Chapter 26: Caring for Clients with Cardiac Dysrhythmias
A patient is undergoing preoperative teaching before cardiac surgery. The nurse explains that a temporary pacemaker will be placed later that day, and it will be removed after the surgery. The patient asks the nurse what will happen if the pacemaker quits functioning. What is the nurse's best response?
"Monitoring for pacemaker malfunctioning and battery failure is something the nurse caring for you does."
The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response?
"The F waves are flutter waves representing atrial activity."
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."
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm?
0.12 and 0.2 seconds.
A client is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this client is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine?
Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
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 heart block
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute.
All options are correct.
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 client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as
Atrial flutter
The nurse is monitoring a patient in the postanesthesia 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
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
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
A nurse is caring for a client who is exhibiting ventricular tachycardia (VT). Because the client is pulseless, the nurse should prepare for what intervention?
Defibrillation
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?
Delayed conduction, producing a prolonged PR interval
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.
A client will be undergoing elective electrical cardioversion. Which nursing intervention will be included in the client's plan of care?
Ensure the client has not eaten or drunk before the procedure.
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
The nurse assesses a client returning from the post anesthesia unit with a new onset of sinus tachycardia with a heart rate of 138 beats per minute and a blood pressure of 128/80mmHg after elevating the head of the bed. What intervention does the nurse consider?
Evaluating laboratory values
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
When planning the care of a client with an implanted pacemaker, what assessment should the nurse prioritize?
Heart rate and rhythm
The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia?
Heart rate of 42 beats per minute (bpm).
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 nurse is writing a plan of care for a client with a cardiac dysrhythmia. What would be the priority goal for the client?
Maintain adequate cardiac output.
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
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?
No one is to be touching the patient at the time shock is delivered.
A client with an ICD calls his cardiologist's office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the client to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what?
Oversensing of dysrhythmias
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?
Pacer rate
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?
QRS complex
The nurse is caring for a client who has had an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. How should the nurse best respond
Recognize that the view of the electrical current changes in relation to the lead placement.
A client has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this client's care, what nursing diagnosis is most appropriate?
Risk for activity intolerance
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?
Sinus 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 client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response?
The medication increases the force of the myocardial contraction.
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client?
The need to have regular blood levels drawn
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 nurse is providing health education to a client scheduled for cryoablation therapy. The nurse should describe what aspect of this treatment?
Using a cooled probe to eliminate the source of dysrhythmia
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?
Ventricular fibrillation
The nurse is caring for a client who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment?
Vigilant monitoring of the client's ECG
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?
alerting the healthcare provider of the third-degree heart block
The nurse is assessing a client with symptomatic bradycardia. What medication does the nurse anticipate will be ordered by the healthcare provider to treat the bradycardia?
atropine
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms?
electrocardiogram
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?
hypovolemia
A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation?
internal cardioverter defibrillator insertion
Which condition is likely to predispose a client with congestive heart failure to developing a serious dysrhythmia?
myocardial ischemia
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as
normal sinus rhythm.
A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute with a regular interval between 0.12 and 0.20 seconds. What type of dysrhythmia does the client have?
sinus bradycardia
