dysryhythmias med surg 1
c
A nurse assesses an older adult client who has multiple chronic diseases. The client's heart rate is 48 beats/min she is stable with no signs or symptoms of decreased perfusion. Which action should the nurse take first? a: Document the finding in the chart. b: Initiate external pacing. c: Assess the client's medications. d: Administer 1 mg of atropine.
b
A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate? a "Make certain that your bath water is warm." b "Avoid straining while having a bowel movement." c "Limit your intake of caffeinated drinks to one a day." d "Avoid strenuous exercise such as running."
b
A 67-year-old man was admitted to the ICU because of chest pain. The night nurse printed out the ECG strips from four different leads and they are shown below. The patient most likely developed: A. Ventricular fibrillation B. Ventricular tachycardia C. Atrial flutter D. Torsades de pointes
a
A client is admitted with chest pain. The nurse caring for this patient reviews the client's rhythm strip before administering metoprolol (Lopressor). See six-second strip #29 below. Which aspect of this strip requires further follow-up by the nurse? A. PR interval B. QRS duration C. Rate D. The strip is within normal limits - no follow up needed
a
A client is experiencing sinus bradycardia with hypotension and dizziness. What medication does the nurse administer? A. Atropine (Atropine) B. Digoxin (Lanoxin) C. Lidocaine (Xylocaine) D. Metoprolol (Lopressor)
b
A client with ventricular tachycardia (VT) is unresponsive and has no pulse. The nurse calls for assistance and a defibrillator. What is the nurse's priority intervention while waiting for the defibrillator to arrive? A. Perform a pericardial thump. B. Initiate cardiopulmonary resuscitation. C. Start an 18-gauge IV in the antecubital. D. Ask the client's family about code status.
b
A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition? a: Sinus tachycardia b: Speech alterations c: Fatigue d: Dyspnea with activity
d
A nurse assesses a client's electrocardiogram (ECG) and observes the reading shown below: How should the nurse document this client's ECG strip? A. Ventricular tachycardia B. Ventricular fibrillation C. Sinus rhythm with premature atrial contractions (PACs) D. Sinus rhythm with premature ventricular contractions (PVCs)
a
A nurse cares for a client who is on a cardiac monitor. The monitor displayed the rhythm shown below: Which action should the nurse take first? A. Assess pulse, airway, breathing, and level of consciousness. B. Administer an amiodarone bolus followed by a drip. C. Cardiovert the client with a biphasic defibrillator. D. Begin cardiopulmonary resuscitation (CPR).
b
A nurse cares for a client who is prescribed magnetic resonance imaging (MRI) of the heart. The client's health history includes a previous myocardial infarction and pacemaker implantation. Which action should the nurse take? a: Schedule an electrocardiogram just before the MRI. b: Notify the health care provider before scheduling the MRI. c: Call the physician and request a laboratory draw for cardiac enzymes. d: Instruct the client to increase fluid intake the day before the MRI.
b
A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiogram. Which action should the nurse take next? a: Administer intravenous diltiazem (Cardizem). b: Assess vital signs and level of consciousness. c: Administer sublingual nitroglycerin. d: Assess capillary refill and temperature.
b
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client's medication administration record to prevent a common complication of this condition? a: Sotalol (Betapace) b: Warfarin (Coumadin) c: Atropine (Sal-Tropine) d: Lidocaine (Xylocaine)
b
A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation? a: A 45-year-old who takes an aspirin daily b: A 50-year-old who is post coronary artery bypass graft surgery c: A 78-year-old who had a carotid endarterectomy d: An 80-year-old with a hip fracture
b
A patient who has heart failure is admitted with a serum potassium level of 2.9 mEq/L. Which action is most important for the nurse to implement? Norm levels: 3.5-5 A. Give 20 mEq of potassium chloride B. Initiate continuous cardiac monitoring C. Teach about the side effects of diuretics D. Arrange a consultation with the dietician.
b
A nurse plans a discharge teaching session with a client who has received a permanent pacemaker. Which of the following instructions should the nurse include in the teaching? A. Avoid using cell phones (just use opposite ear) B. Avoid working over open motors (Car motors) C. Carry nitroglycerin with you at all times D. Have your blood drawn to check your bleeding times
d
A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client? a: Make sure the defibrillator is set to the synchronous mode. b: Administer 1 mg of intravenous epinephrine. c: Test the equipment by delivering a smaller shock at 100 joules. d: Ensure that everyone is clear of contact with the client and the bed.
a
A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement should the nurse include in this client's teaching? a "Minimize or abstain from caffeine." b "Lie on your side until the attack subsides." c "Use your oxygen when you experience PACs." d "Take amiodarone (Cordarone) daily to prevent PACs."
a, b, e
A nurse teaches a client with a new permanent pacemaker. Which instructions should the nurse include in this client's teaching? (Select all that apply.) a "Until your incision is healed, do not submerge your pacemaker. Only take showers." b "Report any pulse rates lower than your pacemaker settings." c "If you feel weak, apply pressure over your generator." d "Have your pacemaker turned off before having magnetic resonance imaging (MRI)." e "Do not lift your left arm above the level of your shoulder for 8 weeks."
d
A patient has undergone insertion of a permanent pacemaker. When developing a discharge teaching plan, the nurse writes a goal of, "The patient will verbalize symptoms of pacemaker failure." Which symptoms are most important to teach the patient?" A. Facial flushing B. Fever C. Pounding headache D. Feelings of dizziness
a
A patient with heart disease is on a continuous telemetry monitor and has developed sinus bradycardia. In determining the possible cause of bradycardia, the nurse assesses the patient's medication record. Which medication is most likely the cause of the bradycardia? A. Propanolol (Inderal) B. Captopril (Capoten) C. Furosemide (Lasix) D. Dobutamine (Dobutrex)
e
A systematic approach to ECG analysis includes: A. Evaluation of waveforms and complexes: P wave, QRS complex, T wave B. Intervals and segments: PR interval, QRS duration, ST segment, QT interval C. Heart Rate D. Rhythm and regularity E. All of the above
b
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching? a: "I should wear a snug-fitting shirt over the ICD." b: "I will avoid sources of strong electromagnetic fields." c "I should participate in a strenuous exercise program." d "Now I can discontinue my antidysrhythmic medication."
d
The nurse is teaching a patient with the following six-second rhythm strip (#30). What is an important teaching point to include at discharge for this patient? *** a fib A. It will be important that you limit your activity for this first week at home. B. You should avoid working over open car engines. C. You should carry nitroglycerin with you at all times. D. You will need to have your blood drawn to check your bleeding times while you are taking the blood thinner.
d
The nurse is working with a 62 year-old woman admitted with a heart rate of 160. After receiving intravenous (IV) metoprolol (Lopressor), her heart rate decreases to 130 but she develops crackles and her oxygen saturation drops to 89%. The physician decides to urgently cardiovert the patient. What diagnostic test would the nurse likely prepare the patient for prior to the cardioversion? A. Cardiac catheterization B. Electrophysiology studies C. Holter monitoring D. Transesophageal echocardiogram
a
To determine whether a patient is "tolerating" a rhythm, the following should be assessed: A. Blood pressure and level of consciousness B. Exercise capacity C. Blood sugar D. Body mass index (BMI)
e
Potential causes of PVCs include: A. Heart disease B. Hypoxia C. Hypokalemia D. Anxiety, pain, stress E. All of the above
a
Sinus bradycardia is associated with: A. Heart rate less than 60 bpm B. Inverted P waves C. A prolonged PR interval D. All of the above
e
Sinus tachycardia is associated with: A. Anxiety, fear, pain, fever B. Hyperthyroidism, hypovolemia C. Potential hemodynamic compromise due to inadequate time for cardiac filling D. Heart rates in excess of 100 bpm E. All of the above
b
The following is characteristic of the sinoatrial (SA) node: A. Intrinsic rate of 40-60 bpm B. Is capable of spontaneously generating an electrical impulse C. Located near the interatrial septum or junction D. Serves as a gatekeeper, delaying impulses to allow time for the ventricles to fill
a
The normal values for the ECG waves and complexes are: A. PR interval 0.12-0.20 seconds B. QRS duration greater than 0.12 seconds C. QT interval variable and greater than or equal to have the distance between consecutive QRS complexes D. T wave denoted as a negative deflection from the isoelectric line
c
The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, "Why do you want to know if I use cocaine?" How should the nurse respond? a "Substance abuse puts clients at risk for many health issues." b "The hospital requires that I ask you about cocaine use." c "Clients who use cocaine are at risk for fatal dysrhythmias." d "We can provide services for cessation of substance abuse."
c
The nurse assesses the client who has the following six-second rhythm strip (#31). The patient is unresponsive, not breathing, and does not have a pulse. The nurse's priority action is to: A. Apply nasal cannula 2L B. Get a 12 lead electrocardiogram (ECG) C. Initiate cardiopulmonary resuscitation (CPR) and call for the defibrillator D. Review the patient's medication regimen
c
The nurse is caring for a client admitted for myocardial infarction. The client's monitor shows frequent premature ventricular contractions (PVCs). What dysrhythmia does the nurse remain alert for? A. Sinus tachycardia B. Rapid atrial flutter C. Ventricular tachycardia D. Atrioventricular junctional rhythm
b
The nurse is caring for a client on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below: After calling for assistance and a defibrillator, which action should the nurse take next? A. Perform a pericardial thump. B. Initiate cardiopulmonary resuscitation (CPR). C. Start an 18-gauge intravenous line. D. Ask the client's family about code status.
e
Treatment of atrial dysrhythmias may include: A. Electrical cardioversion B. Beta blockers C. Digoxin D. Calcium channel blockers E. All of the above
d
The nurse is working with a 62 year-old woman admitted with a heart rate of 160. After receiving intravenous (IV)metoprolol (Lopressor), her heart rate decreases to 130 but she develops crackles and her oxygen saturation drops to 89%. The physician decides to urgently cardiovert the patient. What diagnostic test would the nurse likely prepare the patient for prior to the cardioversion? A. Cardiac catheterization B. Electrophysiology studies C. Holter monitoring D. Transesophageal echocardiogram- looks for clots
b
The nurse is working with a patient experiencing palpitations, lightheadedness, and fatigue. Diagnostic tests reveal atrial fibrillation at a rate of 130. The patient has had unsuccessful cardioversions in the past. After seeing a cardiologist, the patient is scheduled for radiofrequency catheter ablation. What is an important teaching point to include at discharge for this patient? A. The importance of taking antibiotics B. The need to report the recurrence of palpitations, lightheadedness, or fatigue C. The recommendation to avoid all contact sports activities for six months D. The importance of a heart healthy diet to maintain his heart's rhythm
c
The nurse obtains the following rhythm strip (#27) on a patient newly admitted and currently asymptomatic. Assume this strip is 6 seconds in length. You interpret the rhythm as: A. Sinus tachycardia B. Ventricular fibrillation C. Sinus bradycardia D. First degree heart block
33.3
The post-cardiac catheterization patient has a NSR with several runs of non-sustained runs of ventricular tachycardia (VT). His blood pressure is 105/60. The MD prescribes a continuous infusion of the antidyshythmic Amiodarone (Cordarone) 1mg/minute. The drug concentration of Amiodarone is 900mg in 500ml of DSW. The nurse should set the IV pump at how many mL/hour?
d
Which of the following nursing interventions should be included in the care of a patient who has just returned from a permanent pacemaker insertion? A. Give the patient's morning medications upon return to the unit, including aspirin and other anticoagulants, if ordered B. Maintain the patient NPO until the electrocardiogram (ECG) shows normal sinus rhythm C. Maintain the patient on strict bedrest for at least 24 hours after placement of the pacemaker D. Restrict movement of the affected arm and shoulder for at least 6 hours
d
on a telemetry monitor, the nurse observes that a patient's heart rhythm is sustained ventricular tachycardia (VT). Upon assessment, the patient is alert and oriented with no reports of chest pain, but expresses feeling slightly short of breath. His blood pressure is 108/70. What is the nurse's first action? A. Synchronized cardioversion B. CPR and immediate defibrillation C. Administration of IV amiodarone (Cordarone) and dextrose D. Administration of oxygen and observation of the heart rhythm
b
the nurse notes a change in the patient's cardiac rhythm. The patient is second day post-MI. The rhythm strip changed from normal sinus rhythm to sinus rhythm with short runs of ventricular tachycardia. The nurse assesses the patient, whose blood pressure is now 100/54, pulse is palpable 188 bpm. She is lethargic, but arousable. Which intervention should the nurse initiate first? A) Place the crash cart in close proximity to the room. B) Administer amiodarone (cordarone) IV. C) Hang an IV infusion of dopamine (Intropin). D) Charge the defibrillator to 200 joules.
a
the nurse understands that patients with which dysrhythmia constitute the largest group of those hospitalized with dysrhythmias? a: Atrial fibrillation b: Sinus tachycardia c:Sinus bradycardia d: Ventricular fibrillation
