythm.
A client is in ventricular fibrillation. The nurse understands that which of the following is true of ventricular fibrillation? Select all that apply. A) The client has no cardiac output B) The ventricle rate is >160 beats per minute C) The nurse must start CPR immediately D) The nurse must call for a stat EKG E) The client experiences heart palpitations
A&C A) The client has no cardiac output Ventricular fibrillation is a life-threatening medical emergency. The ventricles are quivering, not beating. The client has no cardiac output, and death is imminent without immediate medical intervention. Following ACLS guidelines, the nurse would check for a pulse, call for help, and begin CPR right away. Early defibrillation is the only chance the client will have to get a normal sinus rhythm back. B) The ventricle rate is >160 beats per minute There is no ventricular rate in ventricular fibrillation, because the ventricles are quivering, not beating. C) The nurse must start CPR immediately D) The nurse must call for a stat EKG There is no rhythm to analyze with an EKG, so this would be wasted time. E) The client experiences heart palpitations The client is in cardiac arrest, so the client is unconscious which means no palpitations are felt.
The nurse responds to a code for a client in ventricular fibrillation. Which of the following interventions does the nurse anticipate for this situation? Select all that apply. A) CPR B) Defibrillation C) Epinephrine administration D) Percutaneous coronary intervention E) Atropine administration
A,B&C A) CPR This intervention follows the ACLS guidelines for treatment of ventricular fibrillation. B) Defibrillation This intervention follows the ACLS guidelines for treatment of ventricular fibrillation. C) Epinephrine administration This intervention follows the ACLS guidelines for treatment of ventricular fibrillation. D) Percutaneous coronary intervention This is a treatment for coronary arteries of the heart that have narrowed in coronary artery disease. This is unrelated to ventricular fibrillation. E) Atropine administration Atropine is used to increase the heart rate when a client has bradycardia, so this is contraindicated.
A nurse is caring for a client complaining of chest pain. A 12-lead EKG (ECG) shows normal sinus rhythm. After 30 minutes, the client's lab work results and shows elevated troponin. What are the priority interventions at this time? Select all that apply. A) Repeat the EKG (ECG) B) Re-evaluate the chest pain C) Notify the provider D) Re-draw the troponin E) Administer the ordered morphine
A,B&C A) Repeat the EKG (ECG) The client could be having a non-ST elevation myocardial infarction (NSTEMI). B) Re-evaluate the chest pain C) Notify the provider The repeat EKG, repeat pain evaluation, and a new set of vitals should be reported to the provider as soon as possible. It is highly possible the client is having an NSTEMI, which requires immediate intervention. D) Re-draw the troponin Cardiac enzymes, including troponin, are drawn at specific intervals E) Administer the ordered morphine Morphine is not the priority at this time. The client's pain should be re-evaluated first, and the provider needs to be made aware of the lab results. If a client is having a posterior or inferior MI, morphine could actually cause significant hypotension. Since this is likely an NSTEMI, it's difficult to know this information for sure. It is safer to wait before administering morphine at this time.
The nurse notices Ventricular Fibrillation shown and knows that which of the following is the priority nursing intervention? Select all that apply. A) Call a code B) Check the client C) Notify the healthcare provider D) Obtain an EKG to confirm the rhythm E) Initiate CPR
A,B&E A) Call a code The client is in ventricular fibrillation, which means the heart is not pumping blood forward, and the client has no perfusion. The nurse will immediately call a code. B) Check the client The nurse is aware that this is cardiac arrest, and will run to the client immediately. Once the nurse sees the client is unresponsive and has no pulse, the nurse will call a code and initiate CPR. C) Notify the healthcare provider This is a life threatening arrhythmia and CPR must be initiated. D) Obtain an EKG to confirm the rhythm This is a life threatening arrhythmia and CPR must be initiated. E) Initiate CPR The client is in cardiac arrest.
The nurse is reviewing a client's medications and notes that the client is taking warfarin sodium. Which of the client's following lifestyle habits would concern the nurse? Select all that apply. A) Grapefruit juice every morning B) Kale shakes and salads twice per day C) Playing on a local rugby team D) One glass of wine per week E) Availability of transportation to and from appointments once every two weeks
B&C A) Grapefruit juice every morning Grapefruit juice does not affect warfarin therapy. B) Kale shakes and salads twice per day Kale and other leafy greens contain vitamin K, which is the antidote to warfarin sodium. C) Playing on a local rugby team Clients on anticoagulant therapy should not play contact sports because of the increased risk of bleeding. D) One glass of wine per week One alcoholic drink per week is acceptable when a client is taking warfarin. However, more than two drinks at one time for males and more than one drink at one time for females is inappropriate, as this can increase the effect of warfarin. E) Availability of transportation to and from appointments once every two weeks PT and INR levels should be checked about once per month, so if a client is able to get to an appointment every two weeks, this would not concern the nurse.
A nurse is attempting to determine if their client is having premature ventricular contractions (PVCs) and knows that which of the following are characteristics of PVCs? Select all that apply. A) Normal QRS complex B) Wide QRS complex C) PR interval is not measurable during PVC D) Normal PR interval during PVC E) Normal P:QRS ratio during PVC
B&C A) Normal QRS complex The QRS complex during a PVC is abnormal and wider. B) Wide QRS complex During a PVC the QRS complex is wider. C) PR interval is not measurable during PVC The PR interval is not measured during a PVC because there are no P waves. D) Normal PR interval during PVC The PR interval is not measurable because there are no P waves during a PVC. E) Normal P:QRS ratio during PVC There are no P waves during a PVC.
What is the P:QRS ratio in Ventricular Tachycardia?
Not measurable
What is the PR interval in Atrial Fibrillation?
Not measurable
