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1. Question
A client is wearing a continuous cardiac monitor, which begins to sound its alarm. A nurse sees no electrocardiographic complexes on the screen. Which of the following should be the priority action of the nurse?
Correct
Answer & Rationale:
Option 3 is Correct
Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. Options 1, 2, and 4 are unnecessary.
Test-Taking Strategy: Use the steps of the nursing process. Always assess the client directly before taking any action. Option 3 is the only option that addresses assessment. Review care of the client on a cardiac monitor if you had difficulty with this question.
Incorrect
Answer & Rationale:
Option 3 is Correct
Rationale: Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client and equipment is necessary to determine the cause and identify the appropriate intervention. Options 1, 2, and 4 are unnecessary.
Test-Taking Strategy: Use the steps of the nursing process. Always assess the client directly before taking any action. Option 3 is the only option that addresses assessment. Review care of the client on a cardiac monitor if you had difficulty with this question.
Electrocardiographic Changes in Electrolyte Imbalances