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NR341 Test 2 – Questions & Proper Solutions (100%)
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NR341 Test 2 – Questions & Proper Solutions (100%)
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NR341 Test 2 – Questions & Proper Solutions (100%)Sinus bradycardia Right Ans - <60 bpm
-normal for athletes
-two types: stable/ unstable
S.Bradycardia drug options Right Ans - -Atropine= increase HR
-Dopamine *most common*
-Epi/ norepi
S. Brady option besides drugs Right Ans - Electrical pacing
-transcutaneous
-permanent
S. Brady: atropine Right Ans - -Anti cholinergic
-1st drug used for Brady
-increase SA and AV node conduction
-0.5 mg IV push (same dead/alive)
-pupil dilation
-anticholinergic: drymouth/mucous membranes
S. Brady: Dopamine Right Ans - Ordered as infusion
-titrate to HR
-increases HR and BP
*most common drug used for sinus brady*
S.Brady: Epi Right Ans - used as infusion
-very short half-life
S. Brady: Electrical Right Ans - Pacing
-SubQ first
-TV- trans-venous pacemaker
-permanent PM
Atrial paced: image Right Ans -
ventricular paced Right Ans -
Atrial and Ventricular Paced: Right Ans -
,Permanent Pacemakers Right Ans - -keep away from magnets
-batteries last up to 10 years
-need maintenance and care
Pacemaker restrictions Right Ans -
Paced beats Right Ans - If pacer doesn't see atrial (p-wave) or ventrical (Q-
wave) spike, it will for for them.
3 problems with pacers:
-Failure to pace
-failure to capture
-failure to sense
Failure to pace: image Right Ans -
Failure to pace Right Ans - Fails to deliver pacemaker spike
-cause: batt failure/ oversensing/ lead disconnected or broken
Failure to capture: image Right Ans -
Failure to capture Right Ans - Pacemaker spike present with no QRS
-60-80 mAMP to capture (external)
-caused by low battery or poor connection
Failure to sense: image Right Ans -
Failure to sense Right Ans - -RF for R on T phenom.
-can put into lethal D-rhythm.
-cause: incorrect lead placement/ low batt./ set to high
Causes of issues with Paced beats Right Ans - -lead (need replaced/ or
placed correctly)
-Battery life
Pacemaker indication types Right Ans - -Temporary
-Permanent
,Temporary indication for PM Right Ans - -any condition that has caused or
potentially can cause a slow HR
Permanent PM indicator Right Ans - -Heart block
-slow HR
-Fast HR
-Cardiomyopathy
Diagnostics/ procedures for Cardiac Alterations Right Ans - -Cardiac
enzymes (troponin)
-12 lead EKG
-Echocardiogram
-BNP
How does Ischemia look on telemetry Right Ans - -ST depression
How does injury look on telemetry Right Ans - -ST elevation
Pacemaker post op care Right Ans - -is PM capturing/ pacing/ sensing to its
settings
-Pt is immobilized (avoid arm above shoulder)
-prophylactic anti-B (surgery)
-inspection of surgical site
PM Pt and caregiver teaching Right Ans - -HCP follow up for function tests
(phone interrogation)
-signs of infection at site
-keep incision dry for 4 days post op
-avoid lifting arm above shoulder
-avoid direct blows to pacer
-avoid electric generators
-no MRI
-Microwave ovens do not interfere
-avoid antitheft devices in doorways, walkthru don't stand in them
-travel is not restricted/ inform security, do not place wand directly over PM
-monitor pulse, contact HCP if under set rate
-carry info card of PM and current drugs
-Medic alert ID band
-consider joining PM support group
, Sinus tachycardia Right Ans - >100 bpm
-can see distinguishable P-wave
Sinus Tachy:image Right Ans -
Causes of S. tachy Right Ans - -activity (normal)
-decreased BP/ hypovolemia (compensatory)
-dehydration
-temp (infection)
-pain
Prior to meds for S.TAchy Right Ans - -fix factor that caused
-meds will knock out ability of body to respond and compensate
Meds:
-BB
-CCB
Supraventricular Tachycardia (SVT) Right Ans - >160 w/ QRS (narrow)
-indistinguishable P-wave from T-wave
S/S:
-decreased CO
-pale
-fear/ anxiety
-rapid/ thready pulse
SVT: image Right Ans -
SVT Tx Right Ans - 1-vaso vagal
2- Stable: Adenosine IV push with T-gate flush as fast as possible
-6/ 12/ 12 mg => will push into A.flutter ( a more stable d.rhythm)
3- Unstable = sedate =>Synchronized cardiovert
Adenosine (Adenocard) Right Ans - Antidysrhythmic agent. Slows
conduction time through the AV node, interrupts AV node pathways to restore
NSR.
-Converts supraventricular tachycardia (SVT) to sinus rhythm. Rapid IV (1-2
seconds) push, flush immediately with normal saline.
-IV site: AC- 6mg followed by 20mL NS, can repeat with 12mg
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