The ED nurse is caring for a client who has gone into cardiac arrest.
During external defibrillation, what action should the nurse perform?
Continue to ventilate the client via endotracheal tube during the procedure
Ensure no one is touching the client at the time shock is delivered
Allow at least 3 minutes between shocks
Place gel pads over the apex and posterior chest for better conduction
The Correct Answer is B
Choice B rationale:
It is crucial to ensure that no one is touching the client during defibrillation to prevent accidental electrical shock to others. The electrical current delivered by the defibrillator is extremely powerful and can cause serious injury or even death if it passes through another person's body. This includes both healthcare professionals and bystanders.
Here are key points to emphasize this rationale:
Electrical conduction: The human body is a good conductor of electricity. If someone is touching the client during defibrillation, the electrical current from the defibrillator can easily pass through their body, potentially causing harm.
Cardiac rhythm disruption: Any contact with the client during shock delivery can interfere with the defibrillator's ability to accurately assess the client's heart rhythm and deliver the appropriate shock. This could potentially worsen the client's condition.
Muscle contractions: The electrical current from the defibrillator can cause involuntary muscle contractions. If someone is touching the client, these contractions could cause them to jerk or move suddenly, potentially causing injury to themselves or others.
Safety guidelines: It is a standard safety guideline in all healthcare settings to clear the area around a client before defibrillation to ensure the safety of everyone involved.
I'll now address the other choices, even though they are not the correct answer, to provide a comprehensive understanding:
Choice A rationale:
While ventilation is important during cardiac arrest, it should be temporarily paused during defibrillation. The chest compressions and electrical shock can cause movement of air in the lungs, which can interfere with the effectiveness of the defibrillation. Additionally, the risk of accidental shock to the person providing ventilation is increased if they are close to the client during defibrillation.
Choice C rationale:
Waiting 3 minutes between shocks is not necessary with modern defibrillators. Current guidelines recommend immediate defibrillation for shockable rhythms such as ventricular fibrillation or pulseless ventricular tachycardia. Delaying defibrillation can decrease the chances of successful resuscitation.
Choice D rationale:
The placement of gel pads is important for effective conduction, but it is not the priority action during defibrillation. Ensuring safety by clearing the area and delivering the shock promptly is more critical in the initial moments of defibrillation.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Digoxin is a medication that slows the heart rate. It would be contraindicated in this patient because they are already bradycardic.
Administering digoxin could further slow the heart rate and worsen the patient's symptoms.
Additionally, digoxin can have a negative inotropic effect, which could further compromise the patient's hemodynamic status. Choice B rationale:
While it is important to continue to monitor the patient, this is not an intervention that will address the patient's bradycardia and hypotension.
The patient is already symptomatic, and their heart rate and blood pressure are likely to continue to decline without intervention. Choice C rationale:
Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia.
It is not indicated for sinus bradycardia.
Choice D rationale:
Transcutaneous pacing is a non-invasive method of pacing the heart.
It can be used to temporarily increase the heart rate in patients with symptomatic bradycardia.
This is the most appropriate intervention for this patient because it will address the underlying problem of bradycardia and improve the patient's hemodynamic status.
Correct Answer is B
Explanation
Choice A rationale:
Bradycardia refers to a slow heart rate, typically defined as less than 60 beats per minute.
While some ICDs can provide pacing for bradycardia, this is not their primary purpose.
Their primary goal is to prevent sudden cardiac death from life-threatening arrhythmias.
Therefore, Choice A is not the best response.
Choice B rationale:
Atrial fibrillation (AFib) is a common heart rhythm disorder characterized by rapid and irregular beating of the atria.
While ICDs can sometimes be used in patients with AFib, this is not their primary indication.
AFib is typically managed with medications to control heart rate and rhythm, or with ablation procedures to disrupt the abnormal electrical pathways.
Therefore, Choice B is not the best response.
Choice C rationale:
Ventricular fibrillation (VF) and ventricular tachycardia (VT) are life-threatening arrhythmias that originate in the ventricles of the heart.
VF is characterized by chaotic, disorganized electrical activity in the ventricles, leading to ineffective pumping and cardiac arrest.
VT is a very fast heart rhythm that can degenerate into VF.
ICDs are specifically designed to detect and treat VF and VT.
They do this by delivering electrical shocks to the heart, which can restore a normal rhythm.
Therefore, Choice C is the best response.
Choice D rationale:
While ICDs can deliver shocks during a heart attack, this is not their primary purpose.
Heart attacks are caused by a blockage of blood flow to the heart muscle, and they are typically treated with medications, such as aspirin, nitroglycerin, and clot-busting drugs.
ICDs are primarily used to prevent sudden cardiac death from life-threatening arrhythmias, not to treat heart attacks themselves.
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