PREPU: Chap 26: Management of pts w/ dysrhythmias and conduction problems

peaked T waves

A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding?

inherent rhythmicity of cardiac muscle tissue.

A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:

IV bolus of atropine or temporary pacing

A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist?

The need to have regular blood levels drawn

A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client?

Double-check the monitoring equipment

A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?

-Carry a card identifying yourself as a pacemaker recipient. -Avoid large magnetic fields.

A client has had a pacemaker inserted and is ready for discharge. The nurse is providing education about pacemaker safety. Which of the following are items that the nurse will be sure to address? Choose all that apply.

"Spike" on the rhythm strip

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?

atrial flutter

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

avoid caffeinated beverages

A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to

I can still drink coffee and tea

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching?

ventricular depolarization

A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents:

elevated temperature shock strenuous exercise (All options are correct)

A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart?

I'll keep a log of each time my ICD discharges

A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?

Begin cardiopulmonary resuscitation

A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?

P wave P-R interval T wave

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply.

the only difference is the rate, which will be below 60 bpm in sinus bradycardia

A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between sinus rhythm and sinus bradycardia when I look at the EKG strip" The best reply by the nurse is which of the following?

Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast with wide QRS complexes

A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between ventricular tachycardia and ventricular fibrillation when I look at the EKG strip?" The best reply by the nurse is which of the following?

Ventricular fibrillation

A patient who had myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins assessment but suddenly the pt becomes unresponsive, no pulse, with the monitor showing rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?

Warfarin (Coumadin)

A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi?

Decreased cardiac output and decreased systolic and diastolic blood pressure

After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have?

Defibrillator should be set to deliver a shock during the QRS complex

Cardioversion is used to terminate dysrhythmias. With cardioversion, the:

Atrial rate of 300 to 400

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following?

occur at a rate of more than six per minute

Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:

Heart rate of 42 beats per minute (bpm)

Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a:

the sinoatrial (SA) node initiates the impulse

The client has just been diagnosed with a dysrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm?

The registered nurse administering atropine sulfate intravenously

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated?

normal sinus rhythm

The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as

Document the findings and continue to monitor the patient

The nurse analyzes the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The client's ECG strip demonstrates PR intervals that measure 0.24 seconds. What is the nurse's most appropriate action?

-Check pulse daily, reporting sudden slowing or increase -Avoid handheld screening devices in airports -Wear a medical alert, noting the presence of a pacemaker

The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply.

atrial depolarization

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?

immediate defibrillation

The nurse enters the client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?

Every other complex is a PVC

The nurse is asked to explain ventricular bigeminy to a patient. The nurse explains that it is a conduction defect in which:

delayed conduction, producing a prolonged PR interval

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. He is aware that this dysrhythmia is evident on an ECG strip by which of the following?

Pacer rate

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?

An automatic external defibrillator

The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment?

Atrial flutter

The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?

Delayed conduction, producing a prolonged PR interval

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?

During the procedure, the arrhythmia will be reproduced under controlled conditions.

The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include?

Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following?

given an IV bolus of atropine

The nurse is working on a telemetry unit, caring for a client who has been in a sinus rhythm for the past 2 days with a heart rate of 88 to 96 beats per minute. The client puts on the call light in the bathroom and reports severe dizziness. The telemetry shows a heart rate of 46 beats per minute. What should the nurse be prepared to do?

premature ventricular contraction

The nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II as well as a bizarre, abnormal shape to the QRS complex. The nurse has likely observed which ventricular dysrhythmia?

Atropine sulfate

The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed.

It is used to eliminate ventricular dysrhythmias

The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?

P wave

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?

It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node

Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following?

third degree

When no atrial impulse is conducted through the AV node into the ventricles, the client is said to be experiencing which type of AV block?

Premature ventricular contraction (PVC)

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?

QRS complex

Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?

Anticoagulant

Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?

PR interval

Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block?

hypovolemia and fever

While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of sinus tachycardia include which of the following?

Clients with recurrent life-threatening tachydysrhythmias

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients?

elective electrical cardio version

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client?

The sinoatrial (SA) node initiates the impulse.

Your client has just been diagnosed with a dysrhythmia. The client asks you to explain normal sinus rhythm. What would you explain are the characteristics of normal sinus rhythm?

treat the underlying cause

Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes:

The atrial contraction fills the ventricles and accounts for nearly one third of the volume ejected during ventricular contraction

A nursing student working today on the cardiac unit asks the instructor why loss of the "atrial kick" causes a decrease in cardiac output, because ventricles are still contracting. The instructor's best answer is which of the following

You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site

A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond?

anything that stimulates the sympathetic nervous system (positive chronotropy)

A nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following?

Document the findings and continue to monitor the client

A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response?

It increases the force of the myocardial contraction

A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following?

atrial flutter

A client's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as

Sinus tachycardia

A patient comes to the emergency department with complaints of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?

-Avoid magnetic fields such as metal detection booths. -Call for emergency assistance if feeling dizzy. -Record events that trigger a shock sensation.

A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.)

lead wire dislodgement

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?

"Sawtooth" pattern to the waveform

A patient is being examined for medical management of atrial flutter. The nurse reviews the ECG strip. He expects to see which of the following?

your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion

The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following?

elective cardioversion

The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia?

altered patterns frequently affect the heart's ability to pump blood effectively

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart?

bigeminy

The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record?

a defibrillator

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?

QT interval that is 0. 46 seconds long

The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up?

A client with atrial dysrhythmias

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?

we will be getting rid of our microwave oven so it will not affect my pacemaker

The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education.

fluttering

The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?

-Turn on the defibrillator and place it in "not sync" mode. -Charge defibrillator to prescribed voltage. -Apply multifunction conductor pads to client's chest. -Call "clear" three times ensuring client and environmental safety. -Deliver the prescribed electrical charge.

The nurse participates in the care of a client requiring emergent defibrillation. The nurse determines the steps should be completed in which order?

0.24 seconds

Which PR interval presents a first-degree heart block?

atrial flutter

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?

atropine

Which medication is the drug of choice for sinus bradycardia?

Monitor vital signs and cardiac rhythm

Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?

hypokalemia

Which of the following is a potential cause of premature ventricular complexes (PVCs)?