The nurse has received change-of-shift report about the following ...

[BrownTown3]

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first?
 
  a. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago
  b. A patient with new onset atrial fibrillation, rate 88, who has a first dose of warfarin (Coumadin) due
  c. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating
  d. A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due

Question 2

A 19-year-old student comes to the student health center at the end of the semester complaining that, My heart is skipping beats. An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs).
 
  What action should the nurse take next?
  a. Start supplemental O2 at 2 to 3 L/min via nasal cannula.
  b. Ask the patient about current stress level and caffeine use.
  c. Ask the patient about any history of coronary artery disease.
  d. Have the patient taken to the hospital emergency department (ED).

[Mholman93]

Answer to Question 1

ANS: D
The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.

Answer to Question 2

ANS: B
In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.

[BrownTown3]

Gracias!

[LVPMS]

Excellent