MS test #3- ch 26 , 17 prepu
An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? Imagery Progressive muscular relaxation Optimistic self-recitation Distraction
imagery
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? "You will be just fine; the operating room nurses will take good care of you." "Let me explain to you what will happen next." "We will keep your family informed of your progress." "It is best to take deep breaths and relax before the procedure."
"Let me explain to you what will happen next."
The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed? "If I do not follow the instructions, my surgery could be cancelled." "My medical records will be sent to the ambulatory care center prior to my surgery." "The nurse will explain the details of the surgery before I sign a consent." "The physician will update my family after the procedure and provide specific discharge instructions."
"The nurse will explain the details of the surgery before I sign a consent." Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge.
The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? "The doctor wants to see if your heart will switch back to its normal rhythm by itself." "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." "There is a long list of clients in line to be cardioverted."
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion. The doctor will not wait for a change in rhythm. Resting the heart will not change the rhythm. There is no delay but safer for the clots to be dissolved with the anticoagulant.
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm?0.12 and 0.2 seconds. 0.25 and 0.4 seconds. 0.05 and 0.1 seconds. 0.15 and 0.3 seconds.
0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? 1 3 7 5
7
A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? 7 to 10 days 2 weeks 2 to 3 days 4 weeks
7 to 10 days Aspirin, a common OTC medication that inhibits platelet aggregation, should be prudently discontinued 7 to 10 days before surgery; otherwise, the patient may be at increased risk for bleeding (Rothrock, 2010).
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? 150 to 240 mg/dL 250 to 300 mg/dL 80 to 110 mg/dL 300 to 350 mg/dL
80 to 110 mg/dL
The nurse expects informed consent to be obtained for insertion of: A gastrostomy tube An intravenous catheter A nasogastric tube An indwelling urinary catheter
A gastrostomy tube
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action? a. defibrillation b. cardioversion c. IV bolus of atropine d. IV bolus of dobutamine
A. Adavnced cardiac lifesupport recommends early defibrillation for witnessed ventricular fibrillation. A cardioversion is used with a client who has a pulse. Atropine is used for bradycardia and dobutamine is an intropic medication used to increased cardiac output.
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? Delayed conduction, producing a prolonged PR interval Variable heart rate, usually fewer than 90 bpm P waves hidden within the QRS complex Irregular rhythm
A. Delayed conduction, producing a prolonged PR interval First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.
Which is not a likely origination point for cardiac dysrhythmias? ventricles bundle of His atria atrioventricular node
A. bundle of His Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His.
A client has started to exhibit dangerous PVCs in the cardiac postoperative unit. The client has been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should the nurse be ready to do? Prepare for defibrillation. Adjust the IV infusion. Call for the doctor and just wait. Administer additional lidocaine.
Adjust the IV infusion.Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient.
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? Pituitary Thyroid Parathyroid Adrenal
Adrenal
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client? adrenal insufficiency obstruction hypoglycemia surgical site infection SUBMIT ANSWER Ex
Adrenal insufficiency Patients who have received corticosteroids are at risk for adrenal insufficiency. They are not at greater risk for obstruction, infection, or hypoglycemia.
A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? Discuss the risk for infection caused by wearing the ring. Allow the client to wear the ring and cover it with tape. Remove the ring once the client is sedated. Notify the surgeon to cancel surgery.
Allow the client to wear the ring and cover it with tape.
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? Potassium supplement Antihypertensive Anticoagulant Diuretic
Anticoagulant
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? Asystole Atrial flutter Premature ventricular contraction Ventricular fibrillation
Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? Atrial flutter Ventricular fibrillation Ventricular tachycardia Atrial fibrillation
Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in shape. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? Atrial rate of 300 to 400 Regular rhythm P wave resent before each QRS Normal PR interval
Atrial rate of 300 to 400 ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves.
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? Atropine Amiodarone Dobutamine Lidocaine
Atropine I.V. push atropine is used to treat symptomatic bradycardia. Dobutamine is used to treat heart failure and low cardiac output. Amiodarone is used to treat ventricular fibrillation and unstable ventricular tachycardia. Lidocaine is used to treat ventricular ectopy, ventricular tachycardia, and ventricular fibrillation.
.A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to request sublingual nitroglycerin. lie down and elevate the feet. apply supplemental oxygen. avoid caffeinated beverages.
Avoid caffeinated beverages
The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? Prepare to client for cardioversion. Send the client to the cardiac catheterization laboratory. Administer an IV bolus of atropine. Review the client's medication record.
B. Administer an IV bolus of atropine Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first. Cardioversion is used to treat a fast heart rate. Reviewing the medication record will not help the client initially.
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Fluttering Nausea Fever Hypotension
B. Fluttering Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? Warfarin Atropine Adenosine Amiodarone
B. Warfarin Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone, flecainide, ibutilide, propafenone, or sotalol prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation
The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? atropine sulfate atenolol diltiazem nadolol
B. atropine sulfate Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation. The client will be treated with an anticholinergic that blocks the effects of the vagal nerve. Atenolol and nadolol are beta blockers that are used for chest pain, myocardial infarction, and hypertension. Diltazem is a calcium channel blocker used to treat angina or slow the heart rate.
A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: inherent rhythmicity of all muscle tissue. inherent electrons in muscle tissue. inherent rhythmicity of cardiac muscle tissue. sufficient blood pressure.
B. inherent rhythmicity of cardiac muscle tissue. Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively.
A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? "I will cut back on my smoking and drinking alcohol." "I will drink coffee with only two of my meals." "If I take my metoprolol daily, I will be able to control my heart rate." "I will take my levothyroxine daily."
C. "I will drink coffee with only two of my meals." Stimulation of the sympathetic nervous system with caffeinated beverages, smoking, and drinking alcohol increases heart rate.The client is still drinking caffeine with two meals, increasing the risk for a fast heart rate. Taking medications such as metoprolol and levothyroxine will help the client maintain a normal heart rate by decreasing stimulation of the sympathetic nervous system.
The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width." "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." "The two look very much alike; it is difficult to tell the difference." "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal."
C. "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." Ventricular fibrillation is irregular with undulating waves and no QRS complex, while ventricular tachycardia is usually regular and fast with wide QRS complexes. The rhythms look different on the electrocardiogram strip. The QRS is wide and bizarre or undefined in ventricular fibrillation. The P-R interval is not present in the ventricular dysrhythmias.
The nurse knows that what PR interval presents a first-degree heart block? 0.24 seconds 0.18 seconds 0.14 seconds 0.16 seconds
C. 0.24 seconds In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? assessing blood pressure and heart rate frequently maintaining intravenous fluids identifying a code-level status alerting the healthcare provider of the third-degree heart block
C. Alerting the healthcare provider of the third-degree heart block The client may experience low cardiac output with third-degree AV block. The healthcare provider needs to intervene to preserve the client's cardiac output. Monitoring the blood pressure and heart rate are important, but not the priority. The identification of a code status during a heart block is not appropriate. The IV fluids are not helpful if the heart is not perfusing.
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? Delayed conduction, producing a prolonged PR interval A variable heart rate, usually fewer than 60 bpm P waves hidden with the QRS complex An irregular rhythm
C. Delayed conduction, producing a prolonged PR interval First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds).
A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardiogram as an indicator of sinus tachycardia? heart rate of 118 bpm Q wave of 0.04 seconds QRS duration of 0.16 seconds PR interval of 0.1 seconds
C. heart rate of 118 bpm The sinus node creates an impulse at a faster-than-normal rate. The PR interval of 0.1 seconds, QRS duration of 0.16 seconds and Q wave of 0.04 seconds are consistent with a normal sinus rhythm. Sinus tachycardia occurs when the heart rate is over 100 bpm
The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect? postoperative site hematoma internal bleeding at pacemaker site normal postoperative healing pacemaker site infection
C. pacemaker site infection Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These symptoms include swelling, unusual tenderness, drainage, and increased warmth. When the site is healing normally, there will be no tenderness and throbbing. A hematoma forms a lump at the pacemaker insertion site. Mild bleeding will be drainage.
The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following? Turkey breast, baked sweet potato, asparagus, and an orange Baked chicken, mashed potatoes, broccoli, and strawberries Cheeseburger, french fries, coleslaw, and ice cream Grilled salmon, rice pilaf, green beans, and cantaloupe
Cheeseburger, french fries, coleslaw, and ice cream
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? Clients with recurrent life-threatening bradycardias Clients with sinus tachycardia Clients with ventricular bradycardia Clients with recurrent life-threatening tachydysrhythmias
Clients with recurrent life-threatening tachydysrhythmias 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.
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? During the preoperative period Following the surgical procedure Upon arrival to the surgical unit At the time of discharge instructions
Correct response: During the preoperative period Explanation: The best time to begin teaching about care needed in the postoperative period is during the preoperative time. At this time, the client is more alert and focused on the information provided by the nurse. Clients and family members can better be prepared and participate in the recovery period if they know what to expect. Anxiety is a factor on arrival to the surgical unit that could interfere with learning. Pain could interfere with the learning process, following a surgical procedure. At the time of discharge, both pain and timeliness may be an issue in understanding and obtaining care needed during the postoperative time.
A fractured skull would be classified under which category of surgery based on urgency? Emergent Elective Urgent Required
Correct response: Emergent Explanation: Emergent surgery occurs when the client requires immediate attention. An elective surgery is classified as a surgery that the client should have. A required surgery means that the client needs to have surgery. An urgent surgery occurs when the client requires prompt attention.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? Make inhalation longer than exhalation. Use chest breathing. Use diaphragmatic breathing. Exhale through an open mouth.
Correct response: Use diaphragmatic breathing. Explanation: In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." "I will avoid any large magnets that may affect my pacemaker." "I will call the doctor if my incision becomes swollen and red." "We will be getting rid of our microwave oven so it will not affect my pacemaker." SUBMIT ANSWER
D. "We will be getting rid of our microwave oven so it will not affect my pacemaker." Permanent pacemaker generators have filters that protect them from electrical interference from most household devices, motors, and appliances, so the client can keep the microwave oven. Clients are taught to check pulses daily, avoid large magnets, and report any incisional redness or swelling.
The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." "The doctor wants to see if your heart will switch back to its normal rhythm by itself." "There is a long list of clients in line to be cardioverted." SUBMIT ANSWER
D. "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion. The doctor will not wait for a change in rhythm. Resting the heart will not change the rhythm. There is no delay but safer for the clots to be dissolved with the anticoagulant.
A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next? Place the client on supplemental oxygen. Prepare to administer a calcium channel blocker. Question the client about alcohol and illicit drug use. Instruct the client to hold the breath and bear down.
D. Question the client about alcohol and illicit drug use.The client is experiencing sinus tachycardia. Since the client's findings of tachycardia, dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the client about alcohol and illicit drug use. This information will direct the client's plan of care. Causes of tachycardia include medications that stimulate the sympathetic response, stimulants, and illicit drugs. The treatment goals for sinus tachycardia is usually determined by the severity of symptoms and directed at identifying and abolishing its cause. The other interventions may be implemented, but determining the cause of the tachycardia is essential.
Why is assessment of dentition important in the patient preparing to have a surgical procedure with general anesthesia? Oral hygiene is important for all patients. Decayed teeth or dental prosthesis can become dislodged during intubation. The patient may require referral to the dentist. The patient can sue if a tooth falls out during surgery.
Decayed teeth or dental prosthesis can become dislodged during intubation.
A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia? diuretics insulin corticosteroids anticoagulants
Diuretics Refer to Table 5-4 in the text
A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? Check the security of all connections and increase the milliamperage Document the findings and continue to monitor the client Obtain a 12-lead ECG and a portable chest x-ray Reposition the extremity and turn the client to left side
Document the findings and continue to monitor the client Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the client. Repositioning the client, placing the client on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape.
A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? Check the security of all connections and increase the milliamperage Reposition the extremity and turn the client to left side Document the findings and continue to monitor the client Obtain a 12-lead ECG and a portable chest x-ray
Document the findings and continue to monitor the client Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the client. Repositioning the client, placing the client on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape.
What action by the nurse best encompasses the preoperative phase? Monitoring vital signs every 15 minutes Educating clients on signs and symptoms of infection Documenting the application of sequential compression devices (SCDs) Shaving the client using a straight razor
Educating the patients on signs and symptoms of infection
Informed consent from the surgical client is essential in all of the following categories of surgery except: Elective surgery Required surgery Urgent surgery Emergent surgery
Emergent surgery
A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed? The client exhales forcefully with a short expiration. The client places the hands on the lower chest to feel the rise and fall with breathing. The client performs diaphragmatic breathing in a semi-Fowler's position. The client breathes in deeply through the nose and mouth.
Exhales forcefully with a short expiration Diaphragmatic breathing should be performed gently and fully.
Which domain of perioperative nursing practice focuses on clinical processes and outcomes? Physiological responses Health care systems Safety Behavioral responses
Health care systems
The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia? P-to-QR ratio of 1:2. QR interval of 0.25 seconds. PR interval of 0.24 seconds. Heart rate of 42 beats per minute (bpm).
Heart rate of 42 beats per minute (bpm). The heart rate of 42 bpm is slow but normal when it occurs in athletes with a sinus bradycardia. The PR interval is prolonged at 0.24 seconds, indicating a heart block. The QR interval is prolonged and indicates ventricular delay. The ratio of P to QR should be 1:1 in sinus bradycardia.
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? Hypertension Dehydration Glucosuria Hypoglycemia
Hypoglycemia
The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? Alkalosis Hypokalemia Hypovolemia Bradycardia
Hypovolemia PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? Faulty generator Sensitivity is too low Fracture of the lead wire Lead wire dislodgement
Lead wire dislodgement Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation.
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? Administer every five minutes during cardiac resuscitation Keep the client flat for one hour after administration Monitor vital signs and cardiac rhythm Document heart rate before and after administration
Monitor vital signs and cardiac rhythm The nurse should monitor the client's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill client. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a client flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.
During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse? Notify the nurse manager to follow up on the procedure. Notify the physician regarding postoperative pain medications. Notify the surgical team to remove all latex-based items. Notify the dietary department. SUBMIT ANSWER
Notify the surgical team to remove all latex-based items
The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. gender physical condition age health status Ethnicity nutritional status
Nutritional status Age Physical condition Health status
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults? All older people face similar risks when undergoing surgeries. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. Aging processes reduce the chances that surgery will be successful for these clients. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.
Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients The underlying principle that guides preoperative assessment, surgical care, and postoperative care is that elderly clients have less physiologic reserve (the ability of an organ to return to normal after a disturbance in its equilibrium) than younger clients. The hazards of surgery for the elderly are proportional to the number and severity of coexisting health problems and the nature and duration of the operative procedure. Respiratory and cardiac complications are the leading causes of postoperative morbidity and mortality in older adults. The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function?
A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? Osteoporosis Diabetes Urinary tract infection Pregnancy
Osteoporosis
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? P wave QRS complex PR interval T wave
P wave The P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The T wave depicts the relative refractory period, representing ventricular repolarization.
Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience?
Perioperative period includes the preoperative, intraoperative, and postoperative phases. The preoperative phase is the period of time from when the decision for surgical intervention is made to when the client is transferred to the operating room. The intraoperative phase is the period of time from when the client is transferred to the operating room to when he or she is admitted to the postanesthesia care unit. The postoperative phase is the period of time that begins with the admission of the client to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.
The nurse recognizes that written informed consent is required for insertion of a(n): Oral airway. Nasogastric tube. Urinary catheter. Peripherally-inserted central catheter.
Peripherally-inserted central catheter. Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? Case manager Physician Nurse Certified nurse's aide
Physician It is the physician's responsibility to provide appropriate information. It is not the responsibility of the nurse, case manager, or certified nurse's aide to gain informed consent.
You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility? Place gauze under and over the ring and apply adhesive tape over it. Medicate the client and then remove the ring. Tell the physician and anesthesiologist. Explain that the client cannot go into the operating room with jewelry on
Place gauze under and over the ring and apply adhesive tape over it. If the client is reluctant to remove a wedding band, the nurse may slip gauze under the ring, then loop the gauze around the finger and wrist or apply adhesive tape over a plain wedding band. You would not tell the client that he or she cannot go to the operating room wearing the ring. You would never medicate the client and then remove the ring against his or her will. It is not necessary to tell the physician and the anesthesiologist that the client does not want to remove the wedding band.
When is the ideal time to discuss preoperative teaching Day of surgery Prior to entering the pre-op area When the patient is comfortable and sedated Preadmission visit
Preadmission visit The ideal timing for preoperative teaching is not on the day of surgery but during the preadmission visit, when diagnostic tests are performed. Teaching should be done long before the patient enters the preop area. Preoperative teaching should not be done when the patient is sedated.
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? Notify the nurse manager of the client's questions. Request that the surgeon come and answer the questions. Place the consent form in the client's medical record. Answer the client's questions.
Request that the surgeon come and answer the questions.
The nurse recognizes that the client who takes hydrochlorothiazide to manage hypertension is predisposed for which interaction with anesthesia? Respiratory depression Hypotension Increased risk of bleeding Seizures
Respiratory depression
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? Normal sinus rhythm Sinus tachycardia Ventricular tachycardia Sinus bradycardia
Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy).
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? - "Spike" on the rhythm strip - Vibration under the skin - Quality of the pulse - Scar on the chest
Spike in the rhythm strip 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.
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? Deep breathing and coughing exercises may be used as relaxation techniques. Splint the incision site using a pillow during deep breathing and coughing exercises. Pain medication should be taken before completing deep breathing and coughing exercises. Deep breathing and coughing exercises should be completed every 8 hours.
Splint the incision site using a pillow during deep breathing and coughing exercises
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? The 72-year-old client who takes no routine medications. The 35-year-old client with non-insulin dependent diabetes. The 47-year-old client who stopped smoking 2 years ago. The 28-year-old client who occasionally smoked marijuana in high school.
The 35-year-old client with non-insulin dependent diabetes. The client with diabetes is at risk for complications during the intraoperative or postoperative period. Hypoglycemia can develop during anesthesia or from inadequate carbohydrate intake or excess insulin administration postoperatively. Hyperglycemia can increase the risk for wound infection and delay wound healing. Smokers are encouraged to stop 4 to 8 weeks before surgery. Recent ilicit drug use can increase the risk for adverse reactions to anesthesia. Healthy older adults are not at increased risk.
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? Ventricular repolarization Ventricular depolarization Atrial depolarization Early ventricular repolarization
The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave.
The nurse analyzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up?' PR interval that is 0.18 seconds long ST segment that is isoelectric in appearance QT interval that is 0. 46 seconds long QRS complex that is 0.10 seconds long
The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the client may be at risk for a lethal ventricular dysrhythmia, called torsades de pointes. The other findings are normal.
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? The importance of taking the medication 1 hour before or 2 hours after a meal The need to sit upright for 30 minutes after taking the medication The importance of adequate fluid intake The need to have regular blood levels drawn
The need to have regular blood levels drawn One drawback of warfarin therapy is the need to have blood levels drawn on a regular basis. The medication does not need to be taken on an empty stomach, and the client does not have to sit upright. Adequate fluid intake is useful in a general way, but the need for fluids is not increased by taking warfarin.
When does the nurse understand the patient is knowledgeable about the impending surgical procedure? The patient expresses concern about postoperative pain. The patient participates willingly in the preoperative preparation. The patient discusses stress factors causing the patient to feel depressed. The patient verbalizes fears to family.
The patient participates willingly in the preoperative preparation.
The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true? Tumor excision A biopsy A face-lift Placement of gastrostomy tube
Tumor excision An example of a curative surgical procedure is tumor excision. A biopsy, a face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedures.
When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? Up to 72 hours after alcohol withdrawal Upon awakening in the postanesthesia care unit Immediately upon admission Up to 24 hours after alcohol withdrawal
Up to 72 hours after alcohol withdrawal Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively. Onset of symptoms depends on when alcohol was last consumed. Twenty-four hours is too short a time frame to consider alcohol withdrawal delirium as no longer a threat to a chronic alcoholic.
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Ventricular fibrillation Third-degree heart block Ventricular tachycardia Atrial fibrillation
Ventricular fibrillation The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations.
The nurse would identify which vitamin deficiency to prevent hemorrhaging during surgery? Vitamin K Magnesium Vitamin A Zinc
Vitamin K Explanation:Vitamin K is important for normal blood clotting. Vitamin A and zinc deficiencies would affect the immune system, whereas a magnesium deficiency would delay wound healing.
At what point does the preoperative period end? When the decision is made to proceed with surgery When the client is transferred onto the operating table When the client is admitted to the PACU When the client signs the consent form
When the client is transferred onto the operating table
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? "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." "You should avoid tennis; basketball or football would be a good substitute." "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers."
a "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." 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 (eg, basketball, football, hockey).
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? Double-check the monitoring equipment. Do nothing; there is no cause for alarm. Suggest the need for a new beta-blocker to the doctor. Measure the client's blood pressure.
a Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? Ventricular tachycardia Atrial flutter Atrial fibrillation Ventricular fibrillation
b Atrial flutter Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects (Fuster, Walsh et al., 2011).
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: assesses how well the client is recovering from anesthesia. continuously monitors the sedated client. obtains a surgical consent from the client's mother. performs a complete assessment of the client.
continuously monitors the sedated client. Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness occurs during all phases of perioperative care. Obtaining consent would occur during the preoperative phase of perioperative care. During the postoperative phase the nurse would assess how the client is recovering from anesthesia.
A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? pacemaker insertion internal cardioverter defibrillator insertion electrophysiological study radiofrequency ablation
internal cardioverter defibrillator The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart.
The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse? potassium 6.2 mEq/L white blood cell count 7.2 cells/mm sodium 138 mEq/L calcium 9.8 mg/dL
potassium 6.2 mEq/L
The staff educator is presenting a class on cardiac dysrhythmias. How would the educator describe the characteristic pattern of the atrial waves in atrial flutter?
sawtooth Sawtooth is the characteristic pattern of the atrial waves in atrial flutter.
The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document? -ventricular tachycardia -junctional rhythm -atrial fibrillation -ventricular asystole -sinus rhythm
ventricular tachycardia The dysrhythmia shown is ventricular tachycardia because it has more than 3 premature ventricular contractions. The ventricular rate is 100 to 200 bpm; the atrial rate depends on the underlying rhythm (e.g., sinus rhythm). The QRS duration is 0.12 seconds or more and has an abnormal shape. . Ventricular asystole is characterized by absent QRS complexes; this rhythm is referred to as flatline. Normal sinus rhythm is regular with with a ventricular and atrial rate of 60 to 100 bpm. The P-wave has a consistent shape and is always in front of the QRS. The PR interval is a consistent interval between 0.12 and 0.20 seconds, and the P:QRS ratio is 1:1. A junctional rhythm not caused by a complete heart block has a ventricular rate of 40 to 60 bpm and, if P waves are discernible, an atrial rate of 40 to 60 bpm. The ventricular and atrial rhythm are regular. If the P-wave is in front of the QRS, the PR interval is less than 0.12 seconds. The P:QRS ratio is 1:1 or 0:1. Atrial fibrillation is indicated by an atrial rate of 300 to 600 bpm; the ventricular rate is usually 120 to 200 bpm if untreated. Both the ventricular and atrial rhythm are highly irregular. P-waves will not be discernible; irregular undulating waves that vary in amplitude and shape are referred to as fibrillatory or f waves. The PR interval cannot be measured, and the P:QRS ratio is Many:1.
A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control? respiratory complications liver dysfunction nutrient deficiencies wound healing
wound healing
