The patient has a transcutaneous pacemaker in place. Pacemaker spikes followed by QRS complexes are noted on the cardiac rhythm strip. To determine if the pacemaker is working, the nurse must do which of the following?
a. Obtain a 12-lead electrocardiogram (ECG).
b. Call for a pacemaker interrogation.
c. Palpate the pulse.
d. Run a 2-minute monitor strip for analysis.
C
The electrical and mechanical effectiveness of pacing is assessed. The electrical activity is noted by a pacemaker "spike" that indicates that the pacemaker is initiating electrical activity. The spike is followed by a broad QRS complex. Mechanical activity is noted by palpating a pulse during electrical activity.
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The nurse anticipates what generalized response to the patient's cellular injury?
A) Decreased pH B) Increased protein catabolism C) Inhibition of cell growth D) Inflammation
The nurse inspects the eyes of a child and observes that the sclera is showing over the top of the iris. The nurse documents this finding as:
A) Decorticate posturing B) Nystagmus C) Doll's eye D) Sunsetting
When conducting a spiritual assessment, you should obtain information about the patient's spiritual beliefs and how those beliefs might
a. conflict with the policies of the health care agency or institution. b. affect the patient's views of health, illness, and health care. c. lead to spiritual distress. d. differ from your personal beliefs.
Which type of seizures involves both hemispheres of the brain?
a. Focal b. Partial c. Generalized d. Acquired