A client has been admitted to the CCU for elective synchronized cardioversion. You will help the physician perform the cardioversion. Preparation of the client and equipment would include

setting the defibrillator where it will be synchronized to the client's T wave.

synchronizing the defibrillator to the down slope of the P wave.

having emergency equipment and oxygen available.

allowing the client only clear liquids until the procedure is over.

Answer and Explanation

The Correct Answer is C

A. Setting the defibrillator where it will be synchronized to the client's T wave: Synchronization is set to the R wave, not the T wave, to avoid delivering a shock during ventricular repolarization, which could precipitate ventricular fibrillation. Setting the defibrillator to the T wave would be unsafe and is not proper preparation for cardioversion.

B. Synchronizing the defibrillator to the down slope of the P wave: Synchronization to the P wave is incorrect because cardioversion targets ventricular activity, not atrial depolarization. The R wave of the QRS complex is the correct point for synchronization to ensure safe delivery of the shock.

C. Having emergency equipment and oxygen available: Emergency equipment, including a crash cart, airway supplies, and oxygen, must be immediately available in case the client develops life-threatening arrhythmias or requires resuscitation. This preparation ensures safety and rapid intervention if complications arise during the procedure.

D. Allowing the client only clear liquids until the procedure is over: While fasting may be required for sedation, restricting to clear liquids is not the primary preparation focus for cardioversion. The critical priority is ensuring safety and readiness for emergencies, not dietary management immediately before the procedure.

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Correct Answer is B

Explanation

A. Administration of a calcium channel blocker: Calcium channel blockers are primarily used to manage hypertension, angina, or certain arrhythmias. They do not prevent sudden cardiac death in clients with severe left ventricular dysfunction and have not been shown to improve survival in this population.

B. Insertion of an implantable cardioverter defibrillator (ICD): An ICD continuously monitors the heart rhythm and delivers an electrical shock to terminate life-threatening ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation. This intervention significantly reduces the risk of sudden cardiac death and improve long-term survival in clients with severe left ventricular dysfunction.

C. Administration of a beta-blocker: Beta-blockers improve survival in heart failure and reduce the incidence of arrhythmias, but they do not provide immediate protection against sudden cardiac death in high-risk patients as effectively as an ICD.

D. Insertion of an implantable pacemaker: A pacemaker regulates bradyarrhythmias and maintains adequate heart rate but does not terminate life-threatening ventricular tachyarrhythmias. It does not have the same protective effect against sudden cardiac death as an ICD.

A. hold the insertion site open with a Kelly clamp. B. clamp the chest tube. C. call the rapid response team and continue on to the radiology department. D. cover the insertion site with the cleanest material available.

Correct Answer is D

Explanation

A. Hold the insertion site open with a Kelly clamp: Inserting or holding instruments at the chest tube site is unsafe and can worsen injury or introduce infection. Manipulating the site with a clamp is not appropriate and does not address the immediate risk of air entering the pleural space.

B. Clamp the chest tube: Clamping a chest tube after it has been accidentally dislodged can trap air or fluid in the pleural space, increasing the risk of tension pneumothorax. Clamping is not recommended in this emergency situation unless instructed by a provider for specific circumstances.

C. Call the rapid response team and continue on to the radiology department: While notifying the rapid response team is important, leaving the client without addressing the open chest wound could rapidly lead to respiratory compromise. Immediate action to protect the pleural space takes priority over calling for help or continuing to radiology.

D. Cover the insertion site with the cleanest material available: The priority is to create an occlusive barrier to prevent air from entering the pleural space, which could cause a tension pneumothorax. Using the cleanest material immediately available stabilizes the situation while additional help is summoned, protecting the client from further respiratory compromise.

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