Chapter 26: Mgt of Dysrhythmia
Normal PR intervel
0.12-0.2sec
The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? a. Alkalosis b. Hypovolemia c. Hypokalemia d. Bradycardia
d
he nurse knows that what PR interval presents a first-degree heart block? a. 0.18 seconds b. 0.14 seconds c. 0.16 seconds d. 0.24 seconds
d
Atrial Flutter
irregular beating of the atria; often described as "a-flutter with 2 to 1 block or 3 to 1 block"
The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? a. hypovelmia b. hypokalemia c. bradycardia d. hypercalcemia
b 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*.
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? a. P wave b. T wave c. QRS complex d. PR interval
a
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priorityaction? a. Atropine b. dobutamine c. Defibrillation d. cardio version
c 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* *Dobutamine* is an inotropic medication used to *increased cardiac output.*
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? a. 0.15 and 0.3 seconds. b. 0.25 and 0.4 seconds. c. 0.05 and 0.1 seconds. d. 0.12 and 0.2 seconds.
d 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.
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a. Nausea b. Fever c. Fluttering d. Hypotension
c
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action? a. IV bolus of atropine b. cardioversion c. defibrillation d. IV bolus of dobutamine
c
Class of arrhythmias
I II III
Pacemaker
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
Which electrolyte should we obtain if patient has ventricular tachycardia?
Magnesium and Potassium
Supraventricular Tachycardia (SVT)
Monitor HR, BP
How does calcium imbalance change heart rhythm? Be specific in the heart ECG strip.
QT interval and ST segment.
A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have? a. sinus bradycardia b. none c. heart block d. atrial bradycardia
a
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. Atrial flutter b. Ventricular fibrillation c. Asystole d. Premature ventricular contraction
a
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? a. "I'll keep a log of each time my ICD discharges." b. "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." c. "I need to stay at least 10 inches away from the microwave." d. "I can't wait to get back to my football league."
a
A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? a. "I will drink coffee with only two of my meals." b. "I will cut back on my smoking and drinking alcohol." c. "I will take my levothyroxine daily." d. "If I take my metoprolol daily, I will be able to control my heart rate."
a
A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response? a. Assess the client and monitor leads. b. Administer a pericardial thump. c. Call for assistance and begin CPR. d. Call a code and obtain the crash cart.
a
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, *heart rate 128*, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? a. Sinus tachycardia b. Normal sinus rhythm c. Ventricular tachycardia d. Sinus bradycardia
a
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? a. Sinus tachycardia b. Ventricular tachycardia c. Sinus bradycardia d. Normal sinus rhythm
a
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? a. Delayed conduction, producing a prolonged PR interval b. P waves hidden within the QRS complex c. Irregular rhythm e. Variable heart rate, usually fewer than 90 bpm
a
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? a. atropine sulfate b. diltiazem c. atenolol d. nadolol
a
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. "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs." b. "A transvenous pacemaker is a permanent pacemaker that is asynchronous." c. "A transvenous pacemaker is used in place of a transarterial pacemaker." d. "A transvenous pacemaker is used for a ventricular tachydysrhythmias."
a
When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be a. captured. b. nonsynchronous. c. inhibited. d. triggered.
a
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? a. Lead wire dislodgement b. Faulty generator c. Sensitivity is too low d. Fracture of the lead wire
a 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.
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? a. Administer an IV bolus of atropine. b. Send the client to the cardiac catheterization laboratory. c. Review the client's medication record. d. Prepare to client for cardioversion.
a *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 8cardiac 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.
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? a. Initiate transcutaneous pacing b. Prepare for defibrillation c. Obtain a 12-lead ECG d. Administer 1 mg of IV atropine
a 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.
After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? a. Decreased cardiac output and decreased systolic and diastolic blood pressure b. Decreased peripheral vascular resistance c. Decreased blood pressure with reflex tachycardia d. Increased cardiac output and increased systolic and diastolic blood pressure
a A long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia.
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? a. hypovolemia b. digoxin c. vagal stimulation d. hypothyroidism
a 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.
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? a. atropine sulfate b. diltiazem c. atenolol d. nadolol
a Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation.
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? a. Catheter ablation therapy b. Maze procedure c. Insertion of a permanent pacemaker d. Insertion of an ICD
a 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).
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 will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." b. "You should avoid tennis; basketball or football would be a good substitute." c. "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." d. "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity."
a 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 (e.g., basketball, football, hockey).
A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to a. avoid caffeinated beverages. b. lie down and elevate the feet. c. request sublingual nitroglycerin. d. apply supplemental oxygen.
a premature atrial complexes (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.
What is the treatment of choice for ventricular fibrillation? a. Immediate bystander CPR b. Atropine c. Pacemaker d. Implanted defibrillator
a (maybe)
premature ventricular contraction (PVC)
a ventricular contraction preceding the normal impulse initiated by the SA node (pacemaker)
The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply. a. Wear a medical alert, noting the presence of a pacemaker b. Refrain from walking through antitheft devices c. Avoid the usage of microwave ovens and electronic tools d. Avoid handheld screening devices in airports e. Check pulse daily, reporting sudden slowing or increase
a, d, e
The nurse explains to the patient with PACs that there are many causes, some of which are modifiable. Select all that apply. a. Anxiety b. Alcohol c. Hypoxemia d. Hypovolemia e. Hyperkalemia f. Atrial ischemia
a,b,c,f All of these causes stimulate or increase electrical impulses.
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. a. anxiety b. fever c. hypoglycemia d. blood loss e. sleep
a,b,d
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. a. P-R interval b. S-Q segment c. T wave d. P wave e. QRT wave
a,c,d PR interval, QRS complexes, T wave, P wave
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: a. sufficient blood pressure. b. inherent rhythmicity of cardiac muscle tissue. c. inherent electrons in muscle tissue. d. inherent rhythmicity of all muscle tissue.
b
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? a. "When your spouse needs help, an alarm will go off at the desk." b. "The small box will transmit the heart rhythm to the central monitor all the time." c. "The box is recording the heart's electrical activity, and a physician will review the tracing later." d. "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute."
b
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? a. Ventricular repolarization b. Atrial depolarization c. Ventricular depolarization d. Early ventricular repolarization
b
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? a. identifying a code-level status b. alerting the healthcare provider of the third-degree heart block c. assessing blood pressure and heart rate frequently d. maintaining intravenous fluids
b
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? a. "The two look very much alike; it is difficult to tell the difference." 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 QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width." d. "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal."
b
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? a. Document heart rate before and after administration b. Monitor vital signs and cardiac rhythm c. Administer every five minutes during cardiac resuscitation d. Keep the client flat for one hour after administration
b
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? a. Antihypertensive b. Anticoagulant c. Potassium supplement d. Diuretic
b
The nurse knows that what PR interval presents a first-degree heart block? a. 0.18 seconds b. 0.24 seconds c. 0.14 seconds d. 0.16 seconds
b 1st degree AV block has prolonged PR interval Normal PR intern: 0.12-0.20
Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? a. Atrial fibrillation b. Paroxysmal atrial tachycardia c. Atrial flutter d. Sinus tachycardia
b 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.
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? a. Ventricular repolarization b. Atrial depolarization c. Early ventricular repolarization d. Ventricular depolarization
b 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 nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? a. "I need to stay at least 10 inches away from the microwave." b. "I'll keep a log of each time my ICD discharges." c. "I can't wait to get back to my football league." d. "I have an appointment for magnetic resonance imaging of my knee scheduled for next week."
b The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD.
Which of the following does the nurse recognize as the therapeutic goal of radiofrequency catheter ablation for a client with cardiac dysrhythmias? a. Reperfusion of ischemic heart tissue b. Destruction of errant tissue c. Stimulation of the impulse center d. Dilation of arterial blood vessels
b 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.
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? a. "There is a long list of clients in line to be cardioverted." b. "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." c. "The doctor wants to see if your heart will switch back to its normal rhythm by itself." d. "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion."
b 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
Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? a. Digoxin b. Diazepam c. Atropine d. Enalapril
b Diazepam is a sedation med.
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? a. 0.4 b. 0.2 c. 0.3 d. 0.1
b Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second.
The nurse is caring for a client presenting to the emergency department (ED) reporting chest pain. Which electrocardiographic (ECG) finding would be most concerning to the nurse? a. Isolated premature ventricular contractions (PVCs) b. ST elevation c. Sinus tachycardia d. Frequent premature atrial contractions (PACs)
b The first signs of an acute MI are usually seen in the T wave and the ST segment. The T wave becomes inverted; the ST segment elevates (it is usually flat).
The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first? a. A client diagnosed with new onset of atrial fibrillation, requiring scheduled IV diltiazem b. A client who received elective cardioversion 1 hour ago and whose heart rate (HR) is 115 bpm c. A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV d. A client returned from an electrophysiology procedure 2 hours ago, reporting constipation
c
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? a. Delay activities such as swimming and bowling for at least 3 weeks. b. Avoid sources of electrical interference. c. Keep the arm on the side of the pacemaker higher than the head. d. Keep moving the arm on the side where the pacemaker is inserted.
b he 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.
A client has had an automatic implanted cardioverter defibrillator (AICD) implanted. The nurse explains the purpose and benefits of the AICD to the client's family. The least likely reason for the client's AICD implantation is that the client: a. has survived at least one episode of cardiac arrest with ventricular origin. b. experiences recurrent episodes of atrial flutter. c. is at risk for death due to structural cardiac disease with poor ventricular function. d. experiences recurrent episodes of ventricular tachycardia.
b AICDs are used for dysrhythmias of a ventricular nature. It is not about cardiac arrest. It is not about ventricular tachycardia. It is not about structural cardiac disease.
A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best? a. "It's just a coincidence; most clients with atrial fibrillation don't receive warfarin." b. "Warfarin prevents clot formation in the atria of clients with atrial fibrillation." c. "Warfarin controls heart rate in the client with atrial fibrillation." d. "Warfarin prevents atrial fibrillation from progressing to a lethal arrhythmia."
b Blood pools in the atria of clients with atrial fibrillation. As the blood pools, clots form. These clots can be forced from the atria as the heart beats, placing the client at risk for stroke. *Warfarin* is ordered in most clients with atrial fibrillation to prevent clot formation and decrease the risk of stroke, not to control heart rate. *Digoxin* is typically ordered to control heart rate in atrial fibrillation. Atrial fibrillation doesn't typically progress to a lethal arrhythmia such as ventricular fibrillation.
The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports *tenderness and throbbing around the incision*. The nurse observes mild *swelling, erythema, and warmth* at the pacemaker insertion site. What does the nurse suspect? a. normal postoperative healing b. pacemaker site infection c. internal bleeding at pacemaker site d. postoperative site hematoma
b Postoperative care for a pacemaker insertion includes observing for symptoms of infection Sx: *swelling, unusual tenderness, drainage, and increased warmth*. When the site is healing normally, there will be no tenderness and throbbing. A hematoma forms a lump at the pacemaker insertion site. Mild bleeding will be drainage.
What is the drug of choice for a stable client with ventricular tachycardia? a. Lidocaine b. Amiodarone c. Atropine d. Procainamide
b *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*.
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? a. Lidocaine b. Atropine c. Amiodarone d. Dobutamine
b. 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.
Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low? a. P wave b. U wave c. QT interval d. T wave
b. 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*.
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: a. sufficient blood pressure. b. inherent electrons in muscle tissue. c. inherent rhythmicity of cardiac muscle tissue. d. inherent rhythmicity of all muscle tissue.
c
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. Quality of the pulse b. Scar on the chest c. "Spike" on the rhythm strip d. Vibration under the skin
c
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify *cardiac rhythms*? a. electrocautery b. echocardiogram c. electrocardiogram d. electroencephalogram
c
The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? a. "The heart rate is between 150 to 250 bpm." b. "It is when the heart conduction is primarily from the atrioventricular node." c. "The rhythm has a normal beat, then a premature beat pattern." d. "The rhythm is regular but fast."
c
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 a. first-degree atrioventricular block. b. junctional tachycardia. c. normal sinus rhythm. d. sinus tachycardia.
c
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 epinephrine b. Administer atropine 0.5 mg c. Begin cardiopulmonary resuscitation (CPR) d. Defibrillate with 360 joules (monophasic defibrillator)
c
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. Is this normal?" What is the nurse's best response? a. Atrial flutter b. Sinus tachycardia c. Premature atrial complex d. Ventricular fibrillation
c 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.
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. Asynchronous b. A fixed-rate pacemaker c. Self-activated d. A temporary pacemaker
c 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.
The nurse knows that synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of which of the following? a. Purkinje fiber repolarization b. Atrial depolarization c. Ventricular depolarization d. Ventricular repolarization
c 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.
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? a. Model number b. Date and time of insertion c. Pacer rate d. Location of the generator
c After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.
A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next? a. Place the client on supplemental oxygen. b. Instruct the client to hold the breath and bear down. c. Question the client about alcohol and illicit drug use. d. Prepare to administer a calcium channel blocker.
c Since the client's findings of tachycardia, dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the client about alcohol and illicit drug use.
The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason? a. The delivered shock must be synchronized with the client's QRS complex. b. The shock must be synchronized with the client's T wave. c. The defibrillator won't deliver a shock if the synchronizer switch is turned on. d. The defibrillator won't deliver a shock if the synchronizer switch is turned off.
c 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.
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? a. Diltiazem b. Amiodarone c. Carvedilol Procainamide
c. 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.
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? a. maintaining intravenous fluids b. assessing blood pressure and heart rate frequently c. alerting the healthcare provider of the third-degree heart block d. identifying a code-level status
c. The client may experience low cardiac output with third-degree AV block. The healthcare provider needs to intervene to preserve the client's cardiac output. Monitoring the blood pressure and heart rate are important, but not a priority. The identification of a code status during a heart block is not appropriate. IV fluids are not helpful if the heart is not perfusing.
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? a. Administer digitalis and diuretics 24 hours before cardioversion b. Facilitate CPR until the client is prepared for cardioversion c. Instruct the client to restrict food and oral intake d. Monitor blood pressure every 4 hours
c. 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.
A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? a. Do nothing; there is no cause for alarm. b. Measure the client's blood pressure. c. Suggest the need for a new beta-blocker to the doctor. d. Double-check the monitoring equipment.
d
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. Atropine b. Adenosine c. Amiodarone d. Warfarin
d
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? a. "I will avoid any large magnets that may affect my pacemaker." b. "I will call the doctor if my incision becomes swollen and red." c. "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." d. "We will be getting rid of our microwave oven so it will not affect my pacemaker."
d
The nurse is proving discharge instructions for a client with a new arrhythmia. Which statement should the nurse include? a. Do not be concerned if you experience symptoms of lightheadedness and dizziness. b. It is not necessary to learn how to take your own pulse. c. If you miss a dose of your antiarrhythmic medication, double up on the next dose. d. Your family and friends may want to take a CPR class.
d
The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia? a. QR interval of 0.25 seconds. b. PR interval of 0.24 seconds. c. P-to-QR ratio of 1:2. d. Heart rate of 42 beats per minute (bpm).
d
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? a. The client is sedated before the procedure. b. It is a scheduled procedure 1 to 10 days in advance. c. It uses less electrical energy than cardioversion. d. It is used to eliminate ventricular dysrhythmias.
d
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? a. "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." b. "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." c. "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." d. "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."
d
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? a. radiofrequency ablation b. pacemaker insertion c. electrophysiological study d. internal cardioverter defibrillator insertion
d 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.
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? a. "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate." b. "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase." c. "This is okay as long as you are not having any symptoms." d. "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."
d 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.
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. A variable heart rate, usually fewer than 60 bpm b. P waves hidden with the QRS complex c. An irregular rhythm d. Delayed conduction, producing a prolonged PR interval
d 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).
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first? a. Supraventricular tachycardia b. Atrial fibrillation c. Sustained asystole d. Ventricular fibrillation
d V-fib is like a dying heart, which need intervention immediately. systole means death or patient is off the monitor.
A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond? a. "You'll need to take an extra dose of your antiarrhythmic before you shoot." b. "Being that close to a rifle might make your ICD fire." c. "Enjoy your hunting trip." d. "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."
d. The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with the left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of an antiarrhythmic.
