The nurse has received change-of-shift report about all of these patients on the telemetry unit. Which patient should the nurse see first?
A patient with type 1 second-degree AV block, rate 60, who is dizzy when ambulating
A patient with atrial fibrillation, rate 88, who has a new warfarin (Coumadin) order
A patient who has a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago
A patient whose ICD fired three times today who is scheduled for a dose of amiodarone (Cordarone)
The Correct Answer is D
A. A patient with type 1 second-degree AV block, rate 60, who is dizzy when ambulating: While this patient is experiencing symptomatic bradycardia during activity, the symptoms are situational and can be managed by assisting with ambulation and monitoring. It is important, but not as immediately life-threatening as repeated ICD discharges.
B. A patient with atrial fibrillation, rate 88, who has a new warfarin (Coumadin) order: Initiating anticoagulation is important for stroke prevention, but it is not an urgent, emergent situation. This patient can be safely seen after addressing more critical issues.
C. A patient who has a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago: This patient is currently stable post-procedure with a normal sinus rhythm. Continuous monitoring is necessary, but there are no immediate signs of instability requiring urgent intervention.
D. A patient whose ICD fired three times today who is scheduled for a dose of amiodarone (Cordarone): Multiple ICD discharges indicate recurrent life-threatening arrhythmias or device therapy for ventricular tachyarrhythmias. This patient is at highest risk for sudden cardiac arrest, making assessment and intervention the top priority, including ensuring hemodynamic stability and timely administration of antiarrhythmic therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Sinus bradycardia: Sinus bradycardia is often stable and asymptomatic, especially if the patient is hemodynamically stable and not experiencing syncope, chest pain, or hypotension. A licensed practical nurse (LPN) can safely monitor vital signs, assess for symptoms, and report any changes to the RN while providing routine care and medication administration.
B. Ventricular fibrillation: Ventricular fibrillation is a life-threatening arrhythmia requiring immediate defibrillation and advanced cardiac life support. This patient requires constant, high-acuity monitoring and interventions that cannot be delegated to an LPN.
C. Second-degree AV block type II (Mobitz II): Mobitz II is high-risk for progression to complete heart block and sudden cardiac arrest. Continuous ECG monitoring, preparation for pacing, and prompt RN interventions are required, making delegation unsafe.
D. Ventricular tachycardia: Ventricular tachycardia, especially if symptomatic or unstable, is a potentially fatal dysrhythmia. It requires rapid assessment, advanced interventions, and potential defibrillation, all of which must be managed by an RN.
Correct Answer is C
Explanation
Rhythm: Sinus, regular
Rate: 120 b/min
P wave: Present, normal
PR interval: Normal, 0.16 seconds
QRS: Narrow, 0.04 seconds
Rhythm interpretation: Sinus tachycardia
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