Porth's Ch 33 - Disorders of Cardiac Conduction & Rhythm
A monitored hospitalized patient 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 of the following forms of AF is this?
Paroxysmal
Which of the following 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
Which client will the nurse assess first?
The client with premature ventricular contractions
Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?
Transcutaneous
A nurse is caring for a patient with an average heart rate of 56 beats/min. The patient has no adverse symptoms associated with this heart rate and is receiving no treatment. Which of the following activity modifications should the nurse suggest to avoid further slowing of the heart rate?
"Avoid bearing down while having a bowel movement."
Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
A slow depolarization occurs because of the particular permeability of the cellular membranes.
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
A client has been diagnosed with atrial flutter. What assessment finding does the nurse expect?
An atrial heart rate above 240 beats per minute
A client presents with sinus tachycardia. What is an appropriate nursing action? Select all that apply.
Assess the client's temperature Assess the client's pain level Assess the client's vital signs
A client has been admitted after being resuscitated from a cardiac arrest. The client is stated to be in Class I for electrocardiogram monitoring. What type of monitoring will the nurse perform for this client?
Continuous cardiac monitoring
A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take?
Defibrillate the patient
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
The nurse is assisting a patient who had a myocardial infarction 2 days ago during a bath. The patient suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the patient was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. Which of the following is a priority intervention at this time?
Immediate defibrillation
A nurse is monitoring a client with a resting heart rate of 120 beats/minute who has been diagnosed with sinus tachycardia, which can result from a change in which characteristic of cardiac cells?
Increased automaticity
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
A patient is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which of the following actions is important for the nurse to tell the patient to ensure accuracy in correlating dysrhythmias with symptoms?
It is important to keep a diary of activities and symptoms.
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 arrives at the doctor's office complaining of 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 which of the following?
Myocardial infarction
Considering the PQRST complex of an electrocardiogram (ECG), which of the following letter designations represents atrial depolarization?
P wave
The nurse assesses the electrocardiogram for depolarization of the atria. What does the nurse expect to assess?
P wave above the baseline
The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?
QRS complex
A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which of the following common dysrhythmias is the nurse aware this patient most likely has related to maintaining a large stroke volume?
Sinus bradycardia
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 which of the following?
Sympathetic nervous system
A client is visiting the primary physician and appears extremely nervous. The intake nurse does his vital signs and notes an increase in both his heart rate and blood pressure. In an effort to better understand the client's presenting signs and symptoms the nurse asks the client about his concerns and the client states that the person who performed his pre-visit told him that he had an arrhythmia. Which is the most therapeutic response about cardiac arrhythmias that the nurse can make?
they can occur in diseased or healthy hearts.
