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NURSING319-MED SURG 3 Exam 2

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CARDIAC 1. The patient has chronic atrial fibrillation (AF). What action do you anticipate? A. Monitoring the PR interval B. Defibrillation with 360 joule C. Teaching the patient to monitor the pulse deficit D. Teaching the patient to take an anticoagulant daily ANS: D The chaotic atrial activity results in blood stasis that can lead to embolic events. Patients with chronic AF are given an anticoagulant, most often warfarin (Coumadin), to prevent the formation of emboli. There is no PR interval in AF because the P wave is absent, replaced by chaotic fibrillatory waves. Defibrillation is an elective procedure in chronic AF and is performed at lower levels of electricity. Pulse deficit is a higher-level skill and is not taught to the patient. 2. The patient has an electrocardiographic (ECG) tracing that is 50 beats/minute, the rhythm is regular, and there is a P wave before every QRS complex. The QRS has a normal shape and duration, and the PR interval is normal. What is you response? A. Administer atropine by intravenous push (IVP). B. Administer epinephrine by IVP. C. Monitor the patient for syncope. D. Attach an external pacemaker. ANS: C The rhythm described is sinus bradycardia. Treatment depends on the patient's response and whether adequate perfusion is occurring. If the patient tolerates the rhythm, no treatment is given. 3. The patient has chronic atrial fibrillation (AF). What action do you anticipate? A. Monitoring the PR interval B. Defibrillation with 360 joule C. Teaching the patient to monitor the pulse deficit D. Teaching the patient to take an anticoagulant daily ANS: D The chaotic atrial activity results in blood stasis that can lead to embolic events. Patients with chronic AF are given an anticoagulant, most often warfarin (Coumadin), to prevent the formation of emboli. There is no PR interval in AF because the P wave is absent, replaced by chaotic fibrillatory waves. Defibrillation is an elective procedure in chronic AF and is performed at lower levels of electricity. Pulse deficit is a higher-level skill and is not taught to the patient. 4. The patient has a heart rate of 40 beats/minute. The P waves are regular, and the Q waves are regular, but there is no relationship between the P wave and QRS complex. What treatment do you anticipate? A. Pacemaker B. Continue to monitor C. Carotid massage D. Defibrillation ANS: A In third-degree atrioventricular (AV) block, there is no correlation between the impulse from the atrium to the ventricles and the ventricular rhythm seen. A pacemaker eventually is required. Action must be taken because this usually results in reduced cardiac output with subsequent ischemia if untreated. Carotid massage is vagal stimulation, and it can cause bradycardia. There is a problem in conduction, not abnormal contraction, and defibrillation is not used. 5. When computing a heart rate from the ECG tracing, you count 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, you calculate the patient's heart rate to be what? A. 60 beats/minute B. 75 beats/minute C. 100 beats/minute D. 150 beats/minute CONTINUED.....

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