A client is unresponsive and has no pulse. The nurse notes that ...

[sc00by25]

A client is unresponsive and has no pulse. The nurse notes that the electrocardiogram tracing shows continuous large and bizarre QRS complexes measured greater than 0.12 each. This rhythm is identified as:
 
  1. premature ventricular complexes.
  2. torsades de pointes.
  3. ventricular fibrillation.
  4. ventricular tachycardia.

Question 2

The perioperative nurse is identifying nursing diagnoses appropriate for a client currently having surgery. Which of the following would be appropriate for the client at this time?
 
  1. Risk for infection
  2. Risk for impaired skin integrity
  3. Risk for injury
  4. Risk for inadequate nutrition
  5. Risk for hypothermia
  6. Risk for fluid volume overload

[kaykay69]

Answer to Question 1

4
Ventricular tachycardia occurs when the patient experiences sustained consecutive premature ventricular complexes. Torsades de pointes is characterized by a wide-to-narrow pattern of the QRS complexes. Ventricular fibrillation shows a coarse wavy baseline.

Answer to Question 2

1, 2, 3, 5
Nursing diagnoses for the perioperative client include risk for infection, risk for impaired skin integrity, risk of injury, and risk of hypothermia. Risk for inadequate nutrition and risk for fluid volume overload would be more appropriate during the postoperative period of client care.

[sc00by25]

Thank you

[kaykay69]

Happy to help you