Cardiac Dysrhythmias
The emergency department nurse is caring for a patient who has gone into cardiac arrest. The nurse is performing external defibrillation. Which of the following is a vital step in the procedure? A. Gel pads are placed anteriorly, over the apex, and posteriorly for better conduction. B. No one is to be touching the patient at the time shock is delivered. C. Continue to ventilate the patient via endotracheal tube during the procedure D. Second shock cannot be administered for 1 minute to allow recharging.
B Rationale: In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patient's skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation.
When providing care for a patient with an implantable pacemaker, what assessment would be a priority? A. Temperature B. Pulse C. Blood pressure D. Respiratory rate
B Rationale: For patients with pacemakers, it is vital to check pulse and report any sudden slowing or increasing of the pulse rate. Temperature, blood pressure, and respiratory rate are important to assess, but the pulse is the priority assessment.
What is the drug of choice for a stable patient with ventricular tachycardia? A. Atropine B. Amiodarone C. Procainamide D. Lidocaine
B
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? A. Begin cardiopulmonary resuscitation (CPR) B. Administer atropine C. Defibrillate with 360 joules (monophasic defibrillator) D. Administer lidocaine
A
The nurse is assessing a patient with symptomatic bradycardia. What medication does the nurse anticipate will be ordered by the healthcare provider to treat the bradycardia? A. Atropine B. Lidocaine C. Diltiazem D. Adenosine
A
A nurse is caring for a patient who has premature ventricular contractions. What sign would the nurse assess in this patient? A. Fluttering/heart skipping B. Nausea C. Hypotension D. Fever
A
A nurse is caring for a patient who is exhibiting ventricular tachycardia (VT). Because the patient is pulseless, the nurse should prepare for what intervention? A. Defibrillation B. ECG monitoring C. Implantation of a cardioverter defibrillator D. Angioplasty
A
A patient scheduled for a catheter ablation procedure confides to the nurse that he is worried about having some of his heart cells destroyed. The best response by the nurse is which of the following? A. "Only the specific cells causing your dysrhythmia are destroyed; your heart will function better without these cells." B. "The doctor knows best; just let her worry about which heart c ells to destroy." C. "Everything will turn out fine; do not worry about your heart cells." D. "Don't worry. All resuscitation equipment is kept nearby when these procedures are being done."
A
The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? A. "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." B. "The two look very much alike; it is difficult to tell the difference." C. "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width." D. "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal."
A
The nurse is caring for a client who is receiving an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. Why is this? A. The view of the electrical current changes in relation to the lead placement. B. Conduction of the heart is altered by lead placement. C. The ECG equipment has malfunctioned. D. The circadian rhythm has changed.
A Rationale: Each ECG lead offers a different reference point to view the electrical activity of the heart. The lead displays the configuration of electrical activity of the heart. The heart's activity is not affected by the lead itself, and circadian rhythms are irrelevant to ECG data.
The nurse cares for a patient with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? A. Atrial depolarization B. Early ventricular repolarization C Ventricular depolarization D. Ventricular repolarization
A Rationale: The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave
The nurse is assisting with a "code blue" that has just been called for a patient who appears to be in asystole. Which of the following medications should the nurse identify in the crash cart in anticipation of administering them to the patient? Select all that apply. A. Atropine B. Epinephrine C. Lidocaine D. Magnesium sulfate E. Heparin
A, B
A critical care nurse is part of the code blue response team at the hospital and has been paged to the emergency department where a patient's condition has rapidly decompensated into ventricular fibrillation (VF). The nurse should prepare to assist with which of the following interventions? A. Cardioversion B. Defibrillation C. Administration of IV metoprolol D. Administration of digoxin
B
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? A. P wave B. T wave C. QRS complex D. U wave
C
A patient has been brought to the emergency department in ventricular asystole. The priority for this patient's care is: A. Application of supplementary oxygen by face mask B. Administration of corticosteroids and bronchodilators C. Cardiopulmonary resuscitation D. Chest auscultation
C
Which of the following arrhythmias creates the most significant risk for cerebrovascular accident? A. Sinus tachycardia B. Sinus bradycardia C. Atrial fibrillation D. Premature atrial complex
C
A monitor technician on the telemetry unit asks a charge nurse why every patient whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best? A. "It's just a coincidence; most patients with atrial fibrillation don't receive warfarin." B. "Warfarin controls heart rate in the patient with atrial fibrillation." C. "Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia." D. "Warfarin prevents clot formation in the atria of patients with atrial fibrillation."
D Rationale: Blood pools in the atria of patients with atrial fibrillation. As the blood pools, clots form. These clots can be forced from the atria as the heart beats, placing the patient at risk for stroke. Warfarin is ordered in most patients with atrial fibrillation to prevent clot formation and decrease the risk of stroke, not to control heart rate. Digoxin is typically ordered to control heart rate in atrial fibrillation. Atrial fibrillation doesn't typically progress to a lethal arrhythmia such as ventricular fibrillation.
Is the following statement true or false? Sinus tachycardia is characterized by a normal PR interval but an irregular rhythm.
False
Normal Sinus Rhythm Rate Rhythm P wave PR Interval QRS Duration
Rate: 60-100 Rhythm: Regular P Wave: Normal and consistent shape, before each QRS PR Interval: .12-.20 seconds QRS Duration: Less than .10 seconds
Artifact
Refers to "Noise" that is not related to the heart and produces a "fuzzy" or obscured waveforms. It may be associated with electrical interference by outside sources, poor electrode contact, patient tremors or malfunctioning equipment
