Cardiac 7Q QZ 6/16

A client is being treated for congestive heart failure. Which of the following assessment findings suggests that the treatment is effective?

• Elevated heart rate and anxiety

• Presence of new onset crackles in the lungs

• Decreased lung crackles and improved oxygen saturation

• Increased peripheral edema and weight gain

Answer explanation

Rationale:
Improvement in congestive heart failure treatment is often evidenced by a reduction in fluid overload symptoms. A decrease in pulmonary crackles accompanied by improved oxygen saturation indicates reduced pulmonary congestion and effective management of the condition. This shows that the interventions are positively influencing cardiac output and fluid balance

A client recovering from cardiac ablation for atrial fibrillation verbalizes their expectations about the healing process. Which statement indicates that further instruction is needed?

• I know I need to be alert for any stroke signs, such as numbness or confusion.

• I expect that my heart will beat irregularly a lot in the coming weeks.

• If I become dizzy, I'll report it immediately to my cardiologist provider.

• I anticipate that my energy level will improve as my heart rhythm normalizes.

Answer explanation

Rationale:
Option B demonstrates a misunderstanding of the procedure's goal. Although some minor irregularities can occur during recovery, the client should not expect frequent irregular heartbeats. The other statements correctly describe expected outcomes and necessary precautions.

A patient with supraventricular tachycardia (SVT) is discovered to be stable, with only mild symptoms and no evidence of compromise in blood pressure or chest pain. Which action should the nurse expect to take?

• Administration of adenosine

• Urgent synchronized electrical cardioversion

• Treatment with intravenous atropine

• Unsynchronized shock via defibrillation

Answer explanation

Rationale:
For a stable patient with SVT, using an AV nodal blocking agent like adenosine is appropriate first-step management because it can effectively terminate the abnormal rhythm. Urgent synchronized cardioversion is appropriate when the patient is unstable (e.g., experiencing hypotension or severe chest pain). Intravenous atropine is indicated when the issue is a low heart rate, and defibrillation is reserved for pulseless ventricular arrhythmia.

In the step-down unit, you are caring for a patient with atrial fibrillation who may be at risk for hemodynamic compromise (low cardiac output). Which actions should the nurse include as part of the plan of care?

• Place the patient on continuous telemetry monitoring.

• Administer oxygen therapy when clinical signs of hypoxia or low output occur.

• Be prepared to perform synchronized cardioversion if the condition worsens.

• Regularly assess the effectiveness of pharmacologic rate-control measures.

• Initiate a rapid intravenous fluid bolus as a routine intervention.

Answer explanation

Rationale:
For a patient with atrial fibrillation at risk for low cardiac output, continuous cardiac monitoring is essential to promptly identify adverse changes. Oxygen should be provided if signs of tissue hypoxia occur. Being ready for synchronized cardioversion allows for rapid correction if instability develops, and regular assessment of rate control measures ensures their effectiveness. A rapid IV fluid bolus is not routine and should only be used if there is clear evidence of hypovolemia or shock.

During a review session with a clinical mentor, the nurse is asked to identify the fundamental difference between synchronized cardioversion and defibrillation. Which statement most accurately distinguishes the two?

• Synchronized cardioversion delivers a shock timed with the R wave, whereas defibrillation delivers an unsynchronized shock regardless of the cardiac cycle

• Both procedures require synchronization with the R wave to minimize the risk of inducing ventricular fibrillation

• Both procedures are used in clients presenting with pulseless cardiac rhythms

• Defibrillation requires sedation prior to the intervention, whereas synchronized cardioversion does not

Answer explanation

Rationale:
The correct distinction lies in how the shock is delivered. Synchronized cardioversion times the shock with the R wave to safely terminate an unstable dysrhythmia in a client with a pulse. In contrast, defibrillation is unsynchronized because it is used for pulseless rhythms like ventricular fibrillation, when synchronization is not possible due to the chaotic electrical activity   

The nurse is routinely assessing a client with heart failure. Which of the following findings warrant prompt notification to the physician/provider?

• A weight gain of more than 2 pounds in 24 hours

• An increase in pulmonary crackles on auscultation

• Pedal edema that has not changed from previous assessments

• Increased orthopnea with the client needing more pillows at night

• A slight rise in BP that remains within the client’s target range

Answer explanation

Rationale:
A rapid weight gain signals fluid retention and potential decompensation. New or increased pulmonary crackles suggest worsening pulmonary edema, and increased orthopnea implies reduced cardiac function leading to pulmonary congestion. These findings necessitate timely provider notification. Stable pedal edema and a slight rise in blood pressure within target parameters, however, are generally expected and do not usually require immediate action unless they become markedly abnormal.

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

• 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