Chapter 29 Coordinating Care for Patients with Cardiac Dysrhythmia

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Sample questions from Chapter 29 Coordinating Care for Patients with Cardiac Dysrhythmia

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 58-year-old client with atrial fibrillation is receiving an IV diltiazem infusion. The client becomes pale and dizzy; HR is 42/min, BP is 78/44 mm Hg, and the monitor shows a slow ventricular response. Which action should the nurse take first?

   • A.Stop the diltiazem infusion and summon the rapid response team.
   • B.Obtain a 12-lead ECG before changing the infusion.
   • C.Ask the client to perform a Valsalva maneuver.
   • D.Document the rhythm and reassess the client in 15 minutes.

   Rationale: Stopping the rate-slowing infusion and summoning immediate assistance addresses symptomatic bradycardia with hypotension. Waiting to reassess or obtaining an ECG before intervening delays treatment of hemodynamic instability. A Valsalva maneuver can further slow the heart rate and is not appropriate in this unstable client. Prioritize stabilization and escalation when dysrhythmia is accompanied by poor perfusion.

2. 2.At change of shift in a pediatric cardiac unit, a 4-year-old client with a history of congenital long QT syndrome has a recent episode of syncope. The outgoing nurse reports that the client is now awake and stable. Which tasks may the registered nurse delegate to an experienced unlicensed assistive personnel (UAP)? Select all that apply.

   • A.Interpret the telemetry tracing and report whether the QT interval is prolonged.
   • B.Notify the registered nurse immediately if the client becomes unresponsive.
   • C.Teach the family how to recognize signs of torsades de pointes.
   • D.Obtain and report the client's routine vital signs.
   • E.Assess the client for recurrence of dizziness or syncope.
   • F.Assist the client with bathing while maintaining prescribed activity restrictions.

   Rationale: A UAP may obtain routine vital signs and assist with established activities, provided the nurse specifies the activity restrictions and remains responsible for evaluation. The UAP should immediately report a change such as unresponsiveness, but assessing symptoms, interpreting telemetry, and teaching the family require nursing judgment or education skills. The registered nurse must perform ongoing assessment and interpret cardiac monitoring. Delegate predictable tasks while retaining assessment, interpretation, and teaching.

3. 3.A client states, "I feel fine, so I stopped taking my anticoagulant for atrial fibrillation." At a community clinic, the 71-year-old client has an irregular pulse of 96/min and reports no bleeding. Which response by the nurse is best?

   • A.Reassure the client that anticoagulation is unnecessary if the heart rate is below 100/min.
   • B.Tell the client to take twice the prescribed dose today to make up for missed doses.
   • C.Recommend taking an over-the-counter aspirin instead of the prescribed anticoagulant.
   • D.Explain that anticoagulation can reduce stroke risk even when atrial fibrillation causes no symptoms, and contact the prescriber about restarting the medication.

   Rationale: Atrial fibrillation can increase the risk of thromboembolic stroke even when the client feels well, so the client needs prompt, individualized guidance from the prescriber about resuming therapy. Doubling a dose can cause harm, and heart rate alone does not determine the need for stroke prevention. Aspirin is not an equivalent substitute for a prescribed anticoagulant. Reinforce the purpose of therapy and coordinate medication decisions with the prescriber.

4. 4.A client's potassium is 6.1 mEq/L (reference range 3.5 to 5.0 mEq/L). In a medical-surgical unit, the 47-year-old client with chronic kidney disease has peaked T waves on telemetry and a widened QRS complex. Which action should the nurse take first?

   • A.Encourage the client to eat a potassium-rich snack.
   • B.Ask the UAP to remove the telemetry leads so the client can rest.
   • C.Notify the provider and initiate the facility's emergency response for hyperkalemia with ECG changes.
   • D.Schedule a routine repeat potassium level for the next morning.

   Answer and rationale are in the full material.

5. 5.During a home visit, a 63-year-old client with a newly implanted pacemaker reports light-headedness when walking. The home monitor shows a pulse of 38/min; the client is alert, and BP is 104/66 mm Hg. Which instruction should the nurse give first?

   • A.Place a magnet over the pacemaker until the dizziness resolves.
   • B.Sit or lie down and call emergency medical services; do not drive.
   • C.Walk around the home to see whether the pulse increases.
   • D.Wait until the next scheduled cardiology appointment to report the symptom.

   Answer and rationale are in the full material.