A nurse is caring for two patients who had a coronary artery stent placed yesterday.
What medication should the nurse expect to administer based on the patients’ daily medication administration record?

Choice A rationale:

Calling "all clear" once before discharging the defibrillator is crucial for safety, but it's not the primary action that ensures effective defibrillation.

The purpose of calling "all clear" is to alert everyone in the vicinity to stay clear of the patient and avoid accidental shock.

However, even with a clear announcement, it's essential for the nurse to visually confirm that no one is touching the patient or bed before discharging the defibrillator.

Choice B rationale:

Maintaining firm contact between the paddles and the client's skin is essential for delivering the defibrillation shock effectively.

Here's a detailed breakdown of why this contact is so critical:

Maximizes energy transfer: Firm contact minimizes the impedance (resistance) between the paddles and the skin, allowing for the maximum amount of electrical energy to be transferred to the heart.

Reduces arcing: Arcing occurs when electrical energy jumps through the air instead of passing through the intended path (between the paddles and the heart). This can cause skin burns and reduce the effectiveness of the shock. Firm contact helps prevent arcing by ensuring a direct connection.

Ensures consistent current flow: Consistent contact ensures that the electrical current flows evenly across the chest, reaching all areas of the heart muscle. This increases the likelihood of successful defibrillation.

Minimizes energy loss: Any gaps or poor contact between the paddles and skin can lead to energy loss, reducing the shock's strength and effectiveness.

Choice C rationale:

Sync mode (synchronized cardioversion) is used for specific heart rhythm disturbances, such as atrial fibrillation or atrial flutter, where the shock needs to be timed with the QRS complex on the ECG.

Ventricular fibrillation, however, is a chaotic rhythm without distinct QRS complexes, so sync mode is not appropriate.

Using sync mode in ventricular fibrillation could delay the shock and potentially decrease its effectiveness.

Choice D rationale:

Water is not an appropriate conducting agent for defibrillation.

It can actually increase the risk of burns and decrease the effectiveness of the shock.

Approved conducting agents, such as gel pads or paste, should be used to ensure optimal energy transfer and patient safety.

The correct answer is A. Electrocardiogram.

Choice A rationale:

Electrocardiogram (ECG) is the priority diagnostic procedure for a suspected myocardial infarction (MI) due to several compelling reasons:

Rapidity: An ECG can be performed quickly and easily at the bedside, providing immediate results within minutes. This swiftness is crucial in the context of MI, where time is of the essence to initiate appropriate treatment and salvage viable heart tissue.

Sensitivity: The ECG is highly sensitive in detecting the electrical changes that occur during an MI. It can identify characteristic ST-segment elevation or depression, T wave inversions, and other abnormalities that strongly suggest myocardial ischemia or infarction.

Specificity: While not perfectly specific for MI, the ECG can often distinguish it from other conditions that may cause chest pain, such as pericarditis or pulmonary embolism. This diagnostic differentiation is crucial for guiding appropriate management.

Non-invasiveness: The ECG is a non-invasive procedure that does not involve any needles, catheters, or exposure to radiation. This makes it a safe and readily accessible test, even for patients who may be hemodynamically unstable or have other medical conditions.

Cost-effectiveness: The ECG is a relatively inexpensive diagnostic tool compared to other imaging modalities like echocardiography or cardiac angiography. This cost-effectiveness makes it a valuable first-line test in evaluating potential MI, allowing for efficient resource allocation.

Rationales for other choices:

Choice B (Papercut): This is not a relevant diagnostic procedure for MI and is therefore incorrect.

Choice C (Cardiac Angiogram): While cardiac angiography can definitively visualize coronary artery blockages, it is an invasive procedure that carries risks and requires specialized facilities and personnel. It is typically reserved for cases where the diagnosis remains uncertain after non-invasive testing or when intervention is planned.

Choice D (Echocardiogram): Echocardiography can assess heart function and detect structural abnormalities, but it is less sensitive than ECG for the early electrical changes of MI. It may be used as an adjunct test to provide additional information, but it is not the priority procedure in the initial evaluation.