HEART EKG DYSRYTHMIAS HEART BLOCK PACEMAKER

The monitor begins to alarm showing ventricular tachycardia. What should the nurse do first?Check for a pulseStart cardiac compressionsPrepare to defibrillate the clientAdminister oxygen via an ambu bag

Answer: Check for a pulseRationale:The treatment of ventricular tachycardia depends on the presence of a pulse. Therefore checking for a pulse is the first priority for the nurse. The nurse must rely on client assessment, not solely on the monitor. Cardiac compressions would not be initiated if there was a pulse. Administering oxygen via an ambu bag would only occur if the client was not breathing. The client is not automatically defibrillated. Cardioversion is recommended for slower ventricular tachycardia.

In addition to atrial fibrillation, which cardiac dysrhythmia exhibited by a client does the nurse determine may be converted to sinus rhythm by cardioversion? Cardiac standstill First degree heart block Supraventricular tachycardia Frequent premature complexes

Answer: Supraventricular tachycardiaRationale:Cardioversion involves administration of precordial shock, which is synchronized with the R wave to interrupt the heart rate. It is used for atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia with a pulse when pharmaceutical preparations fail. The heart is stopped by the electrical stimulation, and it is hoped that the sinoatrial (SA) node will take over as pacemaker. Because there are no R waves in a cardiac standstill, defibrillation and not cardioversion should be done. Premature ventricular complexes suggest an irritable myocardium and generally respond to antidysrhythmic agents.

What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Select all that apply. The RR intervals are relatively consistent. One P wave precedes each QRS complex. The ST segment is higher than the PR interval. Four to eight complexes occur in a 6-second strip. The QRS complex ranges from 0.12 to 0.2 seconds.

Answers: The RR intervals are relatively consistent. One P wave precedes each QRS complex. Rationale:The consistency of the RR intervals indicates a regular rhythm. A normal P wave before each complex indicates the impulse originated in the sinoatrial (SA) node. Elevation of the ST segment is a sign of cardiac ischemia and unrelated to the rhythm. The number of complexes in a 6-second strip is multiplied by 10 to approximate the heart rate; normal sinus rhythm is 60 to 100 beats/min. Fewer than six complexes per 6 seconds equals a heart rate less than 60 beats/min. The QRS duration should be less than 0.12 seconds; the PR interval should be 0.12 to 0.2 second.

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

B. Speech Alterations Rationale: Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes in mentation, speech, sensory function, and motor function. Clients with atrial fibrillation often have a rapid ventricular response as a result. Fatigue is a nonspecific complaint. Clients with atrial fibrillation often have dyspnea as a result of the decreased cardiac output caused by the rhythm disturbance.

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. Solatol (Betapace) B. Warfarin (Coumadin) C. Atropine (Sal-Tropine) D. Lidocaine (Xylocaine)

B. Warfarin (Coumadin)Rationale: A-fib puts clients at risk for developing emboli. Clients at risk for developing emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.

A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response.A. Decreased intraocular pressureB. Increased heart rate C. Short period of asystole D. Hypertensive crisis

C. Short period of asystoleRationale: Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea, and chest pain

SThe nurse assesses a client's ECG tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation? A. The client has hyperkalemia causing irregular QRS complexes .B. Ventricular tachycardia is overriding the normal atrial rhythm. C. The client's chest leads are not making sufficient contact with the skin. D. Ventricular and atrial depolarizations are initiated from different sites.

D. Ventricular and atrial depolarizations are initiated from different sites. Rationale: Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarizatoin is initiated at the SA node. QRS complexes without a P wave indicate a different source of initiation of depolarization. This finding on an ECG tracing is not an indication of hyperkalemia, ventricular tachycardia, or disconnection of leads.

The nurse notes that the client's cardiac rhythm strips show more P waves than QRS complexes. There is no relationship between the atria and the ventricles. How should the nurse interpret this rhythm strip? First degree atrioventricular (AV) block Second degree AV block Mobitz I (Wenckebach) Second degree AV block Mobitz II Third degree AV block (complete heart block)

Third degree AV block (complete heart block)Rationale: Third degree block often is called complete heart block because no atrial impulses are conducted through the AV node to the ventricles. In complete heart block, the atria and ventricles beat independently of each other because the AV node is completely blocked to the sinus impulse and is not conducted to the ventricles. One hallmark of third degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform. In first degree AV block, a P wave precedes every QRS complex, and every P wave is followed by a QRS. Second-degree AV block type I, also called Mobitz I or Wenckebach heart block, is represented on the ECG as a progressive lengthening of the PR interval until there is a P wave without a QRS complex. Second degree AV block type II (Mobitz II) is a more critical type of heart block that requires early recognition and intervention. There is no progressive lengthening of the PR interval, which remains the same throughout with the exception of the dropped beat(s).

A client's cardiac monitor indicates ventricular tachycardia. The nurse assesses the client and identifies an increase in apical pulse rate from 100 to 150 beats per minute. What is an appropriate treatment plan? Amiodarone bolus Intracardiac epinephrine Insertion of a pacemaker Cardiopulmonary resuscitation (CPR)

vAnswer: Amiodarone bolusRationale: Amiodarone suppresses ventricular activity; therefore, it is used for treatment of premature ventricular complexes (PVCs) and ventricular tachycardia. It works directly on the heart tissue and slows the nerve impulses in the heart. Epinephrine HCl is not used for ventricular tachycardia (VT) with a pulse; it is used for cardiac arrest and may even precipitate ventricular fibrillation. A pacemaker is used for symptomatic bradycardia and heart blocks. The client has a pulse; CPR is not indicated.