445 Cardiac 5Q 6/16

The nurse is preparing a client for synchronized cardioversion. Which cardiac rhythm would require this treatment?

• Ventricular fibrillation

• Atrial fibrillation with rapid ventricular response

• Asystole

• Pulseless ventricular tachycardia

Answer explanation

Rationale:
Synchronized cardioversion is used for unstable tachydysrhythmias with a pulse, such as atrial fibrillation with rapid ventricular response. The shock is synchronized with the R wave to prevent the induction of lethal dysrhythmias. Ventricular fibrillation and pulseless ventricular tachycardia require immediate defibrillation, whereas asystole is treated with CPR and pharmacologic interventions rather than electrical therapy.

A client develops pulseless ventricular tachycardia. CPR is started and the crash (code) cart has been brought to the client’s bedside. Which intervention is most appropriate?

• Perform synchronized cardioversion

• Initiate immediate unsynchronized defibrillation

• Administer atropine

• Place the client in a Trendelenburg position

Answer explanation

Rationale:
Pulseless ventricular tachycardia is treated with immediate unsynchronized defibrillation as part of ACLS guidelines. Without a pulse, cardioversion is ineffective since it requires synchronization with the R wave, which is not identifiable. Atropine is used for bradycardia, and Trendelenburg positioning does not address the immediate life-threatening dysrhythmia.

The nurse is preparing to deliver a defibrillation shock to a client in ventricular fibrillation. Which actions must be followed?

• Ensure everyone is clear of the client before delivering the shock

• Continue chest compressions while the shock is delivered

• Place pads firmly on the client’s chest according to manufacturer guidelines

• Verify the defibrillator is in synchronized mode

• Ensure defibrillation is performed immediately without delay

Answer explanation

Rationale:
During defibrillation, ensuring that no one is touching the client before delivering the shock is crucial for safety. Pad placement should be correct for optimal energy transfer. Defibrillation must be performed immediately when indicated. Chest compressions should be paused during shock delivery. Synchronized mode is not used in defibrillation; it is needed only for cardioversion.

The nurse is caring for a client with ventricular tachycardia who is alert and has a pulse. Which interventions are appropriate for the nurse to take?

• Prepare for synchronized cardioversion if the client is unstable

• Administer antiarrhythmic medications as prescribed

• Initiate immediate defibrillation

• Continue monitoring if the client remains asymptomatic

• Perform chest compressions immediately

Answer explanation

Rationale:
For a client with ventricular tachycardia and a pulse, synchronized cardioversion is indicated if instability develops. Antiarrhythmic medications may be used for rhythm control. If the client is asymptomatic and hemodynamically stable, ongoing monitoring is appropriate. Immediate defibrillation and chest compressions are reserved for pulseless ventricular tachycardia.

The nurse is caring for a client with newly diagnosed atrial fibrillation. Which actions should be included in the plan of care that are are directly related to the dysrhythmia?

• Administer anticoagulants as prescribed

• Instruct the client to avoid foods high in vitamin K

• Encourage the client to perform deep breathing exercises

• Prepare the client for emergency defibrillation

• Monitor for signs of embolic complications

Answer explanation

Rationale:
Anticoagulation is a cornerstone of atrial fibrillation management to reduce the risk of embolic events such as stroke. Avoiding foods high in vitamin K is necessary if the client is receiving warfarin. Monitoring for embolic complications is essential due to increased clot formation risk. While rate control may be necessary, deep breathing exercises alone are unlikely to significantly impact atrial fibrillation. Emergency defibrillation is reserved for unstable ventricular dysrhythmias, not atrial fibrillation