Sudden Cardiac Death

Question 1

The nurse is caring for a patient who survived sudden cardiac death (SCD) that was brought on by a lethal ventricular dysrhythmia. To reassure the patient, which tests should the nurse explain will be performed to monitor the effectiveness of drug treatment? Select all that apply.
1 Exercise stress testing
2 24-hour Holter monitoring
3 Magnetic resonance imaging
4 Signal-averaged electrocardiogram
5 Electrophysiologic study under fluoroscopy

Answer 1

ANS:1,2,4,5
Because most SCD patients have lethal ventricular dysrhythmias associated with a high recurrence rate, they are closely monitored to assess when they are most likely to have a recurrence and to determine which drug therapies are most effective for them. This monitoring includes exercise stress testing, 24-hour Holter monitoring, signal-averaged electrocardiogram, and an electrophysiologic study done under fluoroscopy. Magnetic resonance imaging is not used to monitor for lethal dysrhythmias.

Question 2

A teenage girl survived an episode of sudden cardiac death (SCD) and is recovering in the intensive care unit (ICU). The nurse anticipates which intervention to prevent a recurrence?
1 Drug therapy with beta-blocker
2 Coronary artery bypass graft (CABG)
3 Percutaneous coronary intervention (PCI)
4 Implantable cardioverter-defibrillator (ICD)

Answer 2

ANS: 4
The most common approach to preventing a recurrence is the use of an ICD. It has been shown that an ICD improves survival compared with drug therapy alone. Drug therapy and a PCI will not prevent a recurrence of SCD. A coronary artery bypass graft is not necessary.

Question 3

. When caring for a patient who has survived a sudden cardiac death (SCD) event and has no evidence of an acute myocardial infarction (AMI), the nurse will anticipate teaching the patient

a. that sudden cardiac death events rarely reoccur.
b. about the purpose of outpatient Holter monitoring.
c. how to self-administer low-molecular-weight heparin.
d. to limit activities after discharge to prevent future events.

Answer 3

ANS: B
Holter monitoring is used to determine whether the patient is experiencing dysrhythmias such as ventricular tachycardia during normal daily activities. SCD is likely to recur. Heparin will not have any effect on the incidence of SCD, and SCD can occur even when the patient is resting.

Question 4

The most frequent dysrhythmia seen initially with sudden cardiac death is

a. premature ventricular contractions.
b. ventricular tachycardia.
c. ventricular fibrillation.
d. asystole.

Answer 4

ANS: B
When the onset of symptoms is rapid, the most likely mechanism of death is ventricular tachycardia, which degenerates into ventricular fibrillation.