Chapter 35 Dysrhythmias

What should the nurse include in discharge instruction for a patient with an implantable cardioverter-defibrillator (ICD)? Select all that apply.

-Avoid large magnets and strong electromagnetic fields -Obtain and wear a Medic Alert ID device at all times -Avoid lifting arm on ICD side above the shoulder until approved

A nurse provides care to a patient with atrial flutter that is clinically stable. The nurse anticipates a prescription for which types of medication? Select all that apply.

-Calcium channel blocker -Antidysrhythmia medication -β- blocker

The nurse teaches a group of nursing students about telemetry monitoring. The nurse should provide information that the steps for applying electrodes should be performed in what order?

-Clip excessive hair with scissors -Gently rub the skin with dry gauze -Affix the electrodes -Monitor for artifact

The nurse documents that a patient is in normal sinus rhythm. The nurse made this interpretation based on what electrocardiogram (ECG) characteristics? Select all that apply.

-The R-R intervals are relatively consistent -One P wave precedes each QRS complex -The T wave is upright.

The nurse presents information about electrocardiogram (ECG) changes associated with myocardial infarction (MI) to a group of nursing students. What should the nurse include in the information? Select all that apply.

-The ST segment will be elevated -A pathologic Q wave that develops during MI is wide and deep -A physiologic Q wave is normally very short and narrow.

A patient undergoing treatment for dysrhythmia is provided with a Holter monitor. What information should the nurse include in the patient teaching about the test? Select all that apply.

-The monitor records the electrocardiogram (ECG) when the patient is ambulatory. -The patient should record activities and any symptoms in a diary -New technology using smart phone apps can obtain and save electrocardiogram (ECG) recordings -The monitor records the electrocardiogram (ECG) when the patient performs daily activities.

The nurse is preparing to perform an electrocardiogram (ECG) on a patient. The nurse observes artifact on the monitor. What are possible causes of the artifact? Select all that apply.

-The patient is shivering -Electrical interference is present -The leads and electrodes are not secure

A patient that reports dizziness and shortness of breath is admitted to the emergency department. The following is the patient's electrocardiogram (ECG) tracing. The nurse reviews the patient's plan of care and should question which item that is listed on the plan?

IV adenosine

The nurse is reviewing discharge instructions with a patient that received an implantable cardioverter-defibrillator (ICD). Which patient statement indicates the need for further teaching?

"I should avoid flying for three years."

A patient with a newly inserted pacemaker receives discharge instructions from the nurse. Which patient statement indicates that further teaching is required?

"I should avoid using microwave ovens."

The registered nurse is reviewing a wireless electrocardiogram (ECG) monitoring system with a nursing student. Which statement made by the student indicates the need for further teaching?

"It fails to record the postevent portion of the ECG."

The nurse provides discharge teaching to a patient that underwent pacemaker implantation in the left chest. What should the nurse include in the instructions? Select all that apply.

-Avoid direct blows to the incision site -Monitor pulse and inform the health care provider if the heart rate drops below the predetermined rate -Microwave ovens are safe to use (The patient should avoid direct blows to the incision site for safety reasons. The patient should monitor the pulse and inform the cardiologist if it drops below the predetermined rate. Microwave ovens are safe to use and do not interfere with the functioning of the pacemaker. Also, the incision site should be kept dry for four days after implantation, so showering should be avoided. The patient should avoid lifting the arm above the shoulder until approved by the cardiologist, because it might affect the functioning of the pacemaker.)

Esmolol is prescribed for some patients with cardiac problems because of what actions it has on the heart's conduction system? Select all that apply.

-Decreases automaticity of the SA node -Slows the impulse conduction in the AV node (Esmolol is a β-adrenergic blocker that decreases the automaticity of the SA node and slows the impulse conduction in the AV node. Esmolol causes prolonged PR intervals. Potassium channel blockers delay repolarization. Class IB sodium channel blockers accelerate repolarization. Esmolol does not suppress atrial dysrhythmias through an unknown mechanism.

The nurse is caring for a patient that develops atrial fibrillation. Which treatments may be included the patient's treatment plan? Select all that apply

-Electrical cardioversion -Anticoagulation therapy -Prepare for radiofrequency catheter ablation

The nurse reviews a patient's admission history and identifies what findings that may be the cause of the patient's sinus bradycardia? Select all that apply.

-Increased intracranial pressure -Hypothermia -Calcium channel blockers

A patient reports a fluttering feeling in the chest. The nurse assesses a rhythm of supraventricular tachycardia (PSVT), a heart rate of 150 beats per minute, and a blood pressure of 120/60 mm Hg. The nurse anticipates that the patient's plan of care will include what treatments? Select all that apply.

-Intravenous adenosine -Intravenous β-blockers -Intravenous calcium channel blockers -Vagal stimulation

A patient who underwent a cardioverter-defibrillator implant (ICD) procedure is being discharged from the health care facility. Which instructions should the nurse give the patient and caregiver? Select all that apply.

-Keep the incision dry for four days after insertion or as instructed -Avoid large magnets and strong electromagnetic fields -Inform the cardiologist if the implanted ICD fires (The incision should be kept dry for as many days as instructed by the cardiologist. The patient should avoid metal detectors, large magnets, and strong electromagnetic fields. If the ICD fires, the patient should inform the cardiologist or contact emergency medical service. The patient should not lift the arm on the side of the ICD until approved by the cardiologist. Air travel is not restricted; however, the patient should not drive unless cleared by the cardiologist. )

The nurse is monitoring a patient in the intensive care unit. Which are the most common leads selected for continuous monitoring? Select all that apply.

-Lead II -Lead V 1

The nurse provides teaching about the conduction system of the heart to a group of nursing students. The nurse should include that the electrical impulses travel through the heart in what order?

-Sinoatrial node -Internodal pathways -Atrioventricular node -Bundle of His -Purkinje fibers

Assessment findings of a patient on a cardiac unit include decreased heart rate (HR), decreased cardiac output (CO), and type I second-degree atrioventricular (AV) block. The nurse identifies that what ECG findings are characteristic of this rhythm and may be responsible for the patient's symptoms? Select all that apply.

-Slower ventricular rateSlower ventricular rate -Progressive lengthening of PR intervals -Blocked QRS complexes

The nurse monitors the electrocardiogram (ECG) of a patient diagnosed with acute coronary syndrome. The patient's baseline rhythm is sinus rhythm. Which additional ECG findings are most suggestive of myocardial infarction? Select all that apply.

-T-wave inversion -Pathologic Q wave -Elevated ST segment

A patient is diagnosed with pulseless ventricular tachycardia. The nurse should perform the steps of defibrillation in what order?

-Turn the defibrillator on and select the proper energy level -Check to see that the synchronizer switch is turned off. -Apply conductive materials to the chest -Charge the defibrillator using the button on the defibrillator or the paddles -Position the paddles firmly on the chest wall over the conductive material -Call and look to see that everyone is "all clear" -Deliver the charge by depressing buttons on both paddles simultaneously

The nurse provides education to a group of nursing students about cardiac conditions that are common causes of dysrhythmias. What should the nurse include in the teaching? Select all that apply.

-Valve disease -Conduction defects -Accessory pathways

The nurse reviews the cardiac cycle and ectopic impulses. The nurse identifies that the greatest risk to the patient is when the ectopy occurs in which part of the cycle?

5

The nurse analyzes a patient's electrocardiogram (ECG) and determines that there are 8 R-R intervals in a span of six seconds. What should the nurse document as the patient's heart rate? Record the answer using a whole number. __ beats/minute.

80

The nurse calculates what ventricular rate on the following electrocardiogram (ECG) tracing? Record the answer using a whole number rounded to the nearest 10. __ beats per minute

80

A patient has sought care following a syncopal episode of unknown etiology. The nurse anticipates that what will be included in the patient's treatment plan?

A head-up tilt-test

The nurse assesses an unresponsive patient and reviews the patient's ECG tracing. The nurse determines that the patient is experiencing pulseless electrical activity (PEA). In addition to identifying the cause, what is the priority nursing action?

Initiate cardiopulmonary resuscitation (CPR)

A patient develops symptomatic sinus tachycardia. The nurse recognizes that which drug will likely be included in the patient's treatment plan?

Adenosine

A patient with chest pain experiences a heart rate of 200 beats/minute and blood pressure of 80/50 mm Hg. The electrocardiogram shows absent P waves. The nurse expects that which intravenous medication will be prescribed?

Adenosine

The nurse is caring for a patient with monomorphic ventricular tachycardia that is clinically stable. What is appropriate to be included on the patient's treatment plan?

Administer amiodarone

A patient on a cardiac unit is shivering. What does the nurse expect to see on the patient's ECG tracing?

Artifact

The nurse responds to a cardiac monitor alarm and notes that atrial flutter has developed on a patient's electrocardiogram (ECG). The nurse visualizes the patient's room and notes that the patient is awake and talking. Which action should the nurse take?

Assess the patient for dyspnea (Because the patient is awake and responsive, the next action is to assess the patient for stability and the possible cause of the dysrhythmia. The nurse should focus the assessment on vital signs, such as blood pressure, heart rate, and respiratory status. Initiating cardiopulmonary resuscitation is only appropriate for a patient that is in respiratory or cardiac arrest. Synchronized cardioversion would only be an option if the patient were unstable. The Trendelenburg position is inappropriate for a patient with atrial flutter.)

The nurse is caring for a patient 24 hours after the patient underwent pacemaker insertion surgery. What will be included on the postoperative plan of care?

Assessing the incision for any redness, swelling, or discharge

A patient states, "I feel tired all the time, and I struggle with activities of daily living." When auscultating the patient's heart rate, the nurse notes disorganization of atrial electrical activity and records a rate of 120 bpm. Which rhythm does the nurse anticipate observing?

Atrial fibrillation

The nurse finds that a patient has an atrial rate of 450 beats per minute and a ventricular rate of 150 beats per minute. What condition is the patient likely experiencing?

Atrial fibrillation

The nurse observing a telemetry monitor notes that a patient that was in sinus rhythm is now in a different rhythm. The electrocardiogram (ECG) now shows no P waves, fine and wavy lines between the QRS complexes, QRS complexes that measure 0.08 sec, and QRS complexes that occur irregularly with a rate of 120 beats/minute. The nurse correctly interprets this rhythm as what?

Atrial fibrillation

The nurse that is monitoring the electrocardiogram (ECG) of a patient with hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial rate 250 beats/minute. How should the nurse document this pattern?

Atrial flutter

A patient's permanent pacemaker is failing to capture. The nurse recalls that the definition of failure to capture is when the electrical charge to the myocardium is insufficient to produce what cardiac activity?

Atrial or ventricular contraction

A patient is hospitalized for treatment of symptoms associated with a junctional escape rhythm, including a heart rate (HR) of 45 beats/min. What does the nurse expect to be prescribed for this patient?

Atropine

he nurse is caring for a patient that is experiencing symptomatic sinus bradycardia. Which drugs are used to treat this rhythm? Select all that apply. Atropine Dopamine Adenosine Metoprolol Epinephrin

Atropine Dopamine Epinephrin

The nurse recalls that the heart's ability to initiate an impulse spontaneously and continuously is known as what property of heart cells?

Automaticity

The nurse expects to assess what heart rate in a patient with paroxysmal supraventricular tachycardia (PSVT)?

Between 150 and 220 beats/minute

While the nurse is administering furosemide via intravenous push (IVP), a patient becomes unresponsive. The patient's electrocardiogram (ECG) tracing shows the following. What action should the nurse perform first Cardiovert Defibrillate Check for a pulse Administer oxygen

Check for a pulse

A patient reports a new onset of jaw pain. The nurse obtains the following electrocardiogram (ECG) tracing. What action should the nurse take?

Contact the primary health care provider

While ambulating, a patient's ECG tracing changes from normal sinus rhythm with a heart rate of 90/beats per minute to the following tracing. Which action should the nurse take?

Continue ambulating the patient

A patient's electrocardiogram (ECG) has changed from a normal sinus rhythm to the following rhythm. The nurse assesses the patient who was sleeping. The patient's respirations are 16 and unlabored, and the blood pressure has dropped from 110/70 to 104/68. What action should the nurse take?

Continue monitoring the patient

A patient has the following electrocardiogram (ECG) tracing. What action should the nurse take?

Continue to monitor the patient

The nurse recalls that cardiac cells enable the conduction system to start an electrical impulse. Which property of heart cells is defined as the ability of the heart to respond mechanically to an impulse?

Contractility

Which property of the cardiac cell aids in responding mechanically to an impulse?

Contractility

A patient reports a sudden onset of dizziness. The nurse records the following electrocardiogram (ECG) tracing. The nurse suspects that the dizziness is most likely a result of what?

Decreased cardiac output

Which action does flecainide have on the heart?

Decreases impulse conduction

A patient is hospitalized with an acute myocardial infarction. The patient's cardiac rhythm suddenly changes from sinus tachycardia to the following rhythm. What is the priority nursing action?

Defibrillate

A patient is hospitalized with an acute myocardial infarction. The patient's cardiac rhythm suddenly changes from sinus tachycardia to the following rhythm. What is the priority nursing action?

Defibrillate (The ECG tracing is ventricular fibrillation, a lethal rhythm requiring a team of health care providers to provide interventions. VF results in an unresponsive, pulseless, and apneic patient. There should be no delay in starting compressions and using a defibrillator once available. It is not necessary for the nurse to check for a pulse; with VF, there will not be a pulse. Defibrillation and CPR take priority over medications. Synchronized cardioversion is a treatment for patients with a pulse; with VF, there will be no pulse.)

The nurse prepares to defibrillate a patient in a life-threatening rhythm. The nurse recalls that defibrillation differs from synchronized cardioversion in which aspect?

Defibrillation is the treatment of choice for ventricular fibrillation

A patient in asystole is likely to receive which drug treatment?

Epinephrine and vasopressin

The nurse notes artifact on a patient's telemetry monitor. Which factors contribute to artifact?

Excessive hair under the electrode pads

A patient's electrocardiogram (ECG) shows prolonged PR interval, normal P waves, and normal QRS complexes. The patient is asymptomatic and has a normal heart rate and a regular rhythm. The nurse interprets the finding as which type of atrioventricular (AV) block?

First-degree AV block

A patient that is being tested for syncope has undergone the head-up tilt-test. After 30 minutes of testing, the patient's blood pressure and heart rate did not respond and no clinical symptoms were reproduced. The nurse anticipates that what medication will be given in a low dose intravenously (IV), to provoke a response?

Isoproterenol (A head-up tilt-test is a procedure used to determine the cause of fainting spells in a patient. In the head-up tilt-test, the patient is placed on a table supported by a belt across the torso and feet. The electrocardiogram and heart rate are recorded continuously and blood pressure is measured every three minutes throughout the test. If the patient's BP and HR responses are abnormal and faintness is reproduced, the test is considered positive. If after 30 minutes there is no response, the table is returned to the horizontal position and an IV infusion of low-dose isoproterenol is started to provoke a response. IV adenosine is the drug used in the treatment of paroxysmal supraventricular tachycardia. IV midazolam is used to sedate a patient before performing synchronized cardioversion. IV magnesium is used to treat polymorphic ventricular tachycardia with a prolonged baseline QT interval.)

What is a disadvantage of a centralized monitoring system?

It requires continuous observation of patients' ECGs

The nurse reviews the following electrocardiogram (ECG) tracing. The nurse recognizes that the abnormal ECG finding is usually caused by what??

Myocardial ischemia

The patient is diagnosed with acute coronary syndrome (ACS). The nurse reviews the patient's electrocardiogram (ECG) and notes ST segment depression and T wave inversion. The ECG findings are indicative of what?

Myocardial ischemia

A patient with a heart rate of 180 beats/minute has a regular heart rhythm, normal P waves, and normal PR intervals. The nurse expects to see what QRS complex shape on the patient's ECG tracing?

Normal

The nurse observes the rhythm strip of a patient sitting up in bed and talking. The strip shows ventricular tachycardia (VT). What action should the nurse take?

Palpate the patient for a pulse. (The rhythm strip characterizes ventricular tachycardia (VT). Therefore the first step is to palpate the pulse. The treatment for VT with a pulse differs greatly than for VT without a pulse. If the VT is monomorphic and the patient has a pulse and has preserved left ventricular function, IV drugs are used. VT without a pulse is a life-threatening situation; rapid defibrillation and CPR are the first lines of treatment in this scenario. The nurse can take the patient's blood pressure after the presence of a pulse has been determined.)

The nurse is reviewing the electrocardiograms of four patients. What should the nurse conclude about these electrocardiograms?

Patient B has accelerated junctional rhythm

The nurse is reviewing prescriptions of four patients. What does the nurse infer from this review?

Patient C has junctional escape rhythm

The nurse reviews the electrocardiogram of four patients. What should the nurse conclude from these findings?

Patient D: There are recurring regular, sawtooth-shaped flutter waves

The ECG monitor of a patient in the cardiac care unit after myocardial infarction (MI) indicates ventricular fibrillation. What should be the nurse's immediate action?

Perform cardiopulmonary resuscitation (CPR)

The electrocardiogram (ECG) of a patient indicates P waves that are hidden in the preceding T waves and normal QRS complexes. The nurse recognizes that the patient is experiencing what condition?

Premature atrial contractions

The nurse reviews a patient's electrocardiogram (ECG) tracing and notes a heart rate of 82 and an irregular rhythm. How should the nurse interpret the findings?

Premature atrial contractions

A patient's electrocardiogram (ECG) tracing shows wide and distorted QRS complexes. How should the nurse interpret the finding?

Premature ventricular contractions

The nurse is monitoring a patient on a wireless electrocardiogram (ECG) monitor. Which observation is a cause for concern?

Prolonged QT interval

The nurse is analyzing patients' ECG tracings. Which patient is at greatest risk for a stroke?

RS-FFFF

A patient is experiencing atrial flutter. The nurse anticipates that what treatment will be included in the patient's plan of care?

Radiofrequency catheter ablation (Radiofrequency catheter ablation is the most effective technique for the treatment of atrial flutter. It is performed in the electrophysiology study laboratory and involves the introduction of a catheter in the right atrium. The tissue is targeted and destroyed by the application of low-voltage, high-frequency electrical impulses. The destruction of the tissue results in a normal sinus rhythm. Anticholinergic drugs would increase the heart rate and are not appropriate to treat atrial flutter. Carotid massage is a maneuver for vagal stimulation and is generally used for treating paroxysmal supraventricular tachycardia. The Maze procedure is performed to treat atrial fibrillations that are refractory to drugs, electrical conversion, and radiofrequency catheter ablation.)

Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)?

Rate 200 beats/minute; P wave not visible

The nurse suspects that a patient is experiencing myocardial infarction (MI). Which component of the patient's electrocardiogram (ECG) is most important for the nurse to analyze to make this determination?

ST segment

The nurse reviews a patient's electrocardiogram (ECG) tracing. How should the nurse interpret the finding?

Sinus bradycardia

A patient's electrocardiogram (ECG) shows a heart rate of 150 beats/minute and a normal P wave preceding each QRS complex. How should the nurse interpret the finding?

Sinus tachycardia

The nurse assesses a patient and notes a temperature of 101.6° F. Which type of dysrhythmia is associated with a fever?

Sinus tachycardia

The nurse has obtained a rhythm strip from a patient's telemetry monitor. Which description of the electrocardiogram (ECG) is correct?

Sinus tachycardia

Which statement made by the student nurse indicates the need for additional teaching about electrocardiograms?

Six bipolar leads (V1 through V6) measure the electrical forces in the horizontal plane.

Which statement is true regarding the role of the autonomic nervous system in impulse formation?

Stimulation of the vagus nerve causes a decreased rate of firing of the sinoatrial (SA) node

A patient is hospitalized following a 3-day history of heart palpitations and dizziness. The patient's electrocardiogram (ECG) shows the following rhythm. The nurse identifies that the patient is at risk for what?

Stroke

A patient develops atrial flutter with a rapid ventricular response. The nurse anticipates that what treatment will be prescribed?

Synchronized cardioversion

A patient with paroxysmal supraventricular tachycardia (PSVT) that is receiving intravenous adenosine becomes hemodynamically unstable. The nurse expects what to be included in the patient's immediate treatment plan?

Synchronized cardioversion

The nurse reviews the electrocardiogram (ECG) tracing of a patient with an electrolyte imbalance and expects to find a disturbance in which waveform?

T wave

After synchronized cardioversion, a patient's electrocardiogram (ECG) tracing reveals the following. How should the nurse interpret the findings?

The cardioversion was successful.

Which statement describes the electrical activity of the heart represented by the PR interval on an electrocardiogram (ECG)?

The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers

A patient arrives in the emergency room with indigestion, shortness of breath, and back pain. The nurse reviews the results of the patient's 12-lead electrocardiogram (ECG) and notes ST elevation in leads II, III, and AVF. How should the nurse interpret the findings?

The patient has acute injury to the right coronary artery.

A patient's electrocardiogram (ECG) tracing has changed from sinus tachycardia (ST) to the following rhythm. What should the nurse conclude from the ECG finding?

The patient is experiencing a myocardial infarction

The nurse provides teaching to a group of nursing students about radiofrequency catheter ablation therapy and should include what information?

The therapy uses electrical energy to remove problematic areas of the heart's conduction system.

The nurse understands that a pacemaker is used for which type of dysrhythmia?

Third-degree AV block (The use of a pacemaker (temporary or permanent) is considered a lifesaving measure for patients who have experienced heart block, particularly third-degree or complete heart block. A temporary pacemaker may be used until the block is resolved through medical interventions or a permanent pacemaker is inserted. In special situations, a pacemaker may be used for ventricular fibrillation or ventricular tachycardia; however, this is more an exception rather than routine. Atrial fibrillation is treated with medication such as diltiazem or synchronized electrical cardioversion. In special situations a ventricular pacemaker may be used for ventricular fibrillation or ventricular tachycardia; however, this is more an exception rather than routine.)

What does the T wave in an electrocardiogram (ECG) represent?

Time for ventricular repolarization

A patient is in ventricular fibrillation, and cardiopulmonary resuscitation (CPR) is in progress. What is the first step the nurse should take?

Turn on the device (The healthcare team will have to perform defibrillation, and the first step is to turn on the defibrillator or AED. Applying conductive gel pads is always completed after the device has been turned on. Proper energy level selection and rhythm analysis is only completed using a defibrillator; they cannot be done with the AED.)

A patient is scheduled to receive IV adenosine. What action should the nurse take while administering the medication?

Use an injection site as close to the heart as possible (Adenosine has a very short half-life (less than 10 seconds). Therefore, it is imperative that it be given rapidly, within one to two seconds, followed immediately by 20 mL of normal saline bolus flush, and be given via an IV site as close as possible to the heart. The nurse should monitor the patient for flushing, dizziness, chest pain, or palpitations. The drug is to be given rapidly. The drug's half-life is very short.)

Defibrillation is indicated for which dysrhythmia?

Ventricular fibrillation

The nurse recognizes that which cardiac dysrhythmia is life-threatening and necessitates immediate intervention?

Ventricular fibrillation

Which type of arrhythmia is associated with the absence of P waves on an electrocardiogram (ECG)?

Ventricular fibrillation