Heart Rhythm Interpretation #1

A clients monitor alerts the nurse that a client's heart rate is 45 bpm. The nurse knows that which of the following medications increase heart rate? Acyclovir Atenolol Atropine Atrovastatin

Atropine Atropine is an antiarrhythmic medication that increases heart rate.

A nurse is measuring the PR interval on an EKG. In order for the measurements to be within the parameters of normal sinus rhythm, the PR interval would need to be between which of the following seconds? 0.16-0.22 0.2-0.3 0.12-0.2 0.36-0.44

0.12-0.2 The PR interval needs to be between 0.12-0.2 seconds. The PR interval is the time from the onset of the P wave to the start of the QRS complex. The normal PR interval is between 0.12-0.2 seconds in duration (three to five small squares).

A nurse is calculating the atrial rate on an atrial flutter rhythm and is concerned that the rate is dangerously high. Which of the following beats per minute is the nurse calculating? 250-300 300-400 200-250 150-200

250-300 The atrial rate in atrial flutter is between 250-300 beats per minute.

A nurse is attempting to identify a rhythm on an EKG and notices the P: QRS ratio is not normal. The nurse identifies the rhythm as atrial flutter. Which of the following P: QRS ratios is the nurse likely observing? Select all that apply. 4:5 1:5 5:1 1:4 4:1

4:1 or 5:1 This is a characteristic of Atrial flutter. The classic sign of Atrial Flutter is a sawtooth baseline. This means there are 3, 4, 5, or more P-waves before each QRS as the atria are firing rapidly. Therefore, the P to QRS ratio in Atrial Flutter tends to be 4:1 or 5:1 depending on how many P-waves are seen.

A student nurse is reviewing an EKG graph and attempting to determine if the rhythm is sinus bradycardia. The student nurse knows that which of the following are normal characteristics of sinus bradycardia? Select all that apply. A. PR interval of 0.16 seconds B. 1 to 2 QRS ratio C. QRS complex of 0.08 seconds D. Irregular rhythm E. PR interval of 0.24 seconds

A & C

A 67-year-old client has been diagnosed with atrial fibrillation. After receiving treatment, the client is going home from the hospital with a prescription for an anticoagulant and a calcium channel blocker. What information should the nurse include with discharge education? Select all that apply. A. The client will need to monitor for signs of bleeding B. The client should be familiar with signs and symptoms of stroke C. The client should avoid grapefruit and grapefruit juice D. The client should notify the healthcare provider if they will be traveling E. The client can take herbal remedies but should not take vitamin supplements

A, B, C Atrial fibrillation occurs when the atria quiver, causing an atrial heart rate of up to 360-600 beats per minute. This rapid movement can prevent the atria from filling with enough blood to then fill the ventricles, and the client's cardiac output is affected. Atrial quiver puts the client at a high risk of blood clots, so prescription anticoagulants may be prescribed, as well as medications to control the rhythm, such as beta blockers or calcium channel blockers. Anticoagulants increase the risk of bleeding, so the nurse should include this teaching. A client taking calcium channel blockers should avoid grapefruit. Since there is a risk for clots when a client has atrial fibrillation, the nurse needs to include stroke education prior to discharge.

The student nurse is observing a rhythm on an EKG, and understands that which of the following are characteristics of atrial fibrillation? Select all that apply. A. No identifiable P waves B. Unmeasurable PR interval C. Normal PR interval D. Normal QRS complex E. Unmeasurable QRS complex

A, B, D Since atrial fibrillation results in the atria quivering rather than contracting the EKG strip does not have identifiable P waves.

A nurse has a client with a heart rate of 40 beats per minute, the nurse is identifying the cause of bradycardia. The nurse knows that which of the following could be possible causes of bradycardia? Select all that apply. A. Being an athlete B. Hyperkalemia C. Hypotension D. Beta blockers E. Digoxin toxicity

A, B, D, & E

A nurse on a telemetry unit is taking care of an asymptomatic client with sinus bradycardia at 50 bpm and occasional premature atrial contractions (PAC). Which of the following orders should the nurse question? Select all that apply. A. Administer 15mg of labetalol IV B. Monitor and report abnormal electrolytes C. Administer atropine 1mg IV D. Administer Adenosine 6mg IV E. Obtain a 12 lead EKG

A, C, D Adenosine blocks the AV node. Labetalol is a beta-blocker. Atropine is used to increase heart rate in some clients. This client is asymptomatic.

The nurse is reviewing a client's medications and notes the client is taking warfarin sodium. Which of the following medications should the nurse tell the client to avoid? Enalapril Promethazine Metoprolol Aspirin

Aspirin Taking warfarin and salicylates concurrently can increase the risk of bleeding, so this should be avoided.

The nurse is caring for a client with newly diagnosed atrial fibrillation. Which medication class does the nurse anticipate the client will need to take to prevent the formation of blood clots? Antipyretics Analgesics Anticoagulants Thrombolytics

Anticoagulants Anticoagulants prevent the formation of blood clots, and are prescribed for clients with atrial fibrillation. Two types of anticoagulants are heparin and warfarin.

The nurse is discharging a client with a new prescription for an oral anticoagulant. Which of the following additional medications taken by the client raises concerns for the nurse? Fish oil Aspirin Metoprolol Acetaminophen

Aspirin The nurse should note when a client who takes aspirin is beginning an oral anticoagulant, since both medications are blood thinners. This client's medication list should be reviewed by the provider.

A nurse is assigned to a 60-year-old client who been admitted to the hospital with heart palpitations and shortness of breath. Which of the following interventions should the nurse perform first? Administer oxygen via nasal cannula Obtain urine sample Assess client pulse and oxygen level Help the client to verbalize feelings of anxiety

Assess client pulse and oxygen level When a client is showing signs of distress, the nurse's first priority is to obtain a set of vital signs. Once the client's oxygen level is known, the nurse can proceed to give oxygen if needed. Checking the pulse rate and rhythm will give the nurse more specific details about what is occurring with the client's heart palpitations. All information is then charted in the client's record.

A nurse enters the room and notices her client has a heart rate of 32 on the monitor. Which of the following is the prioritynursing intervention for this client? Administer 1 mg of atropine Prepare the client for a pacemaker Assess the client's apical pulse Call a code

Assess the client's apical pulse The nurse should assess the client's apical pulse and confirm the rate.

A client has developed bradycardia and symptoms of shock. Which of the following medications would the nurse mostlikely administer to correct this situation? Verapamil Amiodarone Adenosine Atropine

Atropine Atropine is a medication used in the treatment of severe bradycardia, and is one of the first drugs administered for very low heart rate during advanced cardiac life support. When a client develops bradycardia and shows symptoms of poor perfusion, atropine is most likely going to be ordered to be administered to regulate the heart rate.

The nurse is reviewing a client's medications and notes that the client is taking warfarin sodium. Which of the client's following lifestyle habits would concern the nurse? Select all that apply. A. Grapefruit juice every morning B. Kale shakes and salads twice per day C. Playing on a local rugby team D. One glass of wine per week E. Availability of transportation to and from appointments once every two weeks

B, C Kale and other leafy greens contain vitamin K, which is the antidote to warfarin sodium. These should NOT be consumed in excess because they will negate the effect of the drug. Clients on anticoagulant therapy should not play contact sports because of the increased risk of bleeding.

A nurse has a client with a heart rate of 125 beats per minute and is attempting to identify the cause of a client's tachycardia. The nurse knows that which of the following could be possible causes of tachycardia? Select all that apply. A. Beta Blockers B. Fever C. Dehydration D. Hypertension E. Hypotension

B, C, & E

A student nurse is measuring an EKG strip. Which of the following elements on this rhythm strip demonstrate that this client is in normal sinus rhythm? Select all that apply. A. The PR interval is 0.26 seconds B. The small boxes between R waves are equal in number from one R-R interval to the next C. The rate is 90 beats per minute D. There is one P wave for every QRS complex E. The QRS complex is 0.08 seconds

B, C, D, & E A normal sinus rhythm will have a PR interval between 0.12 - 0.20 seconds. A PR interval of 0.26 seconds is prolonged, which may mean the client has a first degree heart block. The client with a PR interval of 0.26 seconds is not in normal sinus rhythm.

The nurse is caring for a client who is suffering from atrial fibrillation. Which of the following statements made by the nurse are correct? Select all that apply. A. It does not increase the risk of stroke B. The client may have dizziness and syncope C. It increases the risk of hemorrhagic stroke D. It can be caused by heart failure E. It arises from several atrial ectopic foci

B, D, E The client may have dizziness and syncope - Signs and symptoms include palpitations, fatigue, dizziness, syncope, shortness of breath, and chest pain. It can be caused by heart failure - Atrial fibrillation can be caused by heart failure, high blood pressure, heart attacks, electrolyte imbalances, and sick sinus syndrome. It increases the rate of embolic stroke, and the heart rate is usually rapid and grossly irregular. It arises from several atrial ectopic foci - The dysrhythmia arises from several atrial ectopic foci.

The nurse is caring for a client with multiple blood pressure medications. The nurse knows that which of the following medications lowers blood pressure by reducing the heart rate? Beta-blockers Diuretics ACE inhibitors Calcium channel blockers

Beta-blockers Beta blockers function in the cardiac system by reducing the heart rate.

The nurse is concerned that a client with atrial fibrillation is not on any anticoagulants and notifies the healthcare provider. The nurse knows that which of the following is a reason why a client with atrial fibrillation is at an increasedrisk for a stroke? Blood contracts faster so it clots easier The rapid ventricular response increases the risk for blood clots Blood pools in the atria due to their quivering There is increased blood since the atria are contracting faster

Blood pools in the atria due to their quivering Blood pools in the atria because of the quivering and forms a clot.

A student nurse is explaining premature atrial contraction (PAC) to his class and would be correct by saying which of the following about where a PAC is produced? By an irritable cell in atria SA node By an irritable cell in ventricle AV node

By an irritable cell in atria The impulse is initiated by an irritated cell in the atria.

A student nurse is reviewing an EKG graph and is attempting to determine if the rhythm is sinus tachycardia. Which of the following are normal characteristics of sinus tachycardia? Select all that apply. A. 1 to 2 QRS ratio B. PR interval of 0.06 seconds C. Regular rhythm D. QRS complex of 0.06 seconds E. PR interval of 0.16 seconds

C, D, & E

A student nurse is reviewing the client's EKG on a telemetry unit. The student nurse is attempting to identify the rhythm as a normal sinus rhythm. Which of the following steps should the student nurse identify for normal sinus rhythm? Select all that apply. A. A prolonged QT interval B. 2 P waves to one QRS C. Regular pattern D. Heart rate between 60-100 BPM E. Normal PR interval

C, D, & E

Which of the following medications lower blood pressure by reducing cardiac cell excitability? ACE inhibitors Beta-adrenoceptors Calcium channel blockers Diuretics

Calcium channel blockers When calcium enters the cell, it causes the cell to contract. Therefore, calcium channel blockers reduce cardiac cell excitability.

A nurse is caring for a client in a cardiac telemetry unit and notes the client's EKG strip indicates normal sinus rhythm. The client's blood pressure is 118/78. What action should the nurse take? Administer a PRN calcium channel blocker Obtain a 12-lead EKG Continue with the current plan of care Notify the healthcare provider

Continue with the current plan of care The client's EKG rhythm shows normal sinus rhythm, and since the client's blood pressure is within normal limits, there is no need to intervene at this time.

A student nurse is reviewing the rhythm on an EKG and knows that which of the following should be present to be considered sinus tachycardia? Client must be asymptomatic and tachycardic Heart rate must be greater than 95 bpm Client must be symptomatic no matter the heart rate Heart rate must be greater than 100 bpm

Heart rate must be greater than 100 bpm The heart rate has to be greater than 100 to be considered ST.

A student nurse is reviewing the rhythm on an EKG and knows that for the rhythm to be sinus bradycardia, which of the following parameters must be present? Symptomatic no matter the heart rate Heart rate must be less than 60 bpm Asymptomatic and bradycardic Heart rate must be less than 55 bpm

Heart rate must be less than 60 bpm The heart rate has to be less than 60 to be considered sinus bradycardia.

The nurse is obtaining vital signs on a newly admitted client. Which vital sign is the most concerning for an adult client? Temperature of 100.6F Respirations of 25 Blood pressure of 98/79 mm Hg Heart rate of 180 bpm

Heart rate of 180 bpm A pulse of 180 is considered extremely high. An adult client at rest can only sustain that pace for a limited amount of time, so the nurse will attempt to find and address the underlying cause of the tachycardia.

A nurse is caring for a client receiving amiodarone and knows to watch for which of the following side effects? Tremors Nausea Hypotension Hypertension

Hypotension Amiodarone blocks abnormal cardiac electrical activity, slowing the cardiac cycle down and may cause bradycardia and/or hypotension

A client with atrial flutter has been struggling with the condition that has been unresponsive to medications and cardioversion. The nurse talks to the client about catheter ablation as a form of treatment. Which of the following accurately describes how catheter ablation can successfully manage atrial flutter? It decreases afterload to improve the ejection fraction It eliminates scar tissue that decreases contractility It suspends the tricuspid valve to improve blood flow to the ventricle It destroys the node that is causing the arrhythmia

It destroys the node that is causing the arrhythmia During catheter ablation, a provider inserts a thin catheter into a chamber of the heart. The catheter delivers a small amount of energy that eliminates the part of the heart's conduction system that is causing the dysrhythmia, which can stop the atrial flutter.

Which describes a benefit of using synchronized cardioversion when compared to defibrillation? It can be used for rhythms such as asystole or PEA It uses more energy and has a greater therapeutic capacity It reduces the risk of ventricular fibrillation It usually only needs to be used once

It reduces the risk of ventricular fibrillation Synchronized cardioversion and defibrillation are two methods of shocking the heart into a normal rhythm when a cardiac arrhythmia has developed. Synchronized cardioversion may be performed in an emergency situation when the client has a pulse. This involves analyzing the client's rhythm and delivering the shock which is synchronized with the peak of the client's QRS wave to minimize the risk of V-fib due to the shock. Synchronized cardioversion uses lower energy levels when compared to defibrillation. Defibrillation delivers a higher energy shock and is delivered at any point during the heartbeat, which is useful when the rhythm cannot be analyzed.

A student nurse is observing a client's heart rate and notices a regular rhythm, heart rate of 65, 1 P wave followed by 1 QRS, PR interval of 0.16 seconds and a QRS complex of 0.06 seconds. The nurse knows that this is which of the following rhythms? Atrial fibrillation Sinus bradycardia Atrial flutter Normal sinus rhythm

Normal sinus rhythm Characteristics of a regular rhythm, heart rate of 65, 1 P wave followed by 1 QRS, PR interval of 0.16 seconds, and a QRS complex of 0.06 seconds describe a normal sinus rhythm.

A student nurse is measuring the PR interval on an atrial flutter rhythm and knows that which of the following is the expected PR interval for this rhythm? 0.04 seconds 0.16 seconds 0.24 seconds Not measurable

Not measurable The PR interval is not measurable with atrial flutter because PR intervals are absent.

After reviewing a normal sinus rhythm on an EKG strip, the student nurse is able to determine the electrical conduction originated in which of the following? SA node Bundle of His Purkinje fibers AV node

SA node In NSR, the electrical conduction originates in the SA node. Next, it travels to the AV node, then through the Bundle of His, and then to the Purkinje fibers.

A student nurse is observing a client's heart rate and notices a regular rhythm, heart rate of 45, 1 P wave followed by 1 QRS, PR interval of 0.16 seconds, and a QRS complex of 0.06 seconds. The student nurse identifies this rhythm as which of the following? Normal sinus rhythm Sinus bradycardia Atrial flutter Atrial fibrillation

Sinus bradycardia The characteristics of regular rhythm, heart rate of 45, 1 p wave followed by 1 QRS, PR interval of 0.16 seconds, and a QRS complex of 0.06 seconds are all related to sinus bradycardia.

The nurse is caring for a client who is suspected of having a sinus dysrhythmia. Which of the following statements made by the nurse is accurate? The origin of the dysrhythmia is the AV node Tachycardia can be due to activation of the parasympathetic nervous system The client will need to have a pacemaker placed Tachycardia can be due to activation of the sympathetic nervous system

Tachycardia can be due to activation of the sympathetic nervous system One type of cardiac dysrhythmia is sinus tachycardia, meaning the tachycardia originates in a sinoatrial node. If the dysrhythmia is sinus tachycardia, it can be due to activation of the sympathetic nervous system. It could also be due to a fever, medications or illicit drug use. Atrial and ventricular rates in sinus tach are 100 - 180 beats per minute.

The nurse is admitting a client to the unit. Which of the following drugs taken by the client is an anticoagulant? Persantine Warfarin Aspirin TPA

Warfarin Warfarin is an anticoagulant, which inhibits certain clotting factors. It prolongs clotting time and is used for long-term anticoagulation.

A client is preparing to undergo placement of a pacemaker to regulate their bradycardia. Following insertion of the pacemaker, the nurse should instruct the client to do which of the following to best protect the device? Apply lotion over the incision site Wear loose fitting clothing over the pacemaker Sleep with arms elevated above the heart level Avoid the use of electronic devices

Wear loose fitting clothing over the pacemaker Placement of a pacemaker requires further care after the client's discharge to ensure that the device remains in place and is not damaged. This includes wearing loose-fitting clothing over the site, avoiding contact sports, avoid operating electrical appliances directly over the device, avoiding transmitter towers and anti-theft devices in stores, and to inform all health care providers that a pacemaker has been inserted. The client should also check and record their pulse daily.