Chp. 28
What is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
A nurse is caring for four clients. Which client is most at risk for atrial fibrillation (AF)?
An older adult man who is 2 days postcoronary artery bypass surgery
Which cardiac drug classification decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?
Beta-adrenergic blockers
Which antiarrhythmic medication works by blunting the effect of sympathetic nervous system stimulation on the heart?
Beta-blockers, such as metoprolol
The nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?
Bradycardia with rate of 20-40
The nurse is caring for a client who has been admitted to the hospital with a diagnosis of unstable angina and the client wants to know why daily ECGs are necessary. The nurse explains that the ECGs can pick up early indications of cardiac ischemia and the nurse knows that according to the American Heart Association practice standards, the client falls into which ECG monitoring category?
Class I
A client has been diagnosed with runs of intermittent ventricular tachycardia where the client loses consciousness and needs to be stimulated to recovery. Knowing this history, the nurse will educate the client about which treatment intervention/procedure that will depolarize the heart to allow the sinoatrial node to regain control of the heart?
Education involving automatic implantable cardioverter-defibrillators implantation
A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?
Holter monitoring
A client arrives at the doctor's office reporting severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate:
Myocardial infarction
A nurse is explaining the conduction system of the heart to a client who is experiencing an dysrhythmia. Which would be the most accurate explanation?
Sinoatrial node (SA), internodal pathways, atrioventricular (AV) node, AV bundle, Purkinje fibers
A client with digoxin toxicity is hospitalized and told that a cardiac monitor will be necessary because the client may develop which complication? Select all that apply.
Sinus arrest Atrial tachycardia Atrial fibrillation
When explaining a new diagnosis of complete heart block to a client and family, the nurse should include which statement?
"One consequence of this type of block is a very slow heart rate that limits circulation to the brain."
A client has been diagnosed with atrial flutter. Which assessment finding correlates with this diagnosis?
An atrial heart rate above 240 beats/min
A client has been admitted after being resuscitated from a cardiac arrest. The client is prescribed Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?
Continuous cardiac monitoring
Considering the PQRST complex of an electrocardiogram (ECG), which letter designation represents atrial depolarization?
P wave
A client with a history of angina presents with uncharacteristic chest pain. The subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which aspects of the cardiac cycle?
Ventricular repolarization
A nurse is caring for a client with an average heart rate of 56 beats/min. The client has no adverse symptoms associated with this heart rate and is receiving no treatment. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?
"Avoid bearing down while having a bowel movement."
A nurse educator is explaining normal cardiac conduction and action potentials to a nursing cohort. How can the nurse best describe the term "slow response" (calcium current) to the students?
"It facilitates the entrance of calcium for the excitation-contraction mechanism that couples the electrical activity with muscle contraction."
A nurse is observing a client's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating:
"The client is experiencing premature atrial contractions (PACs)."
A client has a myocardial infarction (MI) that has damaged the right atrium, which results in interference with the SA node. The compensatory mechanism, the AV node, becomes the pacemaker of the heart and beats how many times per minute?
45 to 50 beats/minute
A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm, what does the nurse report the client has?
A symptomatic bradyarrhythmia
The client is diagnosed with a respiratory sinus dysrhythmia. Which electrocardiogram pattern correlates to this finding?
An increase in heart rate with inspiration and slowing with expiration
A nurse is caring for a client with persistent atrial fibrillation. Which intervention is the priority?
Assessing for shortness of breath or changes in level of consciousness
The purpose of a cardioversion device is the treatment of which cardiac disorder?
Atrial fibrillation
Paroxysmal supraventricular tachycardia arises from which form of reentry?
Atrioventricular (AV) nodal
Brugada syndrome, an autosomal dominant disorder, manifests in adulthood as ST-segment elevation, right bundle branch block, and susceptibility to ventricular tachycardia. In Brugada syndrome, the timing of cardiac events is significant. When do these cardiac events typically occur?
During sleep or rest
A client is having an electrocardiogram (ECG) performed for a routine physical examination. The client states he has been feeling well and has no reports of pain or discomfort. The nurse observes a regular atrial and ventricular rate of 64, a PR interval of 0.26, and a QRS of 0.06 sec. The nurse determines that this rhythm is called:
First-degree heart block
The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priority intervention at this time?
Immediate defibrillation
Respiratory sinus dysrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus dysrhythmia, what is the variation in cardiac cycles related to?
Intrathoracic pressure changes that occur with respiration
When a client has a recurrent, life-threatening arrhythmia originating either supraventricularly or ventricularly, ablation therapy is an option for treatment. What does ablation therapy do?
Isolates and destroys arrhythmogenic cardiac tissue
A client is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which action is important for the nurse to tell the client to ensure accuracy in correlating dysrhythmias with symptoms?
It is important to keep a diary of activities and symptoms.
Sick sinus syndrome is suspected in the case of a child who is postoperative following cardiac surgery. Which nursing action is most appropriate?
Monitor the child's ECG for bradycardia.
A nurse notes that the PR interval on a client's electrocardiogram tracing is 0.22 seconds. Which action should the nurse take?
Monitor the client and document the findings.
The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing?
P wave above the baseline
A monitored hospitalized client with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which form of AF is this?
Paroxysmal
A client experiencing a sinus arrest would demonstrate which symptom or finding?
Prolonged periods of asystole demonstrated on an electrocardiogram
The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?
QRS complex
The nurse is assisting with a synchronized cardioversion for a client with atrial fibrillation (AF). Which waveform does the nurse understand the discharge of electrical energy should be synchronized with?
R wave
An emergency room nurse is caring for a client with cardiomyopathy who has chest pain and shortness of breath. Vital signs include heart rate 100, blood pressure 84/62, RR 30 and temperature 37.0°C. Cardiac monitor reveals an irregular rhythm with frequent premature ventricular complexes. The nurse understands that this client is at risk for:
Serious dysrhythmias
An 80-year-old client with a medical history of atrial fibrillation, type II diabetes, and coronary heart disease is brought to the emergency room following a syncopal episode. The nurse notes on ECG the client lacks P waves and the QRS complexes are a rate of 48-54 beats/minute. The nurse determines the presence of which dysrhythmia?
Sinus arrest with a junctional escape rhythm
A client with supraventricular tachycardia has received a dose of verapamil to slow the heart rate. Which explanation describes the effect of this drug on the heart?
Slows the sinoatrial (SA) node pacemaker and inhibits conduction in the atrioventricular (AV) node
A client comes to the clinic and reports "I feel like my heart is fluttering." The cardiac monitor shows a sinus rhythm with occasional premature atrial contractions (PACs). Which are possible causes of this dysrhythmia? Select all that apply.
Stress Caffeine Low potassium Smoking Alcohol
A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of:
Sympathetic nervous system
Which client will the nurse prioritize to assess first?
The client with sinus arrest
The nurse is caring for a client who develops atrial fibrillation. What concern is the highest priority for this client?
The risk of emboli
A client with a 2-week history of hyperthyroidism due to a virus is admitted for nonemergent cardioversion. The client states that she has been experiencing intermittent episodes of palpitations over the past week along with shortness of breath and fatigue. The nurse attaches the client to a cardiac monitor and notes that the client is in normal sinus rhythm with frequent episodes of atrial fibrillation. The nurse anticipates which of the following to be ordered prior to the cardioversion to avoid a possible stroke?
Transesophageal echocardiography
Which dysrhythmia is considered to be the most fatal and requires immediate treatment?
Ventricular fibrillation
A client is admitted to the hospital with a diagnosis of third-degree heart block after suffering a syncopal episode in the shower that morning. The nurse explains to the client that the hot shower could cause vasodilation of the blood vessels and in combination with the heart block could cause syncope. The nurse understands that the heart block is caused by:
an interference in conduction.
A nursing student is studying the properties of cardiac rhythm to better understand what causes dysrhythmias to occur. The student begins to understand that there is a programmed ability for certain cells to conduct impulses. Interruption in this ability can result in abnormalities of cardiac rate and rhythm; this property would be:
conductivity.
A group of nursing students is discussing ventricular dysrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to:
decreased ventricular filling time.
An 80-year-old male client arrives for his yearly physical without any complaints, and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder, the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
many people live with atrial fibrillation without even knowing they have it.
An intensive care unit nurse is caring for a client who suffered a myocardial infarction involving the anterior wall, and notes a change in the cardiac rhythm. The rhythm has a PR interval that does not change, but there are twice as many P waves as there are R waves. The nurse prepares for a temporary pacemaker insertion because the client has developed:
second-degree, type 2 AV block.
A college student is in pre-op area prior to knee surgery. The nurse attaches the cardiac monitor and notes a gradual lengthening and shortening between the R waves. The nurse realizes that this rhythm is most often found in people with healthy hearts. This rhythm is a respiratory:
sinus dysrhythmia.
A client with a history of Wolff-Parkinson-White (WPW) syndrome is admitted for symptomatic tachyarrhythmias resistant to medications. Which cause can result in the development of reentry circuits abnormalities? Select all that apply.
Hyperkalemia Myocardial ischemia Myocardial infarction
Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?
Inherent spontaneous action-potential
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?
Most ECG-detected ischemic events are clinically silent.
A client is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F (38.3°C) for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 second preceding each QRS complex. What does the nurse determine the rhythm to be?
Sinus tachycardia
The nurse is evaluating a client with cardiac problems and notes that the client's peripheral pulse is different than the apical pulse. To which physiologic response would the nurse attribute the difference in rates?
Premature beats not following normal conduction pathways SUBMIT ANSWER
A client presents with uncharacteristic chest pain, and his ECG reveals T-wave elevation. This finding suggests an abnormality with which aspect of the cardiac cycle?
Ventricular repolarization
Torsade de pointes is a specific type of polymorphic ventricular tachycardia in which the polarity of the QRS complex swings between positive and negative, often on a beat-to-beat basis. It is the result of the long QT syndrome and can cause sudden cardiac death. Which medication is not linked to torsade de pointes as a causative agent?
Tetracycline