Chapter 26

A patient has been scheduled for cardioversion in the treatment of a tachyarrhythmia but is unclear about the particulars of the procedure after signing the necessary informed consent. How can the nurse best explain this procedure to the patient?

"Cardioversion will essentially 'reset' the cells in your heart that control the electrical activity"

The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During the client's most recent follow-up appointment, the nurse identifies data that suggest the client may be socially isolated and depressed. What nursing diagnosis is suggested by these data?

"Ineffective coping related to pacemaker implantation"

The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply?

"The only difference is the heart rate"

A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse?

"The small box will transmit the heart rhythm to the central monitor all the time."

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity?

"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks"

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention?

Administer an IV bolus atropine

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client?

Alerting the healthcare provider of the third-degree block

The nurse is monitoring a patient in the post anesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?

Atrial Flutter

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?

Atrial Flutter

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?

Atrial depolarization

A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia?

Atropine

The nurse is planning discharge teaching for a client with a newly inserted permanent pacemaker. What is the priority teaching point for this client?

Avoid exposure to strong electromagnetic fields

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?

Avoid undergoing magnetic resonance imaging (MRI).

A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation, and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?

Begin cardiopulmonary resuscitation

A client has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this client?

Bleeding at the implantation site

Which is not a likely origination point for cardiac dysrhythmias?

Bundle of HIS

The nurse is caring for a client who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment?

Cardiac monitoring

The nurse is caring for a client who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output?

Changes in level of consciousness

A client is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the client's care?

Diagnose the dysrhythmia.

A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?

Double-check the monitoring equipment.

The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching?

During the procedure, the dysrhythmia will be reproduced under controlled conditions.

The nurse and the other members of the team are caring for a client who converted to ventricular fibrillation (VF). The client was defibrillated unsuccessfully, and the client remains in VF. The nurse should anticipate the administration of what medication?

Epinephrine 1 mg IV push

An adult client with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?

Fewer QRS complexes than P waves

What is the treatment of choice for ventricular fibrillation?

Immediate bystander CPR

Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion?

Instruct the client to restrict food and oral intake

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?

Lead wire dislodgment

Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?

Monitor vital signs and cardiac rhythm

A client is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurse's responsibility in the care of the client's pacemaker?

Monitoring for pacemaker malfunction or battery failure

A client's electrocardiogram reveals an irregular rhythm of 75 bpm with a normal QRS and P wave. The nurse who is caring for the client should anticipate:

No immediate treatment

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?

P-Wave

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?

Pacer rate

A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition?

Premature atrial complex

A client with frequent premature ventricular contractions is prescribed amiodarone. The nurse will withhold the medication until the completion of which diagnostic test?

Pulmonary function

The nursing educator is presenting a case study of an adult client who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG?

QRS complex

Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?

QRS complex

A patient with a history of atrial fibrillation has had a worsening of the condition. The nurse knows that the drug of choice for long-term stabilization of atrial fibrillation is what?

Quinidine (Generic)

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?

RR interval

The nurse is caring for a client with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the client's most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best interpret this finding?

Recognize this as a therapeutic goal of the procedure.

A client has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this client's care, which nursing diagnosis is most appropriate?

Risk for activity intolerance

The nurse is assisting with the monitoring of a client with a dysrhythmia that shows the pattern in the accompanying image. What dysrhythmia does the client have?

Sinus Bradycarida

A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose?

Supraventricular tachycardia

The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the client's heart?

T-Wave

A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi?

Warfarin