Ch 26

When the nurse observes that the patient's heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating a) sinus tachycardia. b) sinus dysrhythmia. c) sinus bradycardia. d) normal sinus rhythm.

sinus dysrhythmia. 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 nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following? a) "Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" b) "Anything that stimulates the parasympathetic nervous system (negative chronotropy)" c) "Beta-adrenergic blocking agents" d) "Hypothyroidism"

"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic stimulation reduces heart rate. Administration of beta-adrenergic blocking agents decreases stimulation of the sympathetic nervous system and subsequently heart rate.

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? a) "I can still drink coffee and tea." b) "I should increase my fluid intake." c) "I should eat foods rich in protein." d) "I'll enroll in an aerobic exercise program."

"I can still drink coffee and tea." The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.

A patient is being examined for medical management of atrial flutter. The nurse reviews the ECG strip. He expects to see which of the following? a) P-to-QRS duration of less than 0.1 seconds b) Ventricular rate below 70 bpm c) PR interval between 0.12 and 0.2 seconds. d) "Sawtooth" pattern to the waveform

"Sawtooth" pattern to the waveform The "sawtooth pattern" is the classic waveform appearance with atrial flutter. The atrial rate is faster than the AV node can conduct. Not all atrial impulses stimulate the ventricle.

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? a) Scar on the chest b) Quality of the pulse c) Vibration under the skin d) "Spike" on the rhythm strip

"Spike" on the rhythm strip Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin.

A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between ventricular tachycardia and ventricular fibrillation when I look at the EKG strip?" The best reply by the nurse is which of the following? a) "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal." b) "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast with wide QRS complexes." c) "The two look very much alike; it is difficult to tell the difference." d) "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia, the QRS is of normal width."

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

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? a) "You should avoid tennis; basketball or football would be a good substitute." b) "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." c) "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." d) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."

"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (eg, basketball, football, hockey).

The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following? a) "There is a long list of clients in line to be cardioverted." b) "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." c) "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." d) "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." 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.

After taking an ECG on a 38-year-old woman, the nurse reports that the PR interval reflects normal sinus rhythm. The nurse has made this interpretation based on the PR interval of: a) 0.12 and 0.2 seconds. b) 0.15 and 0.3 seconds. c) 0.05 and 0.1 seconds. d) 0.25 and 0.4 seconds.

0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.

Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds? a) 0.4 b) 0.2 c) 0.1 d) 0.3

0.2 Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second.

Which PR interval presents a first-degree heart block? a) 0.16 seconds b) 0.14 seconds c) 0.24 seconds d) 0.18 seconds

0.24 seconds In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.

The nurse is defibrillating a patient in ventricular fibrillation with paddles on a monophasic defibrillator. How much paddle pressure should the nurse apply when defibrillating? a) 15 to 20 lbs b) 20 to 25 lbs c) 5 to 10 lbs d) 5 to 10 lbs

20 to 25 lbs When using paddles, 20 to 25 lb of pressure must be used in order to ensure good skin contact.

Idioventricular rhythm occurs when the impulse starts in the conduction system below the AV node. The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? a) 100 to 250 b) 20 to 40 c) Not measurable d) 220 to 350

20 to 40 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.

A patient is admitted to the emergency department (ED) with complaints of chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph (ECG) monitor. The nurse counts 9 RR intervals on the patient's 6-second rhythm tracing. The nurse correctly identifies the patient's heart rate as which of the following? a) 70 bpm b) 100 bpm c) 90 bpm d) 80 bpm

90 bpm An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90.

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) A new myocardial infarction client b) A client with third-degree heart block c) A client with atrial dysrhythmias d) A client with poor kidney perfusion

A client with atrial dysrhythmias 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.

A 26-year-old Air Force staff sergeant is returning for diagnostic follow-up to the cardiologist's office where you practice nursing. Her Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart? a) Shock b) Elevated temperature c) Strenuous exercise d) All options are correct

All options are correct It occurs in clients with healthy hearts as a physiologic response to strenuous exercise, anxiety and fear, pain, fever, hyperthyroidism, hemorrhage, shock, or hypoxemia. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Fever is one cause. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Shock is one cause. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Strenuous exercise is one cause.

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? a) Altered patterns frequently affect the heart's ability to pump blood effectively. b) Altered patterns frequently turn into life-threatening arrhythmias. c) Altered patterns frequently produce neurological deficits. d) Altered patterns frequently cause a variety of home safety issues.

Altered patterns frequently affect the heart's ability to pump blood effectively. The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer.

A nurse is providing evening care for a patient wearing a continuous telemetry monitor. While the nurse is giving the patient a back rub, the patient's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response? a) Call a code and obtain the crash cart. b) Administer a pericardial thump. c) Assess the patient and monitor leads. d) Call for assistance and begin CPR.

Assess the patient and monitor leads. The nurse should assess the patient and monitor leads first. It is important that the nurse "treat the patient, not the monitor." Ventricular asystole may often appear on the monitor when leads are displaced. The other interventions are not necessary.

The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle? a) Ventricular depolarization b) Early ventricular repolarization c) Ventricular repolarization d) Atrial depolarization

Atrial depolarization The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave.

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? a) Ventricular fibrillation b) Asystole c) Atrial flutter d) Premature ventricular contraction

Atrial flutter 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.

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following? a) Atrial rate of 300 to 400 b) P wave resent before each QRS c) Normal PR interval d) Regular rhythm

Atrial rate of 300 to 400 ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves.

Which medication is the drug of choice for sinus bradycardia? a) Lidocaine b) Pronestyl c) Atropine d) Cardizem

Atropine Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias.

A nurse is completing a shift assessment on a patient admitted to the telemetry unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The patient is also experiencing dizziness and shortness of breath. Which of the following medications will the nurse anticipate administering to the patient based on these clinical findings? a) Lidocaine b) Pronestyl c) Atropine d) Cardizem

Atropine The patient is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias.

A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication does the nurse anticpate administering to treat his bradycardia? a) Lidocaine (Xylocaine) b) Amiodarone (Cordarone) c) Dobutamine (Dobutrex) d) Atropine

Atropine 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.

The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed. a) Tenormin b) Corgard c) Atropine sulfate d) Procardia

Atropine sulfate Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation.

A patient tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? a) Request sublingual nitroglycerin. b) Apply supplemental oxygen. c) Lie down and elevate the feet. d) Avoid caffeinated beverages.

Avoid caffeinated beverages. If PACs are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the patient to avoid caffeinated beverages.

A 73-year-old client has returned to the postanesthesia care unit where you practice nursing. The client had a pacemaker implanted and it is your responsibility to begin client education upon his becoming alert. Which of the following postimplantation instructions must you provide to the client now that he has a permanent pacemaker? a) Delay for at least 3 weeks activities such as swimming and bowling. b) Keep the arm on the side of the pacemaker higher than the head. c) Avoid sources of electrical interference. d) Keep moving the arm on the side where the pacemaker is inserted.

Avoid sources of electrical interference. 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. The main warning to a client with a pacemaker is to avoid sources of electrical interference.

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? a) Administer atropine 0.5 mg b) Defibrillate with 360 joules (monophasic defibrillator) c) Administer epinephrine d) Begin cardiopulmonary resuscitation (CPR)

Begin cardiopulmonary resuscitation (CPR) 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.

A nurse is providing morning care for a patient in the ICU. Suddenly, the bedside monitor shows ventricular fibrillation and the patient becomes unresponsive. After calling for assistance, what action should the nurse take next? a) Provide electrical cardioversion. b) Administer intravenous epinephrine. c) Begin cardiopulmonary resuscitation. d) Prepare for endotracheal intubation.

Begin cardiopulmonary resuscitation. In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the patient as soon as possible. If defibrillation is not readily available, CPR is begun until the patient 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 patient in ventricular fibrillation.

The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record? a) Bigeminy b) R-on-T phenomenon c) Couplets d) Multifocal PVCs

Bigeminy 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.

Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which difference will the nurse confirm? a) Both procedures sedate the clients. b) Cardioversion uses less electrical energy. c) Both used to eliminate ventricular dysrhythmias. d) Machine determines when electrical energy is delivered.

Cardioversion uses less electrical energy. Cardioversion uses less electrical energy (50 to 100 joules) than defibrillation (200 to 360 joules). All of the other statements are correct.

A 73-year-old client is due to return from surgery where he has had an automatic implanted cardioverter defibrillator (AICD) implanted. Understanding the purpose of the AICD, you indicate to his family why the implantation is positive for the client. Which of the following would be the least likely reason for the client's AICD implantation? a) Client is at risk for death due to structural cardiac disease with poor ventricular function. b) Client experiences recurrent episodes of atrial flutter. c) Client has survived at least one episode of cardiac arrest with ventricular origin. d) Client experiences recurrent episodes of ventricular tachycardia.

Client experiences recurrent episodes of atrial flutter. AICDs are used for dysrhythmias of a ventricular nature. AICDs are used for dysrhythmias of a ventricular nature. It is not about cardiac arrest. AICDs are used for dysrhythmias of a ventricular nature. It is not about ventricular tachycardia. AICDs are used for dysrhythmias of a ventricular nature. It is not about structural cardiac disease.

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients? a) Clients with recurrent life-threatening bradycardias b) Clients with sinus tachycardia c) Clients with ventricular bradycardia d) Clients with recurrent life-threatening tachydysrhythmias

Clients with recurrent life-threatening tachydysrhythmias 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.

Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke? a) Lovenox b) Aspirin c) Plavix d) Coumadin

Coumadin Warfarin (Coumadin) is indicated if the patient with atrial fibrillation is at high risk for stroke. Aspirin, Lovenox, and Plavix are not indicated. If immediate anticoagulation is necessary, the patient may be placed on heparin until the warfarin level is therapeutic.

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. He is aware that this dysrhythmia is evident on an ECG strip by which of the following? a) Irregular rhythm b) Variable heart rate, usually fewer than 90 bpm c) P waves hidden within the QRS complex d) Delayed conduction, producing a prolonged PR interval

Delayed conduction, producing a prolonged PR interval First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? a) P waves hidden with the QRS complex b) A variable heart rate, usually fewer than 60 bpm c) An irregular rhythm d) Delayed conduction, producing a prolonged PR interval

Delayed conduction, producing a prolonged PR interval First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds).

A nurse is evaluating a client with a temporary pacemaker. The patient's ECG tracing shows each P wave followed by the pacing spike. The nurse's best response is which of the following? a) Document the findings and continue to monitor the patient. b) Reposition the extremity and turn the patient to left side. c) Check the security of all connections and increase the milliamperage. d) Obtain a 12-lead ECG and a portable chest x-ray.

Document the findings and continue to monitor the patient. 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 patient. Repositioning the patient, placing the patient 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.

Jack Johnson is a 58-year-old who's been living with an internal, fixed-rate pacemaker. You're checking his readings on a cardiac monitor and notice an absence of spikes. What should you do? a) Nothing, there's no cause for alarm. b) Double-check the monitoring equipment. c) Suggest the need for a new beta-blocker to the doctor. d) Take Jack's blood pressure.

Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. It's important to be careful. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Focus on the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Check the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

A 65-year-old client has come to the emergency department reporting light-headedness, chest pain, and shortness of breath. As you finish your assessment, the physician enters and orders tests to ascertain what is causing the client's problems. In your client education, you explain the tests. Which test is used to identify cardiac rhythms? a) Electrocardiogram b) Electroencephalogram c) Electrocautery d) Echocardiogram

Electrocardiogram An electrocardiogram is used to identify normal and abnormal cardiac rhythms. An electrocardiogram is the device used to identify normal and abnormal cardiac rhythms.

A patient with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The patient's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of which of the following? a) Myocardial infarction b) Renal failure c) Embolic stroke d) Heart failure

Embolic stroke Intervention is implemented to prevent the development of an embolic event/stroke. Patients 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 patients with atrial fibrillation, especially those at risk of an embolic event, such as a stroke, and is the only therapy that decreases cardiovascular mortality. These patients are often placed on warfarin, in contrast to patients who have no risk factors, who are often prescribed 81 to 325 mg of aspirin daily.

Which of the following is a potential cause of premature ventricular complexes (PVCs)? a) Alkalosis b) Hypokalemia c) Bradycardia d) Hypovolemia

Hypokalemia PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.

While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of sinus tachycardia include which of the following? a) Digoxin and vagal stimulation b) Hypothyroidism and athletic training c) Vagal stimulation and sleep d) Hypovolemia and fever

Hypovolemia and fever Causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, sleep, hypothyroidism, athletic training, and Digoxin all will cause a slow heart rate.

A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist? a) A maze procedure or IV bolus of furosemide b) Cardioversion or IV bolus of dopamine c) Cardiac catheterization d) IV bolus of atropine or temporary pacing

IV bolus of atropine or temporary pacing 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.

A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist? a) Cardioversion or IV bolus of dopamine b) Cardiac catheterization c) IV bolus of atropine or temporary pacing d) A maze procedure or IV bolus of furosemide

IV bolus of atropine or temporary pacing 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.

Which rhythm is also termed a ventricular escape rhythm? a) Idioventricular rhythm b) Ventricular fibrillation c) First degree AV block d) Ventriuclar asystole

Idioventricular rhythm Idioventricular rhythm is also called a ventricular escape rhythm.

A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes? a) Atropine b) Pacemaker c) Epinephrine d) Implantable cardioverter defibrillator

Implantable cardioverter defibrillator 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 and who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention).

A 63-year-old client is in the cardiac step-down unit where you practice nursing. In your discussions about his condition, the client is puzzled as to what causes the heart to be an effective pump. Which of the following statements would you include in your response? a) Sufficient blood pressure b) Inherent rhythmicity of all muscle tissue c) Inherent electrons in muscle tissue d) Inherent rhythmicity of cardiac muscle tissue

Inherent rhythmicity of cardiac muscle tissue 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.

The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? a) It is used to eliminate ventricular dysrhythmias. b) The client is sedated before the procedure. c) It is a scheduled procedure 1 to 10 days in advance. d) It uses less electrical energy than cardioversion.

It is used to eliminate ventricular dysrhythmias. The only treatment for a life-threatening ventricular dysrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion.

Your client has just been prescribed Pronestyl for their dysrhythmia. What would you teach this client about the side effects? a) Hypertension b) Change in mental status c) Lupus-like syndrome d) Decreased appetite

Lupus-like syndrome Procainamide hydrochloride (Pronestyl) can have side effects of hypotension, GI upset, and a lupus-like syndrome; With long-term use, it may cause immune system problems.

What nursing interventions could you institute with a client who has a suspected dysrhythmia that would help detect life-threatening dysrhythmias and would manage and minimize any that occur? a) Provide supplemental oxygen. b) Monitor blood pressure continuously. c) Monitor cardiac rhythm continuously. d) Palpate the client's pulse and observe the client's response.

Monitor cardiac rhythm continuously. The nurse should monitor cardiac rhythm continuously. Cardiac monitors display real-time heart rate and rhythm and alert the nurse to potentially life-threatening dysrhythmias. Monitoring blood pressure continuously and palpating the client's pulse do not help detect life-threatening dysrhythmias. Providing supplemental oxygen helps maintain adequate cardiac output and does not help detect life-threatening dysrhythmias.

The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? a) Shortened QRS duration. b) Atrial rate of 60 bpm or below c) More P waves than QRS complexes d) Extended PR interval

More P waves than QRS complexes 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.

The nurse is analyzing 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 which of the following? a) Normal sinus rhythm b) Sinus tachycardia c) First-degree atrioventricular (AV) block d) Junctional tachycardia

Normal sinus rhythm The 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.

Two days after discharge following a permanent pacemaker insertion, the client returns to the clinic for a follow-up appointment. He reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the site and suspects which of the following: a) Pacemaker site infection b) Postoperative site hematoma c) Internal bleeding at pacemaker site d) Normal postoperative healing

Pacemaker site infection Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These include swelling, unusual tenderness, drainage, and increased warmth.

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? a) Pacer rate b) Location of the generator c) Date and time of insertion d) Model number

Pacer rate After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.

A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding? a) Peaked T waves b) Flattened P waves c) Occasional U waves d) Prolonged QT interval

Peaked T waves The patient's serum potassium level is high. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a patient's serum potassium level is high. The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient's serum potassium level is low. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria and is not affected by a patient's serum potassium level. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization, and is not affected by a patient's serum potassium level.

When the nurse observes an 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? a) Ventricular fibrillation b) Ventricular bigeminy c) Premature ventricular contraction d) Ventricular tachycardia

Premature ventricular contraction 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.

The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up? a) QRS complex that is 0.10 seconds long b) QT interval that is 0. 46 seconds long c) ST segment that is isoelectric in appearance d) PR interval that is 0.18 seconds long

QT interval that is 0. 46 seconds long 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 patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal.

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? a) RR interval b) PP interval c) QT interval d) TP interval

RR interval 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.

The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button? a) Checking the ECG rhythm b) States, "Charging" c) Shouts, "All clear" d) Placing gel on the chest

Shouts, "All clear" Preceding pressing the discharge button, the nurse shouts "All clear" to ensure that no one is in contact with the client. The other options are correct but not the nursing action immediately preceding.

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following? a) SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers b) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers c) SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches d) AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers

Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers The correct sequence of conduction through the normal heart is the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers.

A 26-year-old client is returning for diagnostic follow-up. Her Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minutes. What type of dysrhythmia would you expect the cardiologist to diagnose? a) Sinus bradycardia b) Supraventricular bradycardia c) Supraventricular tachycardia d) Sinus tachycardia

Sinus tachycardia Sinus tachycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a faster than usual rate (100 to 150 beats/minute). Sinus tachycardia is the dysrhythmia with a faster than usual heart rate (100 to 150 beats/minute).

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

Sinus tachycardia Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy).

John, an 82-year-old retired librarian is brought into the ED where you practice nursing. The client's heart rate is greater than 155 beats/minute. As you connect him to the ECG, you notice that his rhythm is regular, rate is 162 beats/minute, and diastole is shortened. He is intermittently alert and reports chest pain. P waves cannot be identified. What condition would you expect the physician to diagnose? a) Supraventricular tachycardia b) Sinus tachycardia c) Atrial flutter d) Heart block

Supraventricular tachycardia Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (≥150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill. Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but a dangerously high heartbeat (≥150 beats/minute). It is not sinus tachycardia. Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but a dangerously high heartbeat (≥150 beats/minute). It is not heart block. Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but a dangerously high heartbeat (≥150 beats/minute). It is not atrial flutter.

The nurse is preparing to administer adenosine (Adenocard) for a patient diagnosed with atrial flutter. Which of the following should be completed when giving this medication? a) The dose is administered rapid IV push. b) The medication is followed by a rapid lactated Ringer's (LR) flush c) The dose is administered slow IV push. d) The medication is followed by a slow saline flush.

The dose is administered rapid IV push. 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.

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? a) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute b) The registered nurse administering atropine sulfate intravenously c) The registered nurse stating to administer all medications accept those which are cardiotonics d) The registered nurse stating to administer Lanoxin (digoxin)

The registered nurse administering atropine sulfate intravenously The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? a) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute b) The registered nurse stating to administer all medications accept those which are cardiotonics c) The registered nurse administering atropine sulfate intravenously d) The registered nurse stating to administer Lanoxin (digoxin)

The registered nurse administering atropine sulfate intravenously The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.

A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? a) Warfarin (Coumadin) b) Adenosine (Adenocard) c) Amiodarone (Pacerone) d) Atropine

Warfarin (Coumadin) Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone (Cordarone), flecainide (Tambocor), ibutilide (Corvert), propafenone (Rythmol), or sotalol (Betapace) prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation (Fuster, Rydén et al., 2011).

When the appropriate complex follows the pacing spike, it is said to be a) triggered. b) captured. c) nonsynchronous. d) inhibited.

captured. Capture is a term used to denote that the appropriate 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 patient's heart.

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

ventricular depolarization. The QRS complex on the ECG strip represents ventricular depolarization. Atrial repolarization usually occurs at the same time as ventricular depolarization and is impossible to distinguish on the ECG. The T wave represents ventricular repolarization. The P wave represents atrial depolarization.

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.) a) Record events that trigger a shock sensation. b) Avoid magnetic fields such as metal detection booths. c) Call for emergency assistance if feeling dizzy. d) The patient may have a throbbing pain that is normal e) 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. 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.