Ch. 26 Mgmt of pt's w/ dysrhythmias and conduction problems
A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching? "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." "I will document the date and time if my ICD fires." "I can play golf with my son in about 2 or 3 weeks." "I should tell close friends and family members that I have an ICD."
"I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." Explanation: The client does not need to take a CPR class. However, it is recommended that the family members and friends of a client who has an ICD learn CPR. The other statements indicate that the nurse's teaching was effective. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, 26-9, p. 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 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 atria and travel through the SA node." "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA 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 needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 716.
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 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 atria and travel through the SA node." "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA 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 needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 716.
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? Scar on the chest "Spike" on the rhythm strip Quality of the pulse Vibration under the skin
"Spike" on the rhythm strip Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Generator Functions, p. 741.
The nurse, along with a nursing student, is caring for a client who is admitted with a fractured pacemaker lead related to Twiddler syndrome. The student asks for information about Twiddler syndrome. The appropriate response by the nurse is which of the following? "The client twiddles with or manipulates the generator or wires, causing the lead to fracture." "A Dr. Twiddler discovered that too much arm movement will cause the lead to fracture." "It has to do with a defective lead wire produced by a company named Twiddler." "The lead wire breaks and causes symptoms related to lack of pacing; the name has nothing to do with the cause."
"The client twiddles with or manipulates the generator or wires, causing the lead to fracture." Explanation: Twiddler syndrome may occur when the client manipulates the generator, causing lead dislodgement or fracture of the lead. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-8, p. 743.
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor's best response?
"The difference is the timing of the delivery of the electric current."
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." "When your spouse needs help, an alarm will go off at the desk." "The box is recording the heart's electrical activity, and a physician will review the tracing later." "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute."
"The small box will transmit the heart rhythm to the central monitor all the time." Explanation: In telemetry, a small box transmits the client's heart rhythm to the central unit for constant monitoring. Telemetry has nothing to do with the client needing help. A Holter monitor is a device that records the heart's electrical activity and for later review by a physician. The telemetry transmits the heart rhythm regardless of the client's heart rate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion, p. 713.
The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." "The two look very much alike; it is difficult to tell the difference." "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width." "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal."
"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." Explanation: Ventricular fibrillation is irregular with undulating waves and no QRS complex, while ventricular tachycardia is usually regular and fast with wide QRS complexes. The rhythms look different on the electrocardiogram strip. The QRS is wide and bizarre or undefined in ventricular fibrillation. The P-R interval is not present in the ventricular dysrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Ventricular Tachycardia, p. 719.
A nurse is teaching nitroglycerin to a client with hospitalized client with coronary artery disease who is being discharged. The nurse tells the client that nitroglycerin has which of the following actions? Choose all that apply
-Reduces myocardial oxygen consumption -Dilates blood vessels -Decreases ischemia -Relieves pain
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. 0.15 and 0.3 seconds. 0.25 and 0.4 seconds.
0.12 and 0.2 seconds. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Normal Sinus Rhythm, p. 718.
The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds? 0.2 0.1 0.3 0.4
0.2 Explanation: Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 715.
The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds? 0.2 0.1 0.3 0.4
0.2 Explanation: Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 715.
The nurse knows that what PR interval presents a first-degree heart block? 0.24 seconds 0.14 seconds 0.16 seconds 0.18 seconds
0.24 seconds Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, First-Degree Atrioventricular Block, p. 732.
A client presents to the emergency department reporting chest pain. Which order should the nurse complete first?
12-lead ECG
The nurse would expect which atrial rate to be an idioventricular rhythm? 20 to 40 Not measurable 100 to 250 220 to 350
20 to 40 Explanation: The rate is 20 to 40. If the rate exceeds 40, the rhythm is known as accelerated idioventricular rhythm (AIVR). The rate is not measurable in asystole. Ventricular tachycardia has a rate of 100 to 250 per minute. Atrial flutter has a rate of 220 to 350. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Idioventricular Rhythm, p. 731.
A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25 small, square boxes within an RR interval. The nurse correctly identifies the client heart rate as 60 bpm. 100 bpm. 80 bpm. 70 bpm.
60 bpm. Explanation: A client's HR can be obtained from the electrocardiogram (ECG) tracing by several methods. A 1-minute strip contains 300 large boxes and 1500 small boxes. Therefore, an easy and accurate method of determining heart rate with a regular rhythm is to count the number of small boxes within an RR interval and divide by 1,500. In this instance, 1,500/25 = 60. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 717.
A client has started to exhibit dangerous PVCs in the cardiac postoperative unit. The client has been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should the nurse be ready to do? Adjust the IV infusion. Administer additional lidocaine. Prepare for defibrillation. Call for the doctor and just wait.
Adjust the IV infusion. Explanation: Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 721.
The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? Administer an IV bolus of atropine. Send the client to the cardiac catheterization laboratory. Prepare to client for cardioversion. Review the client's medication record.
Administer an IV bolus of atropine. Explanation: Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first. Cardioversion is used to treat a fast heart rate. Reviewing the medication record will not help the client initially. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 718.
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? Atrial rate of 300 to 400 Normal PR interval Regular rhythm P wave resent before each QRS
Atrial rate of 300 to 400 Explanation: ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Fibrillation, p. 722.
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? Atropine Dobutamine Amiodarone Lidocaine
Atropine Explanation: I.V. push atropine is used to treat symptomatic bradycardia. Dobutamine is used to treat heart failure and low cardiac output. Amiodarone is used to treat ventricular fibrillation and unstable ventricular tachycardia. Lidocaine is used to treat ventricular ectopy, ventricular tachycardia, and ventricular fibrillation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 718.
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? Diuretic Anticoagulant Antihypertensive Potassium supplement
Anticoagulant Explanation: Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation. The other options may be prescribed but not expected in most situations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pharmacologic Therapy, p. 724.
The nurse participates in the care of a client requiring emergent defibrillation. Arrange the steps in the order the nurse should complete them. All options must be used.
Apply the multifunction conductor pads to the client's chest. Turn on the defibrillator and place it in "not sync" mode. Charge the defibrillator to the prescribed voltage. Call "clear" three times ensuring client and environmental safety. Deliver the prescribed electrical charge.
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? Atrial fibrillation Ventricular fibrillation Sinus tachycardia Nonparoxysmal junctional tachycardia
Atrial fibrillation Explanation: Atrial fibrillation results from abnormal impulse formation that occurs when structural or electrophysiological abnormalities alter the atrial tissue causing a rapid, disorganized, and uncoordinated twitching of the atrial musculature. Characteristics of Atrial fibrillation: Atrial rate is typically 300 to 600 bpm; ventricular rate is 120 to 200 bpm. The ventricular and atrial rhythms are both highly irregular. No discernable P waves. PR interval cannot be measured. P:QRS ratio = many:1. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Flutter, pp. 726-727.
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? Atrial fibrillation Atrial flutter Ventricular tachycardia Ventricular fibrillation
Atrial flutter Explanation: Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects (Fuster, Walsh et al., 2011). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Flutter, p. 726.
A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia
Atrial flutter Explanation: The nurse correctly identifies the electrocardiogram (ECG) tracing as 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 appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 727.
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? Atrial rate of 300 to 400 Normal PR interval Regular rhythm P wave resent before each QRS
Atrial rate of 300 to 400 Explanation: ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Fibrillation, p. 722.
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.) Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation. The patient may have a throbbing pain that is normal The patient will have to schedule monthly chest x-rays to make sure the device is patent.
Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation. Explanation: The nurse should instruct the patient to avoid large magnetic fields such as those created by magnetic resonance imaging, large motors, arc welding, electrical substations, and so forth. Magnetic fields may deactivate the device, negating its effect on a dysrhythmia. The patient should call 911 for emergency assistance if a feeling of dizziness occurs. The patient should maintain a log that records discharges of an implantable cardioverter defibrillator (ICD). Record events that precipitate the sensation of shock. This provides important data for the physician to use in readjusting the medical regimen. Throbbing pain is not normal and should be reported immediately. An initial x-ray is indicated prior to discharge, but monthly x-rays are unnecessary. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, pp. 742-743.
A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker? Avoid sources of electrical interference. Keep the arm on the side of the pacemaker higher than the head. Delay activities such as swimming and bowling for at least 3 weeks. Keep moving the arm on the side where the pacemaker is inserted.
Avoid sources of electrical interference. Explanation: The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 740.
A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker? Avoid sources of electrical interference. Keep the arm on the side of the pacemaker higher than the head. Delay activities such as swimming and bowling for at least 3 weeks. Keep moving the arm on the side where the pacemaker is inserted.
Avoid sources of electrical interference. Explanation: The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 740.
The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? Stay at least 5 feet away from microwave ovens. Never engage in activities that require vigorous arm and shoulder movement. Avoid going through airport metal detectors. Avoid undergoing magnetic resonance imaging (MRI).
Avoid undergoing magnetic resonance imaging (MRI). Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 743.
A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? Insertion of an ICD Insertion of a permanent pacemaker Catheter ablation therapy Maze procedure
Catheter ablation therapy Explanation: Catheter ablation destroys specific cells that are the cause or central conduction route of a tachydysrhythmia. It is performed with or after an electrophysiology study. Usual indications for ablation are atrioventricular nodal reentry tachycardia, a recurrent atrial dysrhythmia (especially atrial fibrillation), or ventricular tachycardia unresponsive to previous therapy (or for which the therapy produced significant side effects). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Catheter Ablation Therapy, p. 725.
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 Explanation: The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Implantable Cardioverter Defibrillator, pp. 744-745.
The nurse recognizes which as being true of cardioversion? Amount of voltage used should exceed 400 watts/second. Electrical impulse can be discharged during the T wave. 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.
Defibrillator should be set to deliver a shock during the QRS complex. Explanation: Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion, p. 737.
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 An irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden with the QRS complex
Delayed conduction, producing a prolonged PR interval Explanation: 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, First-Degree Atrioventricular Block, p. 732.
Which of the following does the nurse recognize as the therapeutic goal of radiofrequency catheter ablation for a client with cardiac dysrhythmias? Reperfusion of ischemic heart tissue Dilation of arterial blood vessels Destruction of errant tissue Stimulation of the impulse center
Destruction of errant tissue Explanation: The therapeutic goal of radiofrequency catheter ablation is to destroy errant tissue, in hopes of allowing impulse conduction to travel over appropriate pathways. The goal does not include dilation of blood vessels or reperfusion of heart tissue. There is no stimulation of the heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 705.
Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent? Disrupting the heart during the critical period of atrial repolarization Disrupting the heart during the critical period of ventricular repolarization Disrupting the heart during the critical period of ventricular depolarization Disrupting the heart during the critical period of atrial depolarization
Disrupting the heart during the critical period of ventricular repolarization Explanation: It is similar to defibrillation. One difference is that the machine that delivers the electrical stimulation waits to discharge until it senses the appearance of an R wave. By doing so, the machine prevents disrupting the heart during the critical period of ventricular repolarization. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737.
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? Document the findings and continue to monitor the client Reposition the extremity and turn the client to left side Obtain a 12-lead ECG and a portable chest x-ray Check the security of all connections and increase the milliamperage
Document the findings and continue to monitor the client Explanation: Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the client. Repositioning the client, placing the client on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 741.
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? During the procedure, the dysrhythmia will be reproduced under controlled conditions. The procedure will occur in the operating room under general anesthesia. The procedure takes less time than a cardiac catheterization. After the procedure, the dysrhythmia will not recur.
During the procedure, the dysrhythmia will be reproduced under controlled conditions. Explanation: During EP studies, the patient is awake and may experience symptoms related to the dysrhythmia. The client does not receive general anesthesia. The EP procedure time is not easy to determine. EP studies do not always include ablation of the dysrhythmia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrophysiology Studies, p. 739.
The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? Defibrillation Maze procedure Pacemaker implantation Elective cardioversion
Elective cardioversion Explanation: Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Maze procedure is only a distractor for this question. Pacemakers are implanted for bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion for Atrial Fibrillation, p. 725.
A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? Elective electrical cardioversion Chemical cardioversion Mace procedure Elective electrical defibrillation
Elective electrical cardioversion Explanation: Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion for Atrial Fibrillation, p. 725.
The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? Hypertension Tachycardia Change in mental status Feeling tired
Feeling tired Explanation: The side effects of procainamide hydrochloride can include hypotension, GI upset, and feelings of tiredness. Procainamide does not cause hypertension, tachycardia, or a change in mental status. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-1, p. 721.
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Fluttering Nausea Hypotension Fever
Fluttering Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 729.
An ECG has been ordered for a newly admitted client. What should the nurse do prior to electrode placement?
Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? Hypokalemia Alkalosis Hypovolemia Bradycardia
Hypokalemia Explanation: PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (e.g., exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729.
The nurse understands that asystole can be caused by several conditions. Select all that apply. Hypoxia Alkalosis Hypovolemia Hypothermia Acidosis
Hypoxia Hypovolemia Hypothermia Acidosis Explanation: Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and identifying underlying and contributing factors. The key to successful treatment is a rapid assessment to identify a possible cause, which is known as the "Hs and Ts": hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 731.
Which rhythm is also termed a ventricular escape rhythm? Idioventricular rhythm Ventricular asystole First degree AV block Ventricular fibrillation
Idioventricular rhythm Explanation: Idioventricular rhythm is also called a ventricular escape rhythm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 731.
A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient? Insertion of a pacemaker Administration of atropine Administration of epinephrine Insertion of an implantable cardioverter defibrillator (ICD)
Insertion of a pacemaker Explanation: Third-degree AV block, also known as a complete block, occurs when no atrial impulse is conducted through the AV node into the ventricles. A permanent pacemaker may be necessary if the block persists. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management of Conduction Abnormalities, p. 734.
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? Instruct the client to restrict food and oral intake Administer digitalis and diuretics 24 hours before cardioversion Facilitate CPR until the client is prepared for cardioversion Monitor blood pressure every 4 hours
Instruct the client to restrict food and oral intake Explanation: The nurse should instruct the client to restrict food and oral intake before the cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion. When the client is in cardiopulmonary arrest, the nurse should facilitate CPR until the client is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a client with cardiac dysrhythmia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 737.
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? 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. It uses less electrical energy than cardioversion.
It is used to eliminate ventricular dysrhythmias. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737.
A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? Calcium and magnesium Potassium and calcium Magnesium and potassium Potassium and sodium
Magnesium and potassium Explanation: Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 730.
A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended? Angiography Maze procedure Open heart surgery Heart transplantation
Maze procedure Explanation: Clients who are not candidates for cardioversion and fail to respond to conventional measures may be candidates for a surgical intervention referred to as the Maze procedure. Angiography, open heart surgery, and heart transplantation are not recommended surgeries for these clients. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Maze and Mini-Maze Procedures, p. 725.
The nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhythmias? Monitor blood pressure continuously. Monitor cardiac rhythm continuously. Provide supplemental oxygen. Palpate the client's pulse and observe the client's response.
Monitor cardiac rhythm continuously. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Dysrhythmias, p. 713.
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? Extended PR interval More P waves than QRS complexes Atrial rate of 60 bpm or below Shortened QRS duration.
More P waves than QRS complexes Explanation: There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Third-Degree Atrioventricular Block, p. 734.
The nurse is analyzing the cardiac rhythm of a client with a pacemaker and notes the QRS complex is absent after pacer spike. The nurse knows that reading can be caused by which of the following factors? Client noncompliance Lead wire fracture Pacer undersensing Loss of pacing
Pacer undersensing Explanation: A pacemaker is an electronic device that provides electrical stimuli to the heart muscle. Pacemakers are usually used when a client has a permanent or temporary slower-than-normal impulse formation, or a symptomatic AV or ventricular conduction disturbance. They may also be used to control some tachyarrhythmias that do not respond to medication. When analyzing the function of the pacemaker, a loss of capture is indicated by a QRS complex not following the pacer spike. This could be caused by lead dislodgment, lead wire fracture, catheter malposition, a depleted battery, or myocardial ischemia. A total absence of pacer spikes indicates a loss of pacing. Pacer spikes occurring at preset intervals indicates undersensing. Pacer spikes not occurring at present intervals indicates oversensing.
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition? Premature atrial complex Atrial flutter Sinus tachycardia Ventricular fibrillation
Premature atrial complex Explanation: A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Atrial Complex, p. 720.
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? Ventricular bigeminy Ventricular tachycardia Premature ventricular contraction Ventricular fibrillation
Premature ventricular contraction Explanation: A premature ventricular contraction (PVC) is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 729.
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? Premature ventricular contraction (PVC) Ventricular bigeminy Ventricular tachycardia Ventricular fibrillation
Premature ventricular contraction (PVC) Explanation: A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729.
What is the drug of choice for a stable client with ventricular tachycardia? Atropine Amiodarone Procainamide Lidocaine
Procainamide Explanation: Procainamide is used for stable VT in clients who do not have acute MI or severe heart failure. Amiodarone administered IV is the medication of choice for a client with impaired cardiac function or acute MI. Atropine is used for bradycardia. Lidocaine had been commonly used for treating ventricular dysrhythmias but has no poven efficacy in cardiac arrest. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 729.
The nurse analyzes 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? QT interval that is 0. 46 seconds long PR interval that is 0.18 seconds long QRS complex that is 0.10 seconds long ST segment that is isoelectric in appearance
QT interval that is 0. 46 seconds long Explanation: The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the client may be at risk for a lethal ventricular dysrhythmia, called torsades de pointes. The other findings are normal. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 716.
The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? PP interval QT interval RR interval TP interval
RR interval Explanation: The rhythm is often identified at the same time the rate is determined. The RR interval is used to determine ventricular rhythm and the PP interval to determine atrial rhythm. If the intervals are the same or if the difference between the intervals is less than 0.8 seconds throughout the strip, the rhythm is called regular. If the intervals are different, the rhythm is called irregular. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 716.
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? Right side of sternum, fourth intercostal space Left side of sternum, fourth intercostal space Midway between V2 and V4 Mid-clavicular line, fifth intercostal space
Right side of sternum, fourth intercostal space Explanation: view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space. V2 is the left side of the sternum, fourth intercostal space. V3 is midway between V2 and V4. V4 is at the mid-clavicular line, fifth intercostal space. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Figure 26-2, p. 715.
An operating room nurse is caring for a client who is having a pacemaker implanted. The health care provider has requested a demand mode pacemaker for this client. What is this type of pacemaker? A fixed-rate pacemaker A temporary pacemaker Self-activated Asynchronous
Self-activated Explanation: Demand (synchronous) mode pacemakers self-activate when the client's pulse falls below a certain level. A fixed-rate pacemaker is asynchronous and permanent. Temporary pacemakers are used until a permanent pacemaker can be implanted. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Design and Types, p. 740.
A nurse is assigned to care for a recently admitted patient who has been diagnosed with refractory angina. Before meeting the patient, the nurse expects her to exhibit the following symptoms:
Severe, incapacitating chest pain
Which dysrhythmia is common in older clients? Sinus bradycardia Sinus tachycardia Sinus arrhythmia Ventricular tachycardia
Sinus bradycardia Explanation: Sinus bradycardia and atrial fibrillation are common dysrhythmia'a in older clients. Sinus tachycardia, sinus arrhythmmai, and ventricular tachycardia are not common dysrhythmias in older clients. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 718.
The nurse is preparing to administer adenosine for a patient diagnosed with atrial flutter. How should the nurse administer this medication? The dose is administered rapid IV push. The dose is administered slow IV push. The medication is followed by a slow saline flush. The medication is followed by a rapid lactated Ringer's (LR) flush
The dose is administered rapid IV push. Explanation: The dose is administered by rapid IV push (1 to 2 seconds), followed with a rapid saline flush. LR is not used during administration of this medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 727.
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? First degree Second degree, type I Second degree, type II Third degree
Third degree Explanation: In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria. In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 732.
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? First degree Second degree, type I Second degree, type II Third degree
Third degree Explanation: In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria. In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 732.
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? Ventricular tachycardia Atrial fibrillation Third-degree heart block Ventricular fibrillation
Ventricular fibrillation Explanation: The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Ventricular Fibrillation, p. 730.
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? nadolol diltiazem atropine sulfate atenolol
atropine sulfate Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management of Conduction Abnormalities, p. 734.
Which is not a likely origination point for cardiac dysrhythmias? bundle of His ventricles atria atrioventricular node
bundle of His Explanation: Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 713.
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action? defibrillation cardioversion IV bolus of atropine IV bolus of dobutamine
defibrillation Explanation: Advanced cardiac life support recommends early defibrillation for witnessed ventricular fibrillation. A cardioversion is used with a client who has a pulse. Atropine is used for bradycardia and dobutamine is an inotropic medication used to increased cardiac output. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 731.
A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of embolic stroke. myocardial infarction. heart failure. renal failure.
embolic stroke. Explanation: Intervention is implemented to prevent the development of an embolic event/stroke. Clients with a history of previous stroke, transient ischemic attack (TIA), embolic event, mitral stenosis, or prosthetic heart valve and who develop atrial fibrillation are at significant risk of developing an embolic stroke. Antithrombotic therapy is indicated for all clients with atrial fibrillation, especially those at risk of an embolic event, such as a stroke, and it is the only therapy that decreases cardiovascular mortality. These client are often placed on warfarin, in contrast to clients who have no risk factors, and who are often prescribed 81 to 325 mg of aspirin daily. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 722.
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? hypovolemia vagal stimulation hypothyroidism digoxin
hypovolemia Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Sinus Tachycardia, p. 719.
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: inherent rhythmicity of cardiac muscle tissue. inherent rhythmicity of all muscle tissue. sufficient blood pressure. inherent electrons in muscle tissue.
inherent rhythmicity of cardiac muscle tissue. Explanation: Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 713.
A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? internal cardioverter defibrillator insertion pacemaker insertion radiofrequency ablation electrophysiological study
internal cardioverter defibrillator insertion Explanation: The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Implantable Cardioverter Defibrillator, p. 744.
A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute with a regular interval between 0.12 and 0.20 seconds. What type of dysrhythmia does the client have? sinus bradycardia atrial bradycardia heart block none
sinus bradycardia Explanation: Sinus bradycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual (less than 60 beats/minute) rate. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 718.
When the nurse observes that the client's heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating normal sinus rhythm. sinus bradycardia. sinus dysrhythmia. sinus tachycardia.
sinus dysrhythmia. Explanation: Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm. Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway. Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.
A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? supraventricular tachycardia sinus tachycardia heart block atrial flutter
supraventricular tachycardia Explanation: Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (over 150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill. These symptoms do not suggest sinus tachycardia, heart block, or atrial flutter. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 729.
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." "If possible, I would like to use the transtelephonic method for a follow-up." "The surveillance frequency of the follow-up varies with each person." "The surveillance checks will determine how much battery life is available."
"I will take acetaminophen prior to the appointment to lessen the interrogation pain." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Therapy, p. 739.
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." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729.
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? "We will be getting rid of our microwave oven so it will not affect my pacemaker." "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." "I will call the doctor if my incision becomes swollen and red." "I will avoid any large magnets that may affect my pacemaker."
"We will be getting rid of our microwave oven so it will not affect my pacemaker." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 744.
x The nurse would expect which atrial rate to be an idioventricular rhythm? 20 to 40 Not measurable 100 to 250 220 to 350
20 to 40 Explanation: The rate is 20 to 40. If the rate exceeds 40, the rhythm is known as accelerated idioventricular rhythm (AIVR). The rate is not measurable in asystole. Ventricular tachycardia has a rate of 100 to 250 per minute. Atrial flutter has a rate of 220 to 350. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Idioventricular Rhythm, p. 731.
A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25 small, square boxes within an RR interval. The nurse correctly identifies the client heart rate as 60 bpm. 100 bpm. 80 bpm. 70 bpm.
60 bpm. Explanation: A client's HR can be obtained from the electrocardiogram (ECG) tracing by several methods. A 1-minute strip contains 300 large boxes and 1500 small boxes. Therefore, an easy and accurate method of determining heart rate with a regular rhythm is to count the number of small boxes within an RR interval and divide by 1,500. In this instance, 1,500/25 = 60. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 717.
x The ECG of a new patient shows a P wave slightly different than normal. The nurse is considering the possibility of premature atrial contractions (PAC). The nurse will ask about which factors when taking this client's history? All options are correct. caffeine nicotine hyperthyroidism or other metabolic disorders
All options are correct. Explanation: There are a number of causes of premature atrial contractions (PAC), which is why it is so important to know and review a patient's complete history when examining for dysrhythmias.
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? Aminophylline Atropine Atenolol Epinephrine
Atenolol Explanation: Atenolol is a beta-blocker that can lower the heart rate. The other medications stimulate the sympathetic response which will increase heart rate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-1, p. 721.
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? Keep the arm on the side of the pacemaker higher than the head Delay activities such as swimming and bowling for at least 3 weeks Keep moving the arm on the side where the pacemaker is inserted Avoid sources of electrical interference
Avoid sources of electrical interference Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Chart 26-9, p. 747.
The nurse and student nurse are observing a cardioversion procedure completed by a physician. At which time is the nurse most correct to identify to the student when the electrical current will be initiated?
During ventricular depolarization
Which diagnostic study best evaluates different medications ability to restore normal heart rhythm? Elective electrical cardioversion Electrocardiogram (ECG) Electrophysiology study Echocardiogram
Electrophysiology study Explanation: An electrophysiology study is a procedure that enables the physician to examine the electrical activity of the heart, produce actual dysrhythmias, and determine the best method for care. Cardioversion uses synchronized electricity to change the rhythm pattern. Electrocardiogram and echocardiograms provide diagnostic information. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrophysiology Studies, p. 738.
The nurse assesses a client returning from the post anesthesia unit with a new onset of sinus tachycardia with a heart rate of 138 beats per minute and a blood pressure of 128/80mmHg after elevating the head of the bed. What intervention does the nurse consider? Assessing blood glucose level Decreasing intravenous fluids Removing anti-embolism stockings Evaluating laboratory values
Evaluating laboratory values Explanation: Evaluating laboratory values such as complete blood count for anemia is an appropriate intervention because the anemia will cause tachycardia. Treating autonomic dysfunction or postural orthostatic tachycardia includes increasing intravenous fluid and applying anti-embolism stockings. Hypoglycemia is associated with bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 716.
The nurse receives a client from the postanesthesia unit with a new onset of sinus tachycardia and a heart rate of 118 beats per minute. To which reasons does the nurse relate the increased heart rate? Select all that apply. Fever Blood loss Sleep Hypoglycemia Anxiety
Fever Blood loss Anxiety Explanation: Fever, blood loss, and anxiety can be related to tachycardia. Sleep and hypoglycemia are contributing factors to bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 719.
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first? Initiate transcutaneous pacing Prepare for defibrillation Administer 1 mg of IV atropine Obtain a 12-lead ECG
Initiate transcutaneous pacing Explanation: The client is experiencing a third-degree heart block. Transcutaneous pacing should be implemented first. A permanent pacemaker may be indicated if the block continues. Defibrillation is not indicated; third-degree heart block does not respond to atropine; a 12-lead ECG may be obtained, but is not completed first. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 734.
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? Instruct the client to restrict food and oral intake Administer digitalis and diuretics 24 hours before cardioversion Facilitate CPR until the client is prepared for cardioversion Monitor blood pressure every 4 hours
Instruct the client to restrict food and oral intake Explanation: The nurse should instruct the client to restrict food and oral intake before the cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion. When the client is in cardiopulmonary arrest, the nurse should facilitate CPR until the client is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a client with cardiac dysrhythmia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 737.
The nurse is caring for an adult client who has gone into ventricular fibrillation. When assisting with defibrillating the client, what must the nurse do?
Maintain firm contact between paddles and the client's skin.
A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended? Angiography Maze procedure Open heart surgery Heart transplantation
Maze procedure Explanation: Clients who are not candidates for cardioversion and fail to respond to conventional measures may be candidates for a surgical intervention referred to as the Maze procedure. Angiography, open heart surgery, and heart transplantation are not recommended surgeries for these clients. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Maze and Mini-Maze Procedures, p. 725.
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition? Premature atrial complex Atrial flutter Sinus tachycardia Ventricular fibrillation
Premature atrial complex Explanation: A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Atrial Complex, p. 720.
A nurse is caring for a client who is on a continuous cardiac monitor. When evaluating the client's rhythm strip, the nurse notes that the QRS interval has increased from 0.08 second to 0.14 second. Based on this finding, the nurse should withhold continued administration of which drug? Metoprolol Procainamide Propafenone Verapamil
Procainamide Explanation: Procainamide may cause an increased QRS complexes and QT intervals. If the QRS duration increases by more than 50%, then the nurse should withhold the drug and notify the physician of her finding. Metoprolol may cause increased PR interval and bradycardia. Propafenone and verapamil may cause bradycardia and atrioventricular blocks. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 730.
The nurse cares for a client who has developed junctional tachycardia with a heart rate (HR) of 80 bpm. Which action should the nurse complete? Request a digoxin level be ordered Withhold the client's oral potassium supplement Prepare for emergent electrical cardioversion Prepare to administer IV lidocaine
Request a digoxin level be ordered Explanation: The nurse should request a digoxin level be obtained. Junctional tachycardia generally does not have any detrimental hemodynamic effect; it may indicate a serious underlying condition, such as digitalis toxicity, myocardial ischemia, hypokalemia, or chronic obstructive pulmonary disease (COPD). Potassium supplements do not cause junctional tachycardia. Lidocaine is indicated for the treatment of premature ventricular contractions (PVCs). Because junctional tachycardia is caused by increased automaticity, cardioversion is not an effective treatment; in fact, it causes an increase in ventricular rate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 728.
The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason? The delivered shock must be synchronized with the client's QRS complex. The defibrillator won't deliver a shock if the synchronizer switch is turned on. The defibrillator won't deliver a shock if the synchronizer switch is turned off. The shock must be synchronized with the client's T wave.
The defibrillator won't deliver a shock if the synchronizer switch is turned on. Explanation: The nurse needs to check the synchronizer switch to ensure the switch is turned off. The defibrillator won't deliver a shock to the client in ventricular fibrillation if the synchronizer switch is turned on because the defibrillator needs to recognize a QRS complex when the switch is turned on. The synchronizer switch should be turned on when attempting to terminate arrhythmias that contain QRS complexes, such as rapid atrial fibrillation that's resistant to pharmacologic measures. A synchronized shock should occur with the QRS complex, not the T wave, to avoid inducing ventricular fibrillation and allow for a lower shock dose. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion, p. 737.
Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low? U wave T wave P wave QT interval
U wave Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 712.
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first? Sustained asystole Supraventricular tachycardia Atrial fibrillation Ventricular fibrillation
Ventricular fibrillation Explanation: Ventricular fibrillation is called the rhythm of a dying heart. It is the rhythm that needs attention first because there is no cardiac output, and it is an indication for CPR and immediate defibrillation. Sustained asystole either is from death, or the client is off of the cardiac monitor. Supraventricular tachycardia and atrial fibrillation are monitored and reported to the physician but are not addressed first. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Ventricular Fibrillation, p. 730.
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What type of dysrhythmia would the cardiologist likely diagnose? sinus tachycardia sinus bradycardia supraventricular tachycardia supraventricular bradycardia
sinus tachycardia Explanation: Sinus tachycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a faster than usual rate (100 to 150 beats/minute). Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 719.
During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during atrial depolarization. ventricular depolarization. ventricular repolarization. the QT interval.
ventricular depolarization. Explanation: In cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) on the cardiac monitor so that the electrical impulse discharges during ventricular depolarization. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion, p. 737.
The nurse is providing discharge instructions for a client with a newly implanted cardiac defibrillator. What statement made by the client indicates the need for further teaching? "I will carry an identification card so I can avoid a handheld security device at the airport." "I will not be able to have a magnetic resonance imaging study." "I will try to have my family take a cardiopulmonary resuscitation class." "I will report if I feel lightheaded and dizzy at my next doctor's appointment."
"I will report if I feel lightheaded and dizzy at my next doctor's appointment." Explanation: The clients with newly implanted devices are told to treat lightheadedness and dizziness as an emergency so these symptoms should be reported as an emergency. Handheld security devices should be avoided because of the electromagnetic interference. Magnetic resonance imaging studies may deactivate the device so they need to be avoided. The CPR training is recommended for family as an emergency backup. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Promoting Home, Community-based, and Transitional Care, p. 735.
A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order?
Heparin
The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response? "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate." "This is okay as long as you are not having any symptoms." "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase."
"Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." Explanation: A client experiencing pacemaker malfunctioning may develop bradycardia as well as signs and symptoms of decreased cardiac output. The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate, which may indicate pacemaker malfunction. The client needs to be evaluated to avoid cardiac output problems. Walking will not keep the heart rate at a safe level. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Surveillance, p. 744.
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." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729.
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? "We will be getting rid of our microwave oven so it will not affect my pacemaker." "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." "I will call the doctor if my incision becomes swollen and red." "I will avoid any large magnets that may affect my pacemaker."
"We will be getting rid of our microwave oven so it will not affect my pacemaker." Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 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." "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." "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." Explanation: Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion. The doctor will not wait for a change in rhythm. Resting the heart will not change the rhythm. There is no delay but safer for the clots to be dissolved with the anticoagulant. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medications That Convert the Heart Rhythm or Prevent Atrial Fibrillation, p. 724.
What ECG findings does the nurse observe in a patient who has had a myocardial infarction (MI)? (Select all that apply.)
-An abnormal Q wave-T-wave inversion-ST-segment elevation
A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25 small, square boxes within an RR interval. The nurse correctly identifies the client heart rate as 60 bpm. 100 bpm. 80 bpm. 70 bpm.
60 bpm. Explanation: A client's HR can be obtained from the electrocardiogram (ECG) tracing by several methods. A 1-minute strip contains 300 large boxes and 1500 small boxes. Therefore, an easy and accurate method of determining heart rate with a regular rhythm is to count the number of small boxes within an RR interval and divide by 1,500. In this instance, 1,500/25 = 60. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 717.
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? A new myocardial infarction client A client with poor kidney perfusion A client with third-degree heart block A client with atrial dysrhythmias
A client with atrial dysrhythmias Explanation: The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737.
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? A new myocardial infarction client A client with poor kidney perfusion A client with third-degree heart block A client with atrial dysrhythmias
A client with atrial dysrhythmias Explanation: The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737.
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? A new myocardial infarction client A client with poor kidney perfusion A client with third-degree heart block A client with atrial dysrhythmias
A client with atrial dysrhythmias Explanation: The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737.
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? Assessing the client's blood pressure and heart rate frequently Identifying the client's code level status Maintaining the client's intravenous fluids Alerting the healthcare provider of the third-degree heart block
Alerting the healthcare provider of the third-degree heart block Explanation: 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 the priority. The identification of a code status during a heart block is not appropriate. The IV fluids are not helpful if the heart is not perfusing. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 734.
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? Asystole Premature ventricular contraction Atrial flutter Ventricular fibrillation
Atrial flutter Explanation: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Flutter, p. 726.
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 Prepare for endotracheal intubation Provide electrical cardioversion Administer intravenous epinephrine
Begin cardiopulmonary resuscitation Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 731.
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? Begin cardiopulmonary resuscitation (CPR) Administer epinephrine Administer atropine 0.5 mg Defibrillate with 360 joules (monophasic defibrillator)
Begin cardiopulmonary resuscitation (CPR) Explanation: Commonly called flatline, ventricular asystole (Fig. 26-19) is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Ventricular asystole is treated the same as PEA, focusing on high-quality CPR with minimal interruptions and identifying underlying and contributing factors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 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 Couplets Multifocal PVCs R-on-T phenomenon
Bigeminy Explanation: The nurse is correct to note bigeminy on the permanent record when every other beat is a PVC. Couplets are two PVCs in a row. Multifocal PVCs originate from more than one location. R-on-T phenomenon occurs when the R wave falls on the T wave. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729.
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 Couplets Multifocal PVCs R-on-T phenomenon
Bigeminy Explanation: The nurse is correct to note bigeminy on the permanent record when every other beat is a PVC. Couplets are two PVCs in a row. Multifocal PVCs originate from more than one location. R-on-T phenomenon occurs when the R wave falls on the T wave. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729.
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 An irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden with the QRS complex
Delayed conduction, producing a prolonged PR interval Explanation: 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). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, First-Degree Atrioventricular Block, p. 732.
The nurse is assessing a client with mitral regurgitation. The nurse expects to note what finding in this client? Dyspnea, fatigue, and weakness Dizziness, syncope, and palpitations Orthopnea, angina, and pulmonary edema Dry cough, wheezing, and hemoptysis
Dyspnea, fatigue, and weakness Explanation: Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation can cause dyspnea, fatigue, and weakness. Dizziness, syncope, and palpitations are usually symptoms of mitral valve prolapse. Orthopnea, angina, and pulmonary edema are more likely with aortic stenosis. Dry cough, wheezing, and hemoptysis are more likely with mitral stenosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Fibrillation, p. 722.
When the postcardiac surgical patient demonstrates vasodilation, hypotension, hyporeflexia, slow gastrointestinal motility (hypoactive bowel sounds), lethargy, and respiratory depression, the nurse suspects which electrolyte imbalance?
Hypermagnesemia
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? Fracture of the lead wire Lead wire dislodgement Faulty generator Sensitivity is too low
Lead wire dislodgement Explanation: Phrenic nerve, diaphragmatic (hiccupping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Chart 26-8, p. 743.
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 Administer every five minutes during cardiac resuscitation Document heart rate before and after administration Monitor vital signs and cardiac rhythm
Monitor vital signs and cardiac rhythm Explanation: The nurse should monitor the client's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill client. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a client flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Summary of Antiarrhythmic Medications, p. 721.
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? P wave PR interval QRS complex T wave
P wave Explanation: The P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The T wave depicts the relative refractory period, representing ventricular repolarization. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 715.
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. QRT wave P wave S-Q segment P-R interval T wave
P wave P-R interval T wave Explanation: The EKG cardiac complex waves include the P wave, the QRS complex, the T wave, and possibly the U wave. The intervals and segments include the PR interval, the ST segment, and the QT interval. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 715.
The nurse analyzes 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? QT interval that is 0. 46 seconds long PR interval that is 0.18 seconds long QRS complex that is 0.10 seconds long ST segment that is isoelectric in appearance
QT interval that is 0. 46 seconds long Explanation: The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the client may be at risk for a lethal ventricular dysrhythmia, called torsades de pointes. The other findings are normal. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 716.
The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? PP interval QT interval RR interval TP interval
RR interval Explanation: The rhythm is often identified at the same time the rate is determined. The RR interval is used to determine ventricular rhythm and the PP interval to determine atrial rhythm. If the intervals are the same or if the difference between the intervals is less than 0.8 seconds throughout the strip, the rhythm is called regular. If the intervals are different, the rhythm is called irregular. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 716.
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? The medication increases the force of the myocardial contraction. The medication causes the kidneys to retain fluid and increase intravascular volume. The medication increases the heart rate. The medication helps the kidneys produce more urine.
The medication increases the force of the myocardial contraction. Explanation: A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Influences on Heart Rate and Contractility, p. 713.
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? The medication increases the force of the myocardial contraction. The medication causes the kidneys to retain fluid and increase intravascular volume. The medication increases the heart rate. The medication helps the kidneys produce more urine.
The medication increases the force of the myocardial contraction. Explanation: A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Influences on Heart Rate and Contractility, p. 713.
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 taking the medication 1 hour before or 2 hours after a meal The need to sit upright for 30 minutes after taking the medication The importance of adequate fluid intake
The need to have regular blood levels drawn Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pharmacologic Therapy, p. 724.
A client asks the nurse about complications associated with use of a cardiac pacemaker. What does the nurse include in their response? Select all that apply. Twiddler syndrome Hiccupping Positive Kernig's sign Localized infection Negative Babinski reflex
Twiddler syndrome Hiccupping Localized infection Explanation: Complications associated with pacemakers include infection at entry site, pneumothorax, bleeding and hematoma, hemothorax, ventricular ectopy and tachycardia, phrenic nerve/diaphragmatic(hiccupping)/skeletal stimulation, cardiac perforation, Twiddler syndrome, and hemodynamic instability. A positive Kernig's sign is an indication of meningitis. A positive Babinski reflex is normal in neonates, but indicates a central nervous system disorder in adults. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, pp. 742-743.
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action? defibrillation cardioversion IV bolus of atropine IV bolus of dobutamine
defibrillation Explanation: Advanced cardiac life support recommends early defibrillation for witnessed ventricular fibrillation. A cardioversion is used with a client who has a pulse. Atropine is used for bradycardia and dobutamine is an inotropic medication used to increased cardiac output. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 731.
A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardiogram as an indicator of sinus tachycardia? heart rate of 118 bpm PR interval of 0.1 seconds QRS duration of 0.16 seconds Q wave of 0.04 seconds
heart rate of 118 bpm Explanation: The sinus node creates an impulse at a faster-than-normal rate. The PR interval of 0.1 seconds, QRS duration of 0.16 seconds and Q wave of 0.04 seconds are consistent with a normal sinus rhythm. Sinus tachycardia occurs when the heart rate is over 100 bpm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Sinus Tachycardia, p. 719.
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? hypovolemia vagal stimulation hypothyroidism digoxin
hypovolemia Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Sinus Tachycardia, p. 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 normal sinus rhythm. sinus tachycardia. junctional tachycardia. first-degree atrioventricular block.
normal sinus rhythm. Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 718.
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? ventricular tachycardia ventricular asystole sinus rhythm junctional rhythm atrial fibrillation
ventricular tachycardia Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Ventricular Tachycardia, p. 730.
The nurse is educating the client about a transvenous pacemaker. What is the best statement to explain why the client will have a transvenous pacemaker? "A transvenous pacemaker is used in place of a transarterial pacemaker." "A transvenous pacemaker is a permanent pacemaker that is asynchronous." "A transvenous pacemaker is used for a ventricular tachydysrhythmias." "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."
"A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs." Explanation: A transvenous pacemaker is a temporary pulse-generating device that sometimes is necessary to manage transient bradydysrhythmias such as those that occur during acute MIs or after coronary artery bypass graft surgery, or to override tachydysrhythmias. The transvenous pacemaker is a temporary pacemaker introduced into the venous system, not the arterial system. The pacemaker does not manage ventricular dysrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Design and Types, p. 740.
The nurse is instructing on home care after placement of an implanted cardioverter defibrillator (ICD). Which statement, made by the client, needs clarification by the nurse? "I need to notify my cardiologist if I feel frequent kicks to the chest." "I can continue to work with my power tools." "I need to stay away from microwaves." "I should opt for a hand search at the airport instead of metal detector scan."
"I need to stay away from microwaves." Explanation: Similar to hand tools, microwaves have shields or are grounded, making them safe for clients with ICDs. There is no restriction from microwave use. All of the other options are correct. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Chart 26-9: Home Care Checklist, Educating the Patient With an Implantable Cardiac Device, p. 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 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 atria and travel through the SA node." "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA 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 needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 716.
The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response? "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate." "This is okay as long as you are not having any symptoms." "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase."
"Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." Explanation: A client experiencing pacemaker malfunctioning may develop bradycardia as well as signs and symptoms of decreased cardiac output. The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate, which may indicate pacemaker malfunction. The client needs to be evaluated to avoid cardiac output problems. Walking will not keep the heart rate at a safe level. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Surveillance, p. 744.
The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response? "The F waves are flutter waves representing atrial activity." "The F waves are flutter waves representing ventricular activity." "The F waves are normal parts of the heart conduction system" "The F waves are most likely caused by the new medication."
"The F waves are flutter waves representing atrial activity." Explanation: F waves are flutter waves representing atrial activity. F waves are not representative of ventricular activity, nor are they normal parts of the heart's conduction system. F waves can be caused by chronic pulmonary disease, valvular disease, thyrotoxicosis, and open heart surgery; they are not caused by medication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Flutter, p. 727.
The nurse is caring for a 32-year-old client admitted with a medical diagnosis of atrial fibrillation, related to "holiday heart" syndrome. A nursing student working with the nurse asks for information about "holiday heart" syndrome. Which is the best response by the nurse? "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." "This is the association of heart dysrhythmias, especially atrial fibrillation, with extramarital sex." "This is the association of heart dysrhythmias, especially atrial fibrillation, with physical activity the client is not used to." "This is the association of heart dysrhythmias, especially atrial fibrillation, with very heavy meals."
"This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." Explanation: Atrial fibrillation may be found in people with acute moderate to heavy ingestion of alcohol. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Chart 26-2, p. 723.
The nurse has been asked to teach a patient how to self-administer nitroglycerin. The nurse should instruct the patient to do which of the following? Select all of the teaching points that apply.
-Let the tablet dissolve in the mouth and keep the tongue still. -The tablet can be crushed between the teeth but not swallowed. -Renew the supply every 6 months. -Take the tablet in anticipation of any activity that can produce pain. -Call emergency services if, after taking three tablets (one every 5 minutes), pain persists.
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? A suction machine A defibrillator Cardioversion equipment An ECG machine
A defibrillator Explanation: The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death. A suction machine is used to remove respiratory secretions. Cardioversion is used in a planned setting for atrial dysrhythmias. An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Defibrillation, p. 738.
A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting for 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure? Administer moderate sedation IV and analgesic medication as prescribed. Administer the prescribed digitalis to the client before the scheduled procedure. Administer anticoagulant therapy as prescribed prior to the procedure. Maintain the client on NPO status for 8 hours prior to the procedure.
Administer moderate sedation IV and analgesic medication as prescribed. Explanation: Before an elective cardioversion, the client should receive moderate sedation IV as well as an analgesic medication or anesthesia. In contrast, in emergent situations, the client may not be premedicated. Digoxin is usually withheld for 48 hours before cardioversion to ensure the resumption of sinus rhythm with normal conduction. If the cardioversion is elective and the dysrhythmia has lasted longer than 48 hours, anticoagulation performed for a few weeks before cardioversion may be indicated. The client is instructed not to eat or drink for at least 4 hours before the procedure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 724.
What is the drug of choice for a stable client with ventricular tachycardia? Atropine Amiodarone Procainamide Lidocaine
Amiodarone Explanation: Amiodarone administered IV is the antidysrhythmic medication of choice for a stable patient with ventricular tachycardia. Atropine is used for bradycardia. Procainamide is used to treat and prevent atrial and ventricular dysrhythmias. Lidocaine is used for treating ventricular dysrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 729.
A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia
Atrial flutter Explanation: The nurse correctly identifies the electrocardiogram (ECG) tracing as 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 appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 727.
A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client's blood glucose level. Which medication is the client most likely taking? Procainamide Carvedilol Amiodarone Diltiazem
Carvedilol Explanation: The nurse must monitor blood glucose levels closely in clients with type 2 diabetes who are taking beta-adrenergic blockers such as carvedilol, because beta-adrenergic blockers may mask the signs of hypoglycemia. The nurse should monitor QRS duration in clients taking procainamide and pulmonary function in clients taking amiodarone (because the drug may cause pulmonary fibrosis). Diltiazem may cause an increased PR interval or bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-1, p. 721.
The nurse knows that a pacemaker is the treatment of choice for what cardiac arrhythmia? Supraventricular tachycardia Atrial flutter Ventricular fibrillation Complete heart block
Complete heart block Explanation: Pacemaker insertion is the treatment for complete heart block. Treatments for supraventricular tachycardia are: Valsalva maneuver, unilateral carotid massage, immersion of face in ice water, administration of IV adenosine, cardioversion, and radiofrequency ablation. Cardioversion and drug therapy are used for the treatment of atrial flutter. Treatment for ventricular fibrillation is defibrillation preceded by or followed with epinephrine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Therapy, p. 739.
A client is prescribed quinine for treatment of moderate depression of depolarization. Which sign indicates the drugs' effectiveness in the client's treatment? Shortened QT segment Decrease in cardiac contractility Decreased QRS duration of about 40% from baseline Hypertension with IV administration.
Decrease in cardiac contractility Explanation: Quinine works by increasing the heart's resistance to activity and causes decreased cardiac contractility. The nurse needs to monitor the blood pressure for signs of hypotension and observe the client for signs of heart failure, chest pain, and arrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-1, p. 721.
The nurse is caring for a client with a cardiac arrhythmia whose cardiac function is being continuously monitored. In which order will the nurse analyze the rhythm strip? Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 Determine the ventricular rate. 2 Determine the ventricular rhythm. 3 Determine the QRS duration. 4 Determine consistency of the QRS duration. 5 Identify the shape of the QRS. 6 Identify P waves and presence before QRS complexes. 7 Identify P wave consistency and shape. 8 Determine the atrial rate. 9 Determine the atrial rhythm 10 Determine the PR interval for consistency and number for each QRS complex
Determine the ventricular rate. Determine the ventricular rhythm. Determine the QRS duration. Determine consistency of the QRS duration. Identify the shape of the QRS. Identify P waves and presence before QRS complexes. Identify P wave consistency and shape. Determine the atrial rate. Determine the atrial rhythm Determine the PR interval for consistency and number for each QRS complex Explanation: When evaluating the cardiac rhythm of a client with an arrhythmia, the ventricular rate should be first determined, followed by the ventricular rhythm. The QRS duration is reviewed next and analyzed for duration, consistency, and shape. This is followed by analysis of the P waves, specifically the location before every QRS complex, and the shape and consistency. Atrial rate and rhythm are next evaluated. This is followed by analysis of the PR interval to determine if they are consistent. The last step is to determine the number of P waves that occur for each QRS complex.
Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? Atropine Digoxin Enalapril Diazepam
Diazepam Explanation: Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as diazepam. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737.
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? Document the findings and continue to monitor the patient Apply oxygen via nasal cannula and obtain a 12-lead ECG Notify the client's primary care provider of the findings Instruct the client to bear down as if having a bowel movement
Document the findings and continue to monitor the patient Explanation: The client's electrocardiogram (ECG) tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block rarely causes any hemodynamic effect; the other blocks may result in decreased heart rate, causing a decrease in perfusion to vital organs, such as the brain, heart, kidneys, lungs, and skin. The most appropriate action by the nurse is to document the findings and continue to monitor the client.
A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the patient about for termination of the dysrhythmia? Defibrillation Mace procedure Pacemaker implantation Elective cardioversion
Elective cardioversion Explanation: Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Mace procedure is only a distractor for this question. Pacemakers are implanted for bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion for Atrial Fibrillation, p. 725.
The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the arrhythmia? Defibrillation Maze procedure Pacemaker implantation Elective cardioversion
Elective cardioversion Explanation: Atrial fibrillation is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. Maze procedures are used for clients who are not candidates for cardiodiversion; these procedures use scar-forming techniques to eliminate rapid firing of ectopic pacemaker sites, thus restoring the normal conduction pathways in the atria. A Maze procedure might be considered for this client only after determining ineligibility for cardiodiversion. Pacemakers are implanted for bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion for Atrial Fibrillation, p. 725.
A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that don't precede a beat. Which condition should the nurse suspect? Failure to pace Failure to capture Failure to sense Asystole
Failure to capture Explanation: Extra pacemaker spikes that don't precede a beat may indicate failure to capture, in which the pacemaker fires but the heart doesn't conduct the beat. In failure to pace, the pacemaker doesn't fire when it should; this causes hypotension and other signs of low cardiac output accompanied by bradycardia or a heart rate slower than the pacemaker's preset rate. In failure to sense, the pacemaker can't sense the client's intrinsic heartbeat; on the rhythm strip, spikes may fall on T waves, or they may fall regularly but at points at which they shouldn't appear. An absent heart rate or rhythm, reflected as a flat line on the rhythm strip, characterizes asystole. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-2, p. 743.
A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order? Heparin Warfarin (Coumadin) Flecainide (Tambocor) Dabigatran (Pradaxa)
Heparin Explanation: Heparin is generally prescribed initially if the dysrhythmia persists longer than 48 hours.
What is the treatment of choice for ventricular fibrillation? Immediate bystander CPR Pacemaker Implanted defibrillator Atropine
Immediate bystander CPR Explanation: The treatment of choice for ventricular fibrillation is immediate bystander cardiopulmonary resuscitation (CPR), defibrillation as soon as possible, and activation of emergency services. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 731.
A client with type 2 diabetes and persistent atrial fibrillation is prescribed atenolol. Which actions will the nurse take when providing the medication to the client? Select all that apply. Monitor heart rate. Assess blood pressure. Track liver function studies. Monitor blood glucose level. Evaluate renal function studies.
Monitor heart rate. Assess blood pressure. Monitor blood glucose level. Explanation: Beta-blockers are classified as Class II antiarrhythmic medications. This classification of medication decreases automaticity and conduction to treat atrial arrhythmias, however, it has the potential for adverse effects such as bradycardia, therefore the heart rate should be monitored. Because it can cause hypotension, the blood pressure should be assessed. The medication also affects blood glucose level. Since the client has type 2 diabetes, the blood glucose level should be monitored. This medication does not affect liver or renal function.
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? Extended PR interval More P waves than QRS complexes Atrial rate of 60 bpm or below Shortened QRS duration.
More P waves than QRS complexes Explanation: There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Third-Degree Atrioventricular Block, p. 734.
Undersensing occurs as a pacemaker malfunctions. The nurse understands undersensing occurs as a result of which event? The complex does not follow the pacing spike Pacing spike occurs at the preset level Total absence of the pacing spike Loss of pacing artifact
Pacing spike occurs at the preset level Explanation: Undersensing means that the pacing spike occurs at a preset interval despite the patient's intrinsic rhythm. Loss of capture occurs when a complex does not follow a pacing spike. Loss of pacing is total absence of the pacing spike. Oversensing occurs when there is a loss of pacing artifact. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-2, p. 744.
Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? Sinus tachycardia Atrial flutter Paroxysmal atrial tachycardia Atrial fibrillation
Paroxysmal atrial tachycardia Explanation: Paroxysmal atrial tachycardia (PAT) is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate. Atrial flutter occurs in the atrium and creates an atrial rate between 250 to 400 times per minute. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 728.
A client with frequent premature ventricular contractions is prescribed amiodarone. The nurse will withhold the medication until the completion of which diagnostic test? Echocardiogram CT scan of the chest Pulmonary function Cardiac catheterization
Pulmonary function Explanation: Amiodarone is categorized as a Class III antiarrhythmic medication. It prolongs repolarization and treats and prevents ventricular arrhythmias. Because an adverse effect of amiodarone is pulmonary toxicity, base pulmonary function tests should be completed before starting the medication. An echocardiogram, CT scan of the chest, and cardiac catheterization do not need to be completed before starting amiodarone.
An operating room nurse is caring for a client who is having a pacemaker implanted. The health care provider has requested a demand mode pacemaker for this client. What is this type of pacemaker? A fixed-rate pacemaker A temporary pacemaker Self-activated Asynchronous
Self-activated Explanation: Demand (synchronous) mode pacemakers self-activate when the client's pulse falls below a certain level. A fixed-rate pacemaker is asynchronous and permanent. Temporary pacemakers are used until a permanent pacemaker can be implanted. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Design and Types, p. 740.
A 26-year-old client, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is treated in the emergency department. The client is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the client becomes lightheaded but does not lose consciousness. Which maneuver(s) may be used to interrupt the client's atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. Stimulating the client's gag reflex Placing the client's face in cold water Performing carotid massage Instructing the client to vigorously exercise Instructing the client to breathe deeply
Stimulating the client's gag reflex Placing the client's face in cold water Performing carotid massage Explanation: The following vagal maneuvers can be used to interrupt atrioventricular nodal reentry tachycardia (AVNRT): stimulating the client's gag reflex, having the client hold the breath, cough, bear down, placing the face in cold water, or performing carotid massage. These measures elicit a vagal response, which will slow AV conduction time and help restore a regular rhythm. Because of the risk of a cerebral embolic event, carotid massage is contraindicated in clients with carotid bruits. If the vagal maneuvers are ineffective, the client may receive a bolus of adenosine to correct the rhythm; this is nearly 100% effective in terminating AVNRT. Overexertion and deep inspirations are measures that could precipitate supraventricular tachycardia (SVT). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 728.
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? The medication increases the force of the myocardial contraction. The medication causes the kidneys to retain fluid and increase intravascular volume. The medication increases the heart rate. The medication helps the kidneys produce more urine.
The medication increases the force of the myocardial contraction. Explanation: A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Influences on Heart Rate and Contractility, p. 713.
The nurse knows which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other? Third-degree atrioventricular (AV) heart block Second-degree heart block First-degree AV block Asystole
Third-degree atrioventricular (AV) heart block Explanation: In third-degree AV heart block there is no relationship or synchrony between the atrial and ventricular contraction. Each is beating at its own inherent rate and is independent of each other, thus the cardiac output is affected. Second-degree AV block occurs when only some of the atrial impulses are conducted through the AV node into the ventricles. First-degree AV block occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval. During asystole, there is no electrical activity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Third-Degree Atrioventricular Block, p. 734.
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? Ventricular tachycardia Atrial fibrillation Third-degree heart block Ventricular fibrillation
Ventricular fibrillation Explanation: The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Ventricular Fibrillation, p. 730.
The nurse knows that synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of which of the following? Ventricular repolarization Atrial depolarization Ventricular depolarization Purkinje fiber repolarization
Ventricular repolarization Explanation: The synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in ventricular tachycardia (VT) or ventricular fibrillation. The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The U wave represents repolarization of the Purkinje fibers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion, p. 737.
A client has a medical diagnosis of an advanced first-degree atrioventricular block and is symptomatic. What initial treatment will the nurse be prepared to complete? administer an IV bolus of atropine prepare the client for a cardioversion administer an IV bolus of furosemide prepare client for a cardiac catheterization
administer an IV bolus of atropine Explanation: The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists. Cardioversion is done with a fast heart rate. Furosemide will be given for fluid overload. Cardiac catheterization is administered for chest pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management of Conduction Abnormalities, p. 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 fibrillation atrial flutter heart block bundle branch block
atrial fibrillation Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 720.
Which is not a likely origination point for cardiac dysrhythmias? bundle of His ventricles atria atrioventricular node
bundle of His Explanation: Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 713.
When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be triggered. captured. inhibited. nonsynchronous.
captured. Explanation: Capture is a term used to denote that the appropriate electrocardiogram (ECG) complex followed by the pacing spike. Triggered response means that the pacemaker will respond when it senses intrinsic heart activity. Inhibited response means that the response of the pacemaker is controlled by the activity of the client's heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 741.
The nurse is admitting a client to a telemetry unit with an atrial dysrhythmia. What symptoms will the nurse further evaluate? chest pain hypertension leg pain hypocarbia
chest pain Explanation: Clients with atrial dysrhythmias may have chest pain, shortness of breath, and low blood pressure. Leg pain is not common with atrial dysrhythmias. Hypocarbia is seen with reduced carbon dioxide, not common with chr pulmonary disease. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Fibrillation, p. 720.
A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of embolic stroke. myocardial infarction. heart failure. renal failure.
embolic stroke. Explanation: Intervention is implemented to prevent the development of an embolic event/stroke. Clients with a history of previous stroke, transient ischemic attack (TIA), embolic event, mitral stenosis, or prosthetic heart valve and who develop atrial fibrillation are at significant risk of developing an embolic stroke. Antithrombotic therapy is indicated for all clients with atrial fibrillation, especially those at risk of an embolic event, such as a stroke, and it is the only therapy that decreases cardiovascular mortality. These client are often placed on warfarin, in contrast to clients who have no risk factors, and who are often prescribed 81 to 325 mg of aspirin daily. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 722.
The nurse is administering propranolol to a client on a telemetry unit. What will the nurse monitor the client for? heart block tachycardia bleeding change in level of consciousness
heart block Explanation: Propranolol and other beta blockers can interfere with conduction and the client should be evaluated for heart block. Propranolol has a desired effect of lowering heart rate, not tachycardia. Bleeding and change in consciousness level are not common side effects of propranolol. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Inderal, p. 729.
x A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? internal cardioverter defibrillator insertion pacemaker insertion radiofrequency ablation electrophysiological study
internal cardioverter defibrillator insertion Explanation: The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Implantable Cardioverter Defibrillator, p. 744.
A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? supraventricular tachycardia sinus tachycardia heart block atrial flutter
supraventricular tachycardia Explanation: Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (over 150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill. These symptoms do not suggest sinus tachycardia, heart block, or atrial flutter. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 729.
