Page 222 - Critical Care Nursing Demystified

Chapter 4 CARE OF THE PATIENT WITH CRITICAL CARDIAC RHY THM DISTURBANCE NEEDS 207

making good contact. To avoid respiratory movement, place the electrodes closer
together.
4. D. The T wave is after the ST segment and is upright, rounded, and symmetrical. The
P wave is upright, rounded, and symmetrical but it is after the T wave and is smaller.
The QRS is after the P wave and can have three phases. The ST segment is after the QRS
and before the T wave.
5. C. The QRS is around 0.06 to 0.1 seconds. The P wave is not usually measured but we
look to see that it is upright, rounded, and symmetrical. The PRI is from 0.12 to 0.2 sec-
onds, and the QT is rate related but is around 0.36 to 0.42 seconds.
6. C. Atrial flutter is detected by its multiple, saw-tooth-patterned P waves that are fast,
countable, and regular. PAT is fast but has only one P wave/one QRS. PACs can fall on
any underlying rhythm, but they are limited to one or two beats with premature
P waves. Atrial fibrillation has uncountable P waves.
7. D. This is the most common mode for permanent ventricular pacing. V = ventricular,
I = inhibited, and R = rate modulated.
8. B. The patient needs to get a medical alert tag as health care providers need to avoid
the generator box site during defibrillation. There are no external wires, so electrical
safety is not an issue. All surgical sites need to be monitored for infection, and home
microwaves do not interfere with newer permanent pacers.
9. A. Transcutaneous pacers are placed on the anterior and posterior chest via electrodes
by the critical care nurse. All other pacers are inserted by the physician. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
10. B. “Epi” or epinephrine is used in almost all cardiac arrest scenarios. Atropine is reserved
for asystole. Adenosine might be given for fast tachydysrhythmias. Sodium bicarbon-
ate is reserved for after a set of arterial blood gases are obtained if the patient is in
acidosis.