The nurse sees a life-threatening arrhythmia on a patient's cardiac monitor. Which of the following actions should the nurse take first?

Examine the patient and collect data.

Notify the health-care provider immediately.

Obtain vital signs.

Administer antiarrhythmic medication.

Answer and Explanation

The Correct Answer is B

A.   While assessment and data collection are important, the priority in the presence of a life-threatening arrhythmia is to initiate immediate interventions to address the situation.
B.   The nurse should immediately inform the healthcare provider about the life- threatening arrhythmia to obtain further guidance and potential orders for intervention.
C.   Vital signs are important, but they should not delay immediate action when a life- threatening arrhythmia is present.

D.   Administering antiarrhythmic medication may be necessary, but the nurse should first notify the healthcare provider to obtain orders and guidance before administering any medications.

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Correct Answer is B

Explanation

A. While atrial fibrillation with a rapid ventricular response requires attention, it is not an immediate concern unless associated with symptoms such as chest pain, shortness of breath, or hemodynamic instability.
B. A heart rate of 50 in a patient with a newly inserted permanent pacemaker may indicate bradycardia, which could be a sign of pacemaker malfunction or lead dislodgement. This patient requires immediate assessment to rule out complications.
C. While recent implantable cardioverter-defibrillator (ICD) discharge warrants evaluation, the patient is currently in normal sinus rhythm with a heart rate of 68, suggesting stability. This patient's assessment can be prioritized after the patient with the pacemaker issue is seen.
D. A heart rate of 58 in a patient with chronic atrial fibrillation on beta-blocker therapy may not be immediately concerning if the patient is asymptomatic and hemodynamically stable. This patient can be assessed after addressing the more urgent pacemaker issue.

A. To reduce risk of infection B. To dry gastric secretions C. To promote postoperative healing D. To correct a clotting problem

Correct Answer is D

Explanation

A. While vitamin K plays a role in immune function, its administration prior to surgery primarily aims to correct potential clotting abnormalities rather than prevent infection.

B. Vitamin K does not affect gastric secretions. Its role in this context is unrelated to gastric function.
C. While vitamin K is involved in various physiological processes, its administration prior to surgery is primarily aimed at preventing bleeding complications by ensuring adequate clotting factor synthesis.
D. Vitamin K is essential for the synthesis of clotting factors in the liver.

Administering vitamin K prior to surgery helps ensure adequate levels of clotting factors, reducing the risk of bleeding during and after the procedure.

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The nurse sees a life-threatening arrhythmia on a patient's cardiac monitor. Which of the following actions should the nurse take first?

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