The nurse is caring for a patient whose cardiac monitor shows a total absence of electrical impulse as indicated by a flat line. The nurse does not detect a pulse or blood pressure. The nurse would document this as which of the following rhythms?
Atrial fibrillation
Asystole
Ventricular fibrillation
Atrial flutter
The Correct Answer is B
A. Atrial fibrillation is characterized by rapid, irregular electrical impulses originating from the atria, resulting in a quivering or fibrillating motion of the atria rather than a coordinated contraction.
B. Asystole is the absence of any electrical activity on the cardiac monitor, resulting in a flat line. It indicates the absence of ventricular contraction and is considered a medical emergency requiring immediate intervention (CPR and advanced cardiac life support).
C. Ventricular fibrillation is characterized by chaotic, disorganized electrical activity in the ventricles, resulting in ineffective quivering of the ventricles and loss of cardiac output.
D. Atrial flutter is characterized by rapid but regular electrical impulses originating from the atria, resulting in a sawtooth pattern on the ECG tracing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Tight fitting clothes may put pressure on the T-tube insertion site and interfere with drainage. Loose-fitting clothing is recommended.
B. Showering is typically preferred over baths to keep the T-tube site clean and dry.
Baths may increase the risk of infection.
C. Regular emptying of the drainage bag helps prevent excessive weight, which can pull on the T-tube and cause discomfort or displacement. However, it should necessarily be emptied at the same time each day.
D. Securing the tubing to clothing helps prevent accidental dislodgment or pulling on the T-tube, reducing the risk of complications.
Correct Answer is B
Explanation
A. This is partially correct but lacks the detail that the examination is done via an endoscope through the throat.
B. An endoscopic retrograde cholangiopancreatography (ERCP) involves the use of an endoscope to visualize and treat problems in the bile ducts, gallbladder, and pancreas.
C. This statement reflects a misunderstanding of the procedure, as ERCP does not involve shock waves to treat gallstones.
D. This statement also reflects a misunderstanding, as ERCP is primarily a diagnostic procedure and does not involve direct medication delivery to the gallbladder.
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