CARDIO: CH 26 HINKLE
The nurse is providing discharge teaching with a client about pacemaker surveillance. Which client statement indicates a need for further teaching? "I will take acetaminophen prior to the appointment to lessen the interrogation pain." "The surveillance frequency of the follow-up varies with each person." "The surveillance checks will determine how much battery life is available." "If possible, I would like to use the transtelephonic method for a follow-up.
"I will take acetaminophen prior to the appointment to lessen the interrogation pain." Pacemaker surveillance is painless, so there is no need to take any acetaminophen for the appointment. The surveillance can be done by transtelephonic transmission. The frequency of the surveillance appointments varies with each client. During the surveillance, battery life will be determined for client safety. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 739
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." "I can't wait to get back to my football league." "I'll keep a log of each time my ICD discharges." "I need to stay at least 10 inches away from the microwave."
"I'll keep a log of each time my ICD discharges." The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 747
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? "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node."
"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."
The nurse recognizes which as being true of cardioversion? Amount of voltage used should exceed 400 watts/second. Defibrillator should be set to deliver a shock during the QRS complex.
Defibrillator should be set to deliver a shock during the QRS complex.
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? Vibration under the skin Quality of the pulse Scar on the chest "Spike" on the rhythm strip
"Spike" on the rhythm strip Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 741
The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? "The QRS complex will be smaller in sinus bradycardia." : "The only difference is the heart rate."
"The only difference is the heart rate."
The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? "It is when the heart conduction is primarily from the atrioventricular node." "The rhythm has a normal beat, then a premature beat pattern." "The rhythm is regular but fast." "The heart rate is between 150 to 250 bpm."
"The rhythm has a normal beat, then a premature beat pattern." Bigeminy is a rhythm in which every other complex is a premature ventricular contraction (PVC). In trigeminy, every third complex is a PVC. The rhythm is not regular and the rate should not be 150-250 bpm. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729
A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? "The small box will transmit the heart rhythm to the central monitor all the time."
"The small box will transmit the heart rhythm to the central monitor all the time."
The nurse is caring for a client scheduled for a transesophageal echocardiogram with a diagnosis of atrial fibrillation. The client's spouse asks the nurse to explain the purpose of the test. What is the nurse's best response? "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." "This test will show if the client needs a cardiac catheterization."
"This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion."
The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." "We will be getting rid of our microwave oven so it will not affect my pacemaker." "I will avoid any large magnets that may affect my pacemaker." "I will call the doctor if my incision becomes swollen and red."
"We will be getting rid of our microwave oven so it will not affect my pacemaker." Permanent pacemaker generators have filters that protect them from electrical interference from most household devices, motors, and appliances, so the client can keep the microwave oven. Clients are taught to check pulses daily, avoid large magnets, and report any incisional redness or swelling. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744
The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? "The doctor wants to see if your heart will switch back to its normal rhythm by itself." "There is a long list of clients in line to be cardioverted." "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion."
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm? 0.05 and 0.1 seconds. 0.12 and 0.2 seconds. 0.25 and 0.4 seconds. 0.15 and 0.3 seconds.
0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718
The nurse knows that what PR interval presents a first-degree heart block? 0.14 seconds 0.18 seconds 0.16 seconds 0.24 seconds
0.24 seconds In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 732
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? All options are correct. elevated temperature shock strenuous exercise
All options are correct. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart, including fever, shock, and strenuous exercise. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 719
What is the drug of choice for a stable client with ventricular tachycardia? Atropine Amiodarone
Amiodarone
The nurse recognizes which as being true of cardioversion? Defibrillator should be set to deliver a shock during the QRS complex. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time. Electrical impulse can be discharged during the T wave. Amount of voltage used should exceed 400 watts/second.
Defibrillator should be set to deliver a shock during the QRS complex.
A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response? Assess the client and monitor leads. Call for assistance and begin CPR. Administer a pericardial thump. Call a code and obtain the crash cart.
Assess the client and monitor leads. The nurse should assess the client and monitor leads first. It is important that the nurse "treat the client, not the monitor." Ventricular asystole may often appear on the monitor when leads are displaced. The other interventions are not necessary. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729
The registered nurse reviewed the patient's vital signs and noted a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. What medication will cause bradycardia? Atropine Aminophylline Atenolol Epinephrine
Atenolol Atenolol is a beta-blocker that can lower the heart rate. The other medications stimulate the sympathetic response which will increase heart rate. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 721
A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at a rate of 150 bpm, with no discernible P waves. What does the nurse determine this rhythm to be? Nonparoxysmal junctional tachycardia Atrial fibrillation Sinus tachycardia Ventricular fibrillation
Atrial fibrillation
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? Ventricular fibrillation Atrial fibrillation Ventricular tachycardia Atrial flutter
Atrial flutter
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? Ventricular fibrillation Atrial fibrillation Ventricular tachycardia Atrial flutter
Atrial flutter Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in shape. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 727
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? Normal PR interval Regular rhythm P wave resent before each QRS Atrial rate of 300 to 400
Atrial rate of 300 to 400
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? Keep moving the arm on the side where the pacemaker is inserted Avoid sources of electrical interference Delay activities such as swimming and bowling for at least 3 weeks Keep the arm on the side of the pacemaker higher than the head
Avoid sources of electrical interference The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the client to avoid strenuous movement (especially of the arm on the side where the pacemaker is inserted), to keep the arm on the side of the pacemaker lower than the head except for brief moments when dressing or performing hygiene, and to delay for at least 8 weeks activities such as swimming, bowling, tennis, vacuum cleaning, carrying heavy objects, chopping wood, mowing, raking, and shoveling snow. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 747
The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? Never engage in activities that require vigorous arm and shoulder movement. Stay at least 5 feet away from microwave ovens. Avoid going through airport metal detectors. Avoid undergoing magnetic resonance imaging (MRI).
Avoid undergoing magnetic resonance imaging (MRI). A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 743
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? Begin cardiopulmonary resuscitation Provide electrical cardioversion Administer intravenous epinephrine Prepare for endotracheal intubation
Begin cardiopulmonary resuscitation In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the client as soon as possible. If defibrillation is not readily available, CPR is begun until the client can be defibrillated, followed by advanced cardiovascular life support (ACLS) intervention, which includes endotracheal intubation and administration of epinephrine. Electrical cardioversion is not indicated for a client in ventricular fibrillation. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 731
The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor of the 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?
Bigeminy
A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? Clients with recurrent life-threatening bradycardias Clients with sinus tachycardia Clients with ventricular bradycardia Clients with recurrent life-threatening tachydysrhythmias
Clients with recurrent life-threatening tachydysrhythmias
The nurse recognizes which as being true of cardioversion?
Defibrillator should be set to deliver a shock during the QRS complex.
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? Variable heart rate, usually fewer than 90 bpm P waves hidden within the QRS complex Delayed conduction, producing a prolonged PR interval Irregular rhythm
Delayed conduction, producing a prolonged PR interval First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in 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? A variable heart rate, usually fewer than 60 bpm P waves hidden with the QRS complex An irregular rhythm Delayed conduction, producing a prolonged PR interval
Delayed conduction, producing a prolonged PR interval First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds). Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 732
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? Check the security of all connections and increase the milliamperage Obtain a 12-lead ECG and a portable chest x-ray Document the findings and continue to monitor the client Reposition the extremity and turn the client to left side
Document the findings and continue to monitor the client
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? Suggest the need for a new beta-blocker to the doctor. Do nothing; there is no cause for alarm. Double-check the monitoring equipment. Measure the client's blood pressure.
Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 743
The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching? The procedure will occur in the operating room under general anesthesia. The procedure takes less time than a cardiac catheterization. During the procedure, the dysrhythmia will be reproduced under controlled conditions. After the procedure, the dysrhythmia will not recur.
During the procedure, the dysrhythmia will be reproduced under controlled conditions.
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Hypotension Nausea Fever Fluttering
Fluttering Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729
What is the treatment of choice for ventricular fibrillation? Immediate bystander CPR Atropine Implanted defibrillator Pacemaker
Immediate bystander CPR
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? It is used to eliminate ventricular dysrhythmias. It uses less electrical energy than cardioversion. It is a scheduled procedure 1 to 10 days in advance. The client is sedated before the procedure.
It is used to eliminate ventricular dysrhythmias. The only treatment for a life-threatening ventricular dysrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 737
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? Lead wire dislodgement Fracture of the lead wire Sensitivity is too low Faulty generator
Lead wire dislodgement
The nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhythmias? Provide supplemental oxygen. Palpate the client's pulse and observe the client's response. Monitor cardiac rhythm continuously. Monitor blood pressure continuously.
Monitor cardiac rhythm continuously. The nurse should monitor cardiac rhythm continuously. Cardiac monitors display real-time heart rate and rhythm and alert the nurse to potentially life-threatening dysrhythmias. Monitoring blood pressure continuously and palpating the client's pulse do not help detect life-threatening dysrhythmias. Providing supplemental oxygen helps maintain adequate cardiac output and does not help detect life-threatening dysrhythmias. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? Keep the client flat for one hour after administration Monitor vital signs and cardiac rhythm Document heart rate before and after administration Administer every five minutes during cardiac resuscitation
Monitor vital signs and cardiac rhythm
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? Date and time of insertion Pacer rate Model number Location of the generator
Pacer rate After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744
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? Ventricular fibrillation Premature ventricular contraction (PVC)
Premature ventricular contraction (PVC)
The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse's pressing the discharge button? Placing gel on the chest Stating "Charging." Checking the ECG rhythm Shouting "Clear!"
Shouting "Clear!" Before pressing the discharge button, the nurse shouts "Clear!" or "All clear!" to ensure that no one is in contact with the client. The nurse may call this warning multiple times. The other options are also performed but not immediately before discharging the defibrillator. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 738
A patient comes to the emergency department with reports 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? Sinus tachycardia Sinus bradycardia Ventricular tachycardia Normal sinus rhythm
Sinus tachycardia Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy). Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 719
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? The need to have regular blood levels drawn The importance of adequate fluid intake The need to sit upright for 30 minutes after taking the medication The importance of taking the medication 1 hour before or 2 hours after a meal
The need to have regular blood levels drawn One drawback of warfarin therapy is the need to have blood levels drawn on a regular basis. The medication does not need to be taken on an empty stomach, and the client does not have to sit upright. Adequate fluid intake is useful in a general way, but the need for fluids is not increased by taking warfarin. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 724
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? The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute The registered nurse stating to administer all medications except those which are cardiotonics The registered nurse stating to administer digoxin The registered nurse administering atropine sulfate intravenously
The registered nurse administering atropine sulfate intravenously The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718
Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low? QT interval U wave P wave T wave
U wave The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a client's serum potassium level is low. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a client's serum potassium level is high. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 712
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Atrial fibrillation Ventricular fibrillation Third-degree heart block Ventricular tachycardia
Ventricular fibrillation
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Third-degree heart block Ventricular tachycardia Ventricular fibrillation Atrial fibrillation
Ventricular fibrillation
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? Warfarin Amiodarone Adenosine Atropine
Warfarin Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone, flecainide, ibutilide, propafenone, or sotalol prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation (Fuster, Rydén et al., 2011). Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 724
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? identifying a code-level status maintaining intravenous fluids assessing blood pressure and heart rate frequently alerting the healthcare provider of the third-degree heart block
alerting the healthcare provider of the third-degree heart block The client may experience low cardiac output with third-degree AV block. The healthcare provider needs to intervene to preserve the client's cardiac output. Monitoring the blood pressure and heart rate are important, but not a priority. The identification of a code status during a heart block is not appropriate. IV fluids are not helpful if the heart is not perfusing. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 734
A client has an irregular heart rate of around 100 beats/minute and a significant pulse deficit. What component of the client's history would produce such symptoms? atrial flutter bundle branch block heart block atrial fibrillation
atrial fibrillation In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. Atrial flutter, heart block, and bundle branch block would not produce these symptoms.
The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? diltiazem atenolol nadolol atropine sulfate
atropine sulfate Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation. The client will be treated with an anticholinergic that blocks the effects of the vagal nerve. Atenolol and nadolol are beta blockers that are used for chest pain, myocardial infarction, and hypertension. Diltiazem is a calcium channel blocker used to treat angina or slow the heart rate. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 734
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? electrocardiogram electroencephalogram echocardiogram electrocautery
electrocardiogram An electrocardiogram is used to identify normal and abnormal cardiac rhythms.
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? vagal stimulation digoxin hypovolemia hypothyroidism
hypovolemia The causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, hypothyroidism, and digoxin will cause a sinus bradycardia. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 719
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 junctional tachycardia. sinus tachycardia. normal sinus rhythm. first-degree atrioventricular block.
normal sinus rhythm. The electrocardiogram (ECG) tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718
The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect? postoperative site hematoma pacemaker site infection internal bleeding at pacemaker site normal postoperative healing
pacemaker site infection Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These symptoms include swelling, unusual tenderness, drainage, and increased warmth. When the site is healing normally, there will be no tenderness and throbbing. A hematoma forms a lump at the pacemaker insertion site. Mild bleeding will be drainage. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 746
During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during the QT interval. atrial depolarization. ventricular depolarization. ventricular repolarization.
ventricular depolarization.
The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document? sinus rhythm atrial fibrillation junctional rhythm ventricular asystole ventricular tachycardia
ventricular tachycardia The dysrhythmia shown is ventricular tachycardia because it has more than 3 premature ventricular contractions. The ventricular rate is 100 to 200 bpm; the atrial rate depends on the underlying rhythm (e.g., sinus rhythm). The QRS duration is 0.12 seconds or more and has an abnormal shape. . Ventricular asystole is characterized by absent QRS complexes; this rhythm is referred to as flatline. Normal sinus rhythm is regular with with a ventricular and atrial rate of 60 to 100 bpm. The P-wave has a consistent shape and is always in front of the QRS. The PR interval is a consistent interval between 0.12 and 0.20 seconds, and the P:QRS ratio is 1:1. A junctional rhythm not caused by a complete heart block has a ventricular rate of 40 to 60 bpm and, if P waves are discernible, an atrial rate of 40 to 60 bpm. The ventricular and atrial rhythm are regular. If the P-wave is in front of the QRS, the PR interval is less than 0.12 seconds. The P:QRS ratio is 1:1 or 0:1. Atrial fibrillation is indicated by an atrial rate of 300 to 600 bpm; the ventricular rate is usually 120 to 200 bpm if untreated. Both the ventricular and atrial rhythm are highly irregular. P-waves will not be discernible; irregular undulating waves that vary in amplitude and shape are referred to as fibrillatory or f waves. The PR interval cannot be measured, and the P:QRS ratio is Many:1. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 730
