LIPPINCOT EXERCISE 3

Permanent pacemaker care:

 Results Before discharge, you should teach a patient to:

	take his medication.
	program his pacemaker.
	assess his heart rhythm.
	check his pulse for 1 full minute.

Rationale: Teach patients how to check their pulse for 1 full minute. Their pulse rate should be the same as the pacemaker rate or faster.

A permanent pacemaker three-letter code represents:

	the manufacturer.
	how it's programmed.
	nothing; it has no meaning.
	its name.

Rationale: The three-letter code represents how the pacemaker is programmed.

The purpose of a biventricular pacemaker is to:

	increase heart rate.
	maintain a constant heart rate.
	coordinate right and left ventricular contraction.
	decrease heart rate.

Rationale: Biventricular pacemakers coordinate the stimulation of the right and left ventricles to improve cardiac function.

A patient reports feeling light-headed and dizzy when working around electrical equipment. What does this indicate?

	Pacemaker malfunction due to electrical interference
	Increase in heart rate
	Normal pacemaker function
	Decrease in heart rate

Rationale: Pacemaker malfunction due to electrical interference may occur. If so, instruct the patient to move away from the device, and pacemaker function should return to normal.

How many leads do biventricular pacemakers have?

	2
	4
	1
	3

Rationale: Biventricular pacemakers have three leads—one atrial and two ventricular.

Which complication can result from permanent pacemaker placement?

	Elevated heart rate
	Perforated ventricle
	Asystole
	Bradycardia

Rationale: Lead placement can lead to ventricular perforation, which can lead to cardiac tamponade.

What information does a pacemaker identification card contain?

	The phone number and address of the manufacturer
	The serial number, manufacturer's name, pacing rate, date of implantation, and doctor's name
	The patient's address and medical condition
	The patient's birth date and social security number

Rationale: The pacemaker identification card contains the type of pacemaker, the serial number, the manufacturer's name, the pacing rate, the date of implantation, and the doctor's name.

A biventricular pacemaker is effective in patients with:

	stroke.
	heart failure.
	infection.
	myocardial infarction.

Rationale: A biventricular pacemaker has three leads—one attached to the atrium and the other two to each ventricle—that allows the ventricles to beat simultaneously. A biventricular pacemaker is most effective in patients with heart failure.

In which mode do permanent pacemakers function?

	Demand
	Constant
	Inhibited
	Automatic

Rationale: Permanent pacemakers function in the demand mode, which allows a patient's heart to beat on its own but prevents it from failing.

Patients with permanent pacemakers may experience:

	electromagnetic interference.
	shortness of breath.
	asystole.
	shocks.

Rationale: Although today's pacemakers are designed and insulated to eliminate electrical interference, it may occur and the patient needs to be aware.

What must a patient do before having a permanent pacemaker inserted?

	Receive education.
	Get approval.
	Take medication.
	Sign a consent.

Rationale: A consent form must be signed by the patient or a responsible family member before insertion.

Pacemaker status checks can be performed:

	by a caregiver.
	in the operating room.
	by telephone.
	in the doctor's office only.

Rationale: Pacemaker status checks can be performed by telephone; to do so, patients need to keep their transmission schedule and instructions.

Pain assessment: Results

The patient states he has pain. Which response is best?

	"Where do you have pain?"
	"It isn't time for your pain medication."
	"Let's use the Numerical Pain Scale."
	"Would you like your pain medication now?"

Rationale: If the patient states that he has pain, ask about the pain's character and quality, onset, and location and whether it has radiated, its duration, and its frequency. An open-ended question is an effective communication technique.

Your patient is nonverbal and can't self-report his pain level. Which should you do?

	Administer pain medication only at the request of the patient's family member or caregiver.
	Assess for pathologic sources of pain and ask his caregiver about changes in the patient's behavior.
	Check the patient's blood pressure and administer pain medication if it's elevated.
	Maintain a quiet environment and don't disturb the patient.

Rationale: For patients who can't self-report, use a combination of assessment strategies, such as behavior interpretation, pathologic causes of pain, a pain estimate by others such as a family member or unlicensed caregiver who is familiar with the patient, or even an analgesic trial to determine whether there is a reduction in pain as shown by a change in behavior. Using just one strategy in this population is not sufficient for proper assessment.

Which statement by the patient about pain management indicates a need for further teaching?

	"Analgesics are the only way to control pain."
	"I can reduce my pain by using hot or cold therapy."
	"Imagining I'm on a beautiful beach can help reduce my pain."
	"Reading a magazine or listening to music can help control pain."

Rationale: Several nonpharmacologic techniques for pain management, such as guided imagery , distraction, and the application of heat or ice, can effectively reduce pain levels.

Which statement about pain assessment is best?

	It isn't possible to assess pain in a nonverbal patient.
	Pain assessments are completed only when a patient reports pain.
	Perform a pain reassessment after each pain management intervention.
	Pain assessment for those at the end of life is unnecessary.

Rationale: Perform a comprehensive reassessment of the patient's pain level if clinical indicators of pain are present; after implementation of pain interventions; after infusion rates of sedation, analgesic, or anesthetic medication have changed; and within 1 hour of any other type of intervention to ensure adequacy of pain management and to detect unmanaged pain.

Which goal is appropriate for pain management?

	The patient will not report his pain until you to ask him to.
	The patient will determine the level of pain he can tolerate.
	The patient will report a pain level of 0.
	The patient will use a pain assessment tool at discharge.

Rationale: Work with the patient and his family to determine what level of pain he can tolerate while still being able to participate in care with some relief or comfort. Try to keep the pain at that level or lower. Depending on the patient's condition or the procedure being performed, a 0 pain level may not be realistic.

Standard precautions: Results

 Which action should you take when caring for a patient on contact precautions?

	Perform hand hygiene thoroughly if gloves aren't available for use.
	Place a mask on the patient.
	Remove your gown outside the patient's room.
	Wear a gown to protect clothing from becoming contaminated.

Rationale: You should always wear gloves and a gown when caring for a patient on contact precautions to prevent contamination, especially when the possibility of contact with infected blood or body fluids exists.

Which equipment must be used when caring for a patient on droplet precautions?

	A face shield
	A gown
	Sterile gloves
	A mask

Rationale: Health care practitioners must wear a mask when coming within 3′ of a patient on droplet precautions.

When should you wear goggles or a face shield?

	Whenever the possibility of contact with splashing or splattering body fluids exists
	When discarding contaminated syringes
	When caring for any patient on isolation precautions
	When caring for any patient on contact precautions

Rationale: You should wear eye protection whenever you may come in contact with splashing or splattering blood, body fluids, secretions, or excretions.

When should you perform hand hygiene?

	When gloves aren't available for use when caring for a patient
	When coming in contact with sharp instruments
	After contact with a patient
	Before and after contact with a patient, regardless of whether gloves are worn

Rationale: You should perform hand hygiene before and after contact with all patients regardless of whether gloves are worn to prevent disease transmission.

Which step should you follow when handling a contaminated syringe?

	Wear sterile gloves when discarding the syringe.
	Throw the syringe into a red isolation bag for disposal.
	Place the uncapped syringe into a puncture-resistant disposal container.
	Place the cap on the syringe and discard it in the trash.

Rationale: You should discard used needles or syringes in puncture-resistant disposal containers to prevent injuries and contamination.

Standard precautions should be used in the care of:

	all patients.
	only patients who are bleeding profusely.
	only those patients with bloodborne illnesses.
	only patients who are immunosuppressed.

Rationale: Standard precautions should be used in the care of all patients regardless of their status.

Which reason best describes why standard precautions were designed?

	To protect against the transmission of infection
	To prevent infections spread by the airborne route
	To prevent the spread of infectious organisms through close respiratory or mucous membrane contact
	To prevent the spread of epidemiologically important infectious organisms through direct or indirect contact with the patient

Rationale: Standard precautions were designed to protect health care personnel, patients, and visitors against the transmission of infection.

Which action requires you to wear clean gloves?

	Touching a contaminated surface
	Handling sterile items
	Delivering a food tray
	Touching intact skin

Rationale: Part of routine infection control practices, standard precautions include wearing gloves for situations involving known or anticipated contact with blood, body fluids, tissue, mucous membranes, or non-intact skin.

In which instance should you wear clean gloves?

	When caring for a patient who is incontinent of stool
	At all times
	When a patient is newly transferred to the nursing unit
	After discarding a contaminated item

Rationale: You should wear clean gloves whenever you may come in contact with a patient's blood, body fluids, secretions, or excretions and when handling any contaminated item.

Time-out, OR: Results

The time-out in the operating room is performed:

	after the surgeon makes the incision.
	halfway through the procedure.
	immediately before the procedure.
	in the preoperative holding area.

Rationale: The final time-out should be performed immediately before the procedure starts and should be repeated for each additional procedure.

What should you do first in the event of a disagreement or discrepancy during the time-out?

	Work with the surgical team to resolve the disagreement or discrepancy.
	Notify the charge nurse.
	Check the patient's medical record for additional information.
	Document the disagreement or discrepancy.

Rationale: Work with the surgical team to resolve the disagreement or discrepancy. Don't proceed with the surgery until the issue is resolved, unless the delay compromises the patient's safety, such as with a life-threatening injury.

The surgery can begin when:

	the surgeon says so.
	all questions and concerns have been resolved.
	the surgeon arrives in the operating room.
	anesthesia is given.

Rationale: The surgery can't begin until all questions and concerns have been addressed and resolved.

After you read the information for the time-out, all team members should:

	start the procedure.
	sign a statement of agreement.
	verbalize agreement if it's correct.
	perform their surgical scrubs.

Rationale: All team members should verbalize agreement with the proposed information in the time-out.

Which is the first step in the time-out procedure?

	Confirm the patient's identity.
	Verify that the patient has signed a consent form for surgery.
	Ensure that all surgical staff is present in the operating room.
	Confirm that the patient is alert and oriented.

Rationale: The first step is to confirm the patient's identity according to your facility's policy. Whenever possible, the patient should take part in the time-out process by confirming his identifying information.

How should you handle the time-out if the patient is having more than one procedure completed during the surgery?

	Perform a time-out before the first procedure.
	Perform the time-out when the surgeon asks for one.
	Perform time-outs at the beginning and end of all of the procedures.
	Perform a time-out before each procedure is started.

Rationale: A time-out should be performed before each procedure being performed during the surgery.

Which team member should be involved in the time-out process?

	Surgeon
	Circulating nurse
	Anesthesia care provider
	All team members involved with the procedure

Rationale: All team members who are involved with the procedure should be involved in the time-out process. This includes, but isn't limited to, the surgeon, anesthesia care provider, and circulating and scrub nurses.

Which information is included in the documentation of a time-out?

	The surgical site, the procedure, and the time
	The procedure, pertinent laboratory results, the surgical site, and the persons involved
	The time, persons involved in the time-out, and the patient's involvement
	The time, procedure, and persons involved

Rationale: Document the time, procedure, and persons involved for each time-out performed according to facility policy. Include the presence of radiology and diagnostic test results. Requested equipment and implants should also be documented, if applicable.

During the time-out, the patient is:

	involved, if possible.
	on the operating room table.
	not present.
	anesthetized.

Rationale: The patient should be involved with the time-out, if possible. If the patient is incapacitated, this information should be verified with the patient's family or a medical professional accompanying the patient, if present.

How many identifiers should be used to identify the patient?

	Two
	Four
	At least one
	At least two

Rationale: At least two patient identifiers, such as name and date of birth, should be used to identify the patient according to your facility's policy.

Transdermal patch application:

 Results The outermost layer of a transdermal patch:

	contains the main dose of the drug.
	consists of an aluminized polyester barrier.
	contains a small amount of the drug.
	controls release of the drug from the main portion of the patch.

Rationale: A transdermal patch consists of several layers. The outermost layer consists of an aluminized polyester barrier.

A transdermal patch delivers:

	variable amounts of medication, depending on the patch's location.
	constant, controlled medication directly into the bloodstream.
	topical medication.
	large dosages of medication in a short period.

Rationale: Through an adhesive patch applied to the skin, transdermal drugs deliver constant, controlled medication directly into the bloodstream for a prolonged systemic effect.

Transdermal patches shouldn't be applied to scarred or callused skin because these conditions:

	increase drug delivery amounts.
	increase absorption.
	impair absorption.
	increase irritation.

Rationale: Transdermal patches shouldn't be applied to broken or irritated skin, which would increase irritation, or to scarred or callused skin, which might impair absorption.

Apply the patch to an appropriate skin area, such as:

	behind the patient's ear.
	the patient's forearm.
	the patient's back.
	the patient's calf.

Rationale: Apply the patch to appropriate skin areas, such as the patient's upper arm or chest and behind the ear.

Contraindications for transdermal drug application include:

	decreased hormone levels.
	skin allergies.
	age older than 65.
	hypertension.

Rationale: Contraindications for transdermal drug application include skin allergies or skin reactions to the drug.

The ideal time for a patient to apply the patch is:

	in the morning.
	after lunch.
	at bedtime.
	before showering.

Rationale: Instruct the patient to apply the patch at the same time at the prescribed interval to ensure continuous drug delivery. Bedtime application is ideal because body movement is reduced during the night.