A nurse is caring for an alert client who reports heart palpitations, nausea, and dizziness. An electrocardiogram (EKG) confirms the client is experiencing vector tachycardia (VT). The nurse should anticipate which action?
Start CPR
Prepare for radiofrequency catheter ablation
Prepare for defibrillation
Prepare for cardioversion
The Correct Answer is D
A. Start CPR: CPR is indicated if the client is unresponsive and pulseless, which is not the case here as the client is alert.
B. Prepare for radiofrequency catheter ablation: This is a long-term treatment for recurrent VT but not appropriate for acute management.
C. Prepare for defibrillation: Defibrillation is used for pulseless VT or ventricular fibrillation, not for a stable VT with a pulse.
D. Prepare for cardioversion: Synchronized cardioversion is the appropriate intervention for a stable VT with a pulse to restore normal rhythm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. BP 170/64, pulse 58: Cushing's triad includes increased systolic blood pressure with widened pulse pressure, bradycardia, and irregular respirations, indicating increased intracranial pressure.
B. BP 180/90, pulse 96: Hypertension is present, but the elevated pulse does not align with bradycardia seen in Cushing's triad.
C. BP 110/70, pulse 100: These values do not reflect the classic signs of Cushing's triad.
D. BP 100/60, pulse 54: While bradycardia is present, hypotension does not align with Cushing’s triad.
Correct Answer is A
Explanation
A. Troponin: Troponin is the most specific and reliable biomarker for myocardial injury. Levels rise within 3-6 hours and remain elevated for days, providing diagnostic and prognostic information.
B. Alkaline phosphatase: This is related to liver and bone disorders, not cardiac events.
C. Creatine kinase (CK): While CK-MB is specific to cardiac tissue, it is less specific and remains elevated for a shorter period compared to troponin.
D. Myoglobin: Myoglobin is an early but nonspecific marker of muscle damage and is not as reliable for diagnosing myocardial injury.
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