NCIV Rhythms and Pacemakers - Exam 1

Ablation is used for what rhythms?

Invasive procedure mainly used to treat *atrial dysrhythmias (atrial fibrillation, atrial flutter)*

Is defibrillation synchronized or unsynchronized?

-"Unsynchronized" -Don't need anesthesia/sedation

What is mechanical cardioversion?

-A planned, orchestrated, synchronized event; everyone has a role, practiced it *-Synchronized shocking delivered at a specific time and point*

What can be used for defibrillation?

-AEDs -"All stand clear"

What are limitations after placing a pacemaker?

-Activity limitations -May limit shoulder movement above head for 24-48 hours

Capture (or catching)

-Atria or ventricles contract in response to the stimulus -The heart is responsible for capturing/catching what the pacemaker is putting out -Pacemaker should deploy electrical activity. *The heart captures/catches the electrical activity/pulse* and then the atrium or ventricle (depending on where the stimulus went) contracts in response

What is mechanical cardioversion used for?

-Atrial arrhythmias (atrial flutter, atrial fibrillation) -Stable (pulse) ventricular tachycardia

Three common pediatric arrhythmias

-Bradyarrhythmias -Tachyarrhythmias -Pulseless rhythms

Why is atrial fibrillation with slow ventricular response a contraindication to cardioversion?

-Can cause post-cardioversion bradycardia/asystole -Typically, rates are going to be greater than 120, but someone could be in slow Afib which would be a contraindication into shocking them because could go into asystole or a lethal rhythm much easier

Non-pharmacological interventions for pediatric arrhythmias

-Carotid sinus massage -Valsalva maneuver (initiating vagal response to slow down HR, bare down & act like trying to have a BM)

General nursing interventions

-Check the Patient First! -Assess for underlying causes (hypoxia, MI, hypervolemia, fever, pain) -Assess electrolytes (potassium #1, magnesium #2) -Administer antidysrhythmic medications -Recognize patient response to treatment

Why is atrial fibrillation of unknown duration with inadequate anticoagulation a contraindication to cardioversion?

-Could cause a thromboembolism -If we don't know how long a patient has been in Afib and don't have the ability to do a TEE and we are concerned about a clot being there, that risk outweighs the benefit of cardioversion; the risk of a stroke is so high, once we go to NSR, it'll squeeze that atrium pushing the clot all the way through the system

What does an implantable cardioverter-defibrillator (ICD) do?

-Detects life threatening dysrhythmias -Automatically delivers a shock -Can pace the heart -Records and stores data so providers can adjust settings or medications

What are the contraindications to cardioversion?

-Dig toxicity -Electrolyte abnormalities (hypokalemia, hyperkalemia, hypomagnesemia) -Atrial fibrillation with slow ventricular response -Atrial fibrillation of unknown duration with inadequate anticoagulation -Pacemaker dependency -Low-amplitude R wave

Nursing management of ICD

-Educate Client on device -Continuous cardiac monitoring post procedure to make sure it's firing appropriately -Do not perform CPR unless ICD does not fire -May lose consciousness -Discomfort or tingling when firing if you are touching the patient

Rare exceptions to pediatric arrythmias

-Electrolyte abnormalities/imbalances -Toxic drug ingestions that mess up their acid/base balance

Transvenous pacemaker

-Goes through a vein (subclavian) -Put a guide wire through that vein that goes to the heart

Cardiopulmonary arrest

-Gradual deterioration of a pediatrics respiratory system which will lead to a circulatory issue -Treat the respiratory emergency first which will often fix the cardiac involvement/event -See them compensate for a long time because have (ex:) pneumonia and then they become so hypoxic that they start to have cardiac involvement; but if we can restore their oxygen and respirations, the rhythm will normally resolve on its own issue

How does maze work?

-Happens during an open heart procedure (coronary artery bypass surgery or mitral valve surgery) -Directly on top of the heart itself -Ablates/burns pathways on the heart tissue to promote scar tissue and force normal conduction -Scar tissue disrupts path of electrical impulses

Epicardial pacemaker

-Happens with open heart surgery -Corkscrew in pacer leads into the heart tissue and they will come out of chest wall connected to a pacer and we can pace the heart until it's over the excitability of the surgery and then they get pulled out

What causes pulseless rhythms in pediatrics?

-Hypovolemia -Hypothermia -Electrolyte imbalance -Tamponade -Toxic ingestion

Nursing responsibilities for mechanical cardioversion

-Informed consent -NPO 6-8 hours prior (avoid aspiration) -Equipment (suction, oxygen, crash cart, IV) -Sedation: conscious sedation vs. anesthesia -Document EKG strips during the procedure -Document vital signs

What is a valsalva maneuver?

-Initiates vagal response to slow down HR -Bare down & act like trying to have a BM Easier to occlude a straw and blow into the straw (initiates bearing down effect)

What is TEE used for?

-May be done prior to cardioversion -Looks for clots in the atrium (don't want a clot to go someplace else - ex: stroke)

DDD

-Most common mode of permanent pacemakers -Most closely resembles the SA node -Mimics normal sinus rhythm -Makes atrium contract, ventricles contract, and does so at a rate of 60-100

Failure to pace

-No energy was given -The HR is going below its programmed rate -Expecting to see a pacer spike followed by a P wave, pacer spike followed by a QRS. When you look on the monitor, don't see pacer spikes

What is a carotid sinus massage?

-Occludes both carotid arteries -Induces nerve that runs along side of it to slow down rhythm

Transcutaneous pacemaker

-Outside of the body -Short-term

Sensing (or seeing)

-Pacemaker *detects the hearts' intrinsic or own activity* -Looking at the heart and saying, what are you doing. If you're doing something, great, I don't need to. If you're not doing something/I don't see it, then I need to do something about it

Undersensing

-Pacemaker cannot detect intrinsic/own electrical activity -Fence is too high, so the pacemaker can't see what's happening on the other side, so it can't sense and fires at will

Oversensing

-Pacemaker detects non-cardiac electrical signals and results in a failure to pace -The fence is too low & the pacemaker can see everything that is happening. -Might pick up other movement that isn't cardiac movement. It doesn't do anything because it sees movement, so it chills out/does nothing

AAI

-Paces the atrium when the pacemaker doesn't sense intrinsic atrial contraction -Goes into backup mode if doesn't contract

VVI

-Paces the ventricles when the pacemaker doesn't sense intrinsic ventricular contraction -Goes into backup mode if doesn't contract

What causes pediatric arrhythmias?

-Pain -Fever -Fear -Hypoxia

s/s of decreased cardiac output

-Palpitations -Fluttering -Dizziness -Lightheadedness -Syncope -Chest pain -SOB

Who can do a carotid sinus massage?

-Physicians only -Lots of decreased blood flow to the brain)

Complications after placing a pacemaker

-Pneumothorax (collapsed lung) -Pocket erosion (infection in pocket) -Abdominal twitching (hiccups)

How does ablation work?

-Procedure is similar to a heart catheter -The catheter delivers energy (radiofrequency) to ablate/burn cardiac tissue and puts scar tissue at the point where the electrical activity was trying to go -When scar tissue is built up, it forces the electrical activity back to where it was supposed to go (SA, AV, Bundle of His, or Purkinje)

What do pacemakers do?

-Provides electrical stimulus when the heart fails to generate or conduct it on its own rate -An external source to wake up the heart and beat

What is the most common pulseless rhythm in pediatrics?

-Pulseless electrical activity (PEA) -Leads to asystole if not resolved

What are the two main principles of pacemakers

-Sensing -Capture

Types of permanent pacemakers

-Single (one) chamber -Dual chamber

What causes pediatric bradyarrhythmia?

-Sleeping -Very strong vagal response (coughing, placing NG tube)

Types of pacemakers

-Temporary -Permanent

Failure to capture

-The heart doesn't depolarize/contract to the energy given -Might see a pacer spike followed by nothing; heart didn't wake up to contract

Why is dig toxicity a contraindication to cardioversion?

-The likelihood of going into NSR post-shock is minimal -More likely will go into ventricular irritability/asystole

Why do we use defibrillation?

-The patient doesn't have a pulse -The patient is dead

Types of temporary pacemakers

-Transcutaneous -Transvenous -Epicardial

What are the types of responses to sensing?

-Trigger = give an impulse -Inhibiting = chill -Or both

Troubleshooting/issues with pacemakers

-Undersensing -Oversensing -Failure to pace -Failure to capture

Defibrillation is used for what rhythms?

-Ventricular fibrillation -Unstable (pulseless) ventricular tachycardia

When is maze used?

-When medications and other treatments don't -Only used then because it's invasive and a long recover time

What is chamber sensed?

-Where the pacemaker is looking - same as first chamber -Can only look where there is a lead

Options available for chamber paced function

0 - none A - atrium V - ventricle D - dual (A+ V)

Options available for chamber sensed function

0 - none A - atrium V - ventricle D - dual (A+ V)

Options available for programmability, rate modulation function

0 - none P - programmable M - multiprogrammable C - communicating R - rate modulating

Options available for response to sensing function

0 - none T - triggered I - inhibited D - dual (T +I)

A client has had an automatic implanted cardioverter defibrillator (AICD) implanted. The nurse explains the purpose and benefits of the AICD to the client's family. The least likely reason for the client's AICD implantation is that the client: A. Experiences recurrent episodes of atrial flutter. B. Has survived at least one episode of cardiac arrest with ventricular origin. C. Experiences recurrent episodes of ventricular tachycardia. D. Is at risk for death due to structural cardiac disease with poor ventricular function.

A AICDs are used for dysrhythmias of a ventricular nature. It is not about cardiac arrest. It is not about ventricular tachycardia. It is not about structural cardiac disease.

The nurse is caring for a client 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 client's level of consciousness (LOC)

A Following catheter ablation therapy, the client 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 nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? A. "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." B. "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." C. "You should avoid tennis; basketball or football would be a good substitute." D. "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers."

A It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (e.g., basketball, football, hockey).

Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. The nurse knows elective cardioversion prevents what? A. Disrupting the heart during the critical period of ventricular repolarization. B. Disrupting the heart during the critical period of atrial repolarization. C. Disrupting the heart during the critical period of ventricular depolarization. D. Disrupting the heart during the critical period of atrial depolarization.

A It is similar to defibrillation. One difference is that the machine that delivers the electrical stimulation waits to discharge until it senses the appearance of an R wave. By doing so, the machine prevents disrupting the heart during the critical period of ventricular repolarization.

A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? A. Double-check the monitoring equipment. B. Do nothing; there is no cause for alarm. C. Suggest the need for a new beta-blocker to the doctor. D. Measure the client's blood pressure.

A One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? A. "I'll keep a log of each time my ICD discharges." B. "I can't wait to get back to my football league." C. "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." D. "I need to stay at least 10 inches away from the microwave."

A The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD.

A nurse is caring for a client who has had an automatic cardiac defibrillator implanted. What instructions should the nurse provide to the client? A. Avoid devices with a magnetic field. B. Use digital cellular telephones. C. Avoid driving for at least 3 months. D. Avoid using microwave ovens.

A The nurse should instruct the client to avoid devices with a magnetic field. Examples include magnetic resonance imaging devices, extracorporeal shock wave lithotripsy machines, electrocautery and diathermy devices, peripheral nerve stimulators, large industrial electrical motors, and arc welding equipment. Electrical signals from digital cellular telephones may mimic an abnormal heart rhythm, activating the automatic implanted cardiac defibrillator. The nurse should instruct the client to use analog cellular telephones and to restrict driving for at least 6 months. Microwave ovens have shields or are grounded, making them safe for use by clients with an automatic implanted cardiac defibrillator.

The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply. A. Avoid handheld screening devices in airports B. Refrain from walking through antitheft devices C. Check pulse daily, reporting sudden slowing or increase D. Avoid the usage of microwave ovens and electronic tools E. Wear a medical alert, noting the presence of a pacemaker

A, C, E Handheld screening devices used in airports may interfere with the pacemaker. Patients should be advised to ask security personnel to perform a hand search instead of using the handheld screening device. With a permanent pacemaker, the client should be instructed initially to restrict activity on the side of implantation. Clients also should be educated to perform a pulse check daily and to wear or carry medical identification to alert personnel to the presence of the pacemaker. Client should walk through antitheft devices quickly and avoid standing in or near these devices. Client can safely use microwave ovens and electronic tools.

What is maze?

An invasive, surgical procedure used to treat atrial arrhythmias

A client has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this client? A. Chest pain B. Bleeding at the implantation site C. Malignant hyperthermia D. Bradycardia

B Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? A. Scar on the chest B. "Spike" on the rhythm strip C. Quality of the pulse D. Vibration under the skin

B Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin.

When planning the care of a client with an implanted pacemaker, what assessment should the nurse prioritize? A. Core body temperature B. Heart rate and rhythm C. Blood pressure D. Oxygen saturation level

B For clients with pacemakers, close monitoring of the heart rate and rhythm is a priority, even though each of the other listed vital signs must be assessed.

The ED nurse is caring for a client 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 client at the time shock is delivered. C. Continue to ventilate the client via endotracheal tube during the procedure. D. Allow at least 3 minutes between shocks.

B 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 client's skin to prevent leaking. Second, ensure that no one is in contact with the client or with anything that is touching the client when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the client. Ventilation should be stopped during defibrillation.

During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response? A. "Cardioversion is done on a beating heart; defibrillation is not." B. "The difference is the timing of the delivery of the electric current." C. "Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not." D. "Cardioversion is always attempted before defibrillation because it has fewer risks."

B One major difference between cardioversion and defibrillation is the timing of the delivery of electrical current. In cardioversion, the delivery of the electrical current is synchronized with the client's electrical events; in defibrillation, the delivery of the current is immediate and unsynchronized. Both can be done on beating heart (i.e., in a dysrhythmia). Cardioversion is not necessarily attempted first.

The nurse is caring for a client with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the client's most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best interpret this finding? A. Recognize that the procedure was unsuccessful. B. Recognize this as a therapeutic goal of the procedure. C. Liaise with the care team in preparation for repeating the maze procedure. D. Prepare the client for pacemaker implantation.

B The maze procedure is an open heart surgical procedure for refractory atrial fibrillation. Small transmural incisions are made throughout the atria. The resulting formation of scar tissue prevents reentry conduction of the electrical impulse. Consequently, scar formation would constitute a successful procedure. There is no indication for repeating the procedure or implanting a pacemaker.

The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason? A. The delivered shock must be synchronized with the client's QRS complex. B. The defibrillator won't deliver a shock if the synchronizer switch is turned on. C. The defibrillator won't deliver a shock if the synchronizer switch is turned off. D. The shock must be synchronized with the client's T wave.

B The nurse needs to check the synchronizer switch to ensure the switch is turned off. The defibrillator won't deliver a shock to the client in ventricular fibrillation if the synchronizer switch is turned on because the defibrillator needs to recognize a QRS complex when the switch is turned on. The synchronizer switch should be turned on when attempting to terminate arrhythmias that contain QRS complexes, such as rapid atrial fibrillation that's resistant to pharmacologic measures. A synchronized shock should occur with the QRS complex, not the T wave, to avoid inducing ventricular fibrillation and allow for a lower shock dose.

A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond? A. "Enjoy your hunting trip." B. "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." C. "Being that close to a rifle might make your ICD fire." D. "You'll need to take an extra dose of your antiarrhythmic before you shoot."

B The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with the left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of an antiarrhythmic.

Undersensing occurs as a pacemaker malfunctions. The nurse understands undersensing occurs as a result of which event? A. The complex does not follow the pacing spike B. Pacing spike occurs at the preset level C. Total absence of the pacing spike D. Loss of pacing artifact

B Undersensing means that the pacing spike occurs at a preset interval despite the patient's intrinsic rhythm. Loss of capture occurs when a complex does not follow a pacing spike. Loss of pacing is total absence of the pacing spike. Oversensing occurs when there is a loss of pacing artifact.

A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting for 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure? A. Administer the prescribed digitalis to the client before the scheduled procedure. B. Administer anticoagulant therapy as prescribed prior to the procedure. C. Administer moderate sedation IV and analgesic medication as prescribed. D.Maintain the client on NPO status for 8 hours prior to the procedure

C Before an elective cardioversion, the client should receive moderate sedation IV as well as an analgesic medication or anesthesia. In contrast, in emergent situations, the client may not be premedicated. Digoxin is usually withheld for 48 hours before cardioversion to ensure the resumption of sinus rhythm with normal conduction. If the cardioversion is elective and the dysrhythmia has lasted longer than 48 hours, anticoagulation performed for a few weeks before cardioversion may be indicated. The client is instructed not to eat or drink for at least 4 hours before the procedure.

A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? A. Insertion of an ICD B. Insertion of a permanent pacemaker C. Catheter ablation therapy D. Maze procedure

C Catheter ablation destroys specific cells that are the cause or central conduction route of a tachydysrhythmia. It is performed with or after an electrophysiology study. Usual indications for ablation are atrioventricular nodal reentry tachycardia, a recurrent atrial dysrhythmia (especially atrial fibrillation), or ventricular tachycardia unresponsive to previous therapy (or for which the therapy produced significant side effects).

The nurse is planning discharge teaching for a client with a newly inserted permanent pacemaker. What is the priority teaching point for this client? 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 strong electromagnetic fields D. Avoid walking through store and library antitheft devices.

C High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows clients 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 clients 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.

The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button? A. Placing gel on the chest B. Checking the ECG rhythm C. Shouts, "All clear" D. States, "Charging"

C Preceding pressing the discharge button, the nurse shouts "All clear" to ensure that no one is in contact with the client. The other options are correct but not the nursing action immediately preceding.

The nurse and student nurse are observing a cardioversion procedure completed by a physician. At which time is the nurse most correct to identify to the student when the electrical current will be initiated? A. During stimulation of the SA node B. During repolarization of the heart C. During ventricular depolarization D. During the QRS complex

C The electrical current is initiated at the R wave when ventricular depolarization occurs. The electrical current completely depolarizes the entire myocardium with the goal of restoring the normal pacemaker of the heart. The other options focus on an incorrect timing that will not restore the normal electrical conduction.

Why is pacemaker dependency a contraindication to cardioversion?

Can cause a rise in thresholds with loss of capture

Why are electrolyte abnormalities (hypokalemia, hyperkalemia, hypomagnesemia) contraindications to cardioversion?

Can cause ventricular irritability/fibrillation

What is TEE

Transesophageal electrocardiogram

What is the response to sensing?

What the pacemaker is supposed to do with what it sees

What is chamber paced?

Where they put the leads

What are pediatric arrhythmias generally going to be related to?

Respiratory/oxygenation issues

What does A paced mean?

Should see pacer spike then P wave

What does AV paced mean?

Should see pacer spike then P wave, pacer spike then QRS

What is an implantable cardioverter-defibrillator (ICD) used for?

Sudden death survivors and recurrent ventricular tachycardia

Why is low-amplitude R wave a contraindication to cardioversion?

Synchronization on T wave leading to ventricular fibrillation

The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During the client's most recent follow-up appointment, the nurse identifies data that suggest the client may be socially isolated and depressed. What nursing diagnosis is suggested by these data? A. Decisional conflict related to pacemaker implantation B. Deficient knowledge related to pacemaker implantation C. Spiritual distress related to pacemaker implantation D. Ineffective coping related to pacemaker implantation

D Depression and isolation may be symptoms of ineffective coping with the implantation. These psychosocial symptoms are not necessarily indicative of issues related to knowledge or decisions. Further data would be needed to determine a spiritual component to the client's challenges.

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? A. Date and time of insertion B. Location of the generator C. Model number D. Pacer rate

D After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.

Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? A. Atropine B. Digoxin C. Enalapril D. Diazepam

D Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as diazepam.

A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? A. Clients with recurrent life-threatening bradycardias B. Clients with sinus tachycardia C. Clients with ventricular bradycardia D. Clients with recurrent life-threatening tachydysrhythmias

D The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect.

The nurse is defibrillating a patient in ventricular fibrillation with paddles on a monophasic defibrillator. How much paddle pressure should the nurse apply when defibrillating? A. 5 to 10 lbs B. 5 to 10 lbs C. 15 to 20 lbs D. 20 to 25 lbs

D When using paddles, 20 to 25 lb of pressure must be used in order to ensure good skin contact.

To slow down fast rhythms, the patient must be stable meaning what?

Has a pulse