A nurse is reviewing a client's cardiac monitor. Which of the following findings should the nurse identify as an indication for synchronized cardioversion?

Asystole

Ventricular fibrillation

Pulseless ventricular tachycardia

Atrial fibrillation

Answer and Explanation

The Correct Answer is D

A. Asystole: Synchronized cardioversion is ineffective for asystole because there is no electrical activity to reset. The appropriate intervention for asystole is immediate CPR and administration of epinephrine.

B. Ventricular fibrillation: Defibrillation, not synchronized cardioversion, is the appropriate treatment for ventricular fibrillation because it is a pulseless, chaotic rhythm that requires immediate high-energy shocks.

C. Pulseless ventricular tachycardia: Pulseless ventricular tachycardia is treated with defibrillation rather than synchronized cardioversion, as there is no coordinated cardiac activity to synchronize with. CPR and advanced cardiac life support (ACLS) protocols should be initiated.

D. Atrial fibrillation: Synchronized cardioversion is indicated for atrial fibrillation, particularly when it is associated with hemodynamic instability. Cardioversion helps restore a normal sinus rhythm by delivering a shock synchronized to the R wave of the QRS complex.

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Correct Answer is C

Explanation

A. 150 mL of greenish yellow NG drainage: This amount and color of drainage are expected after abdominal surgery, as bile-stained gastric contents can be present. It does not indicate a complication that requires provider notification.

B. Client requests medication for nausea: Nausea is a common postoperative symptom, often managed with antiemetics. While it should be addressed, it is not an urgent finding that requires immediate provider notification.

C. Urinary output of 250 mL over past 12 hr: Oliguria, defined as urine output less than 30 mL/hr (or less than 400 mL in 24 hr), suggests inadequate renal perfusion, possibly due to hypovolemia or acute kidney injury. This finding requires prompt provider notification.

D. Hypoactive bowel sounds: Reduced bowel activity is common after abdominal surgery due to anesthesia and opioid use. While monitoring is necessary, hypoactive sounds alone are not an urgent concern unless accompanied by other signs of ileus or obstruction.

A. "Place an aspirin in your ostomy pouch to control odor." B. "Your ostomy should start functioning in five days." C. "Empty your ostomy pouch when it becomes a third to halfway full." D. "Notify your provider if your stoma becomes dark red:"

Correct Answer is C

Explanation

A. "Place an aspirin in your ostomy pouch to control odor.": Aspirin should never be placed in an ostomy pouch, as it can damage the pouch material and irritate the stoma. Deodorizers or dietary adjustments are safer alternatives for odor control.

B. "Your ostomy should start functioning in five days.": An ostomy typically begins functioning within 2 to 4 days postoperatively, depending on bowel motility. Waiting five days without output could indicate an obstruction or ileus, requiring medical evaluation.

C. "Empty your ostomy pouch when it becomes a third to halfway full.": Keeping the pouch from becoming too full prevents leaks, discomfort, and excessive pressure on the stoma. This practice helps maintain skin integrity and ostomy function.

D. "Notify your provider if your stoma becomes dark red.": A dark red stoma is normal and indicates good blood supply. However, a stoma that turns pale, dusky, or black requires immediate medical attention, as it suggests compromised circulation and possible necrosis.

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A nurse is reviewing a client's cardiac monitor. Which of the following findings should the nurse identify as an indication for synchronized cardioversion?

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