Chapter 28
P wave above the baseline
The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing?
ventricular repolarization
A client with a history of angina presents with uncharacteristic chest pain. The subsequent electrocardiogram (ECG) reveals T-wave elevation. This finding suggests an abnormality with which aspects of the cardiac cycle?
An older adult man who is 2 days postcoronary artery bypass surgery
A nurse is caring for four clients. Which client is most at risk for atrial fibrillation (AF)?
Severe anxiety
A nurse witnesses an older adult woman sitting outside who suddenly faints and is helped to the ground by family. She is awake, although confused, heart rate 130, RR 28. The woman states that all of a sudden she felt dizzy, but denies other symptoms. She says that her husband died last week and she has been very upset. The nurse determines that which of the following is the most likely reason for the syncopal episode?
conductivity
A nursing student is studying the properties of cardiac rhythm to better understand what causes dysrhythmias to occur. The student begins to understand that there is a programmed ability for certain cells to conduct impulses. Interruption in this ability can result in abnormalities of cardiac rate and rhythm; this property would be:
second-degree, type 2 AV block.
An intensive care unit nurse is caring for a client who suffered a myocardial infarction involving the anterior wall, and notes a change in the cardiac rhythm. The rhythm has a PR interval that does not change, but there are twice as many P waves as there are R waves. The nurse prepares for a temporary pacemaker insertion because the client has developed:
During sleep or rest
Brugada syndrome, an autosomal dominant disorder, manifests in adulthood as ST-segment elevation, right bundle branch block, and susceptibility to ventricular tachycardia. In Brugada syndrome, the timing of cardiac events is significant. When do these cardiac events typically occur?
P wave
Considering the PQRST complex of an electrocardiogram (ECG), which letter designation represents atrial depolarization?
Most ECG-detected ischemic events are clinically silent.
ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?
Bradycardia with rate of 20-40
The nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?
QRS complex
The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?
SA node - AV node - bundle of His - bundle branches - Purkinje fibers
What is the correct sequence for the generation of electrical impulses in the heart causing ventricular contraction?
Sinus bradycardia
A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which common dysrhythmia is the nurse aware this client most likely has related to maintaining a large stroke volume?
Ventricular repolarization
A client presents with uncharacteristic chest pain, and his ECG reveals T-wave elevation. This finding suggests an abnormality with which aspect of the cardiac cycle?
many people live with atrial fibrillation without even knowing they have it.
An 80-year-old male client arrives for his yearly physical without any complaints, and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder, the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:
Poor prognosis
An intensive care nurse is assessing a client just admitted from the emergency room postmyocardial infarction (MI) and notes that the client's cardiac rhythm is a sinus bradycardia with a rate in the low 50s. The nurse is concerned the client may develop:
Depolarization of the sinoatrial node
The nurse is assessing the electrical activity of the heart recorded on the electrocardiogram (ECG). What does the P wave represent?
Anticoagulants Antiarrhythmics
Two months following a myocardial infarction (MI), a client visits the health care provider with reports of severe fatigue, shortness of breath, and frequent episodes of palpitations. A 12-lead ECG reveals the client has atrial fibrillation with a heart rate of 120. Which medications should the health care provider consider prescribing for this client? Select all that apply.
The association of P waves and QRS complexes is not random.
What does it mean when a client is in second-degree atrioventricular block and there is a relationship between the P waves and the QRS complex resulting in recurring PR intervals?
Isolates and destroys arrhythmogenic cardiac tissue
When a client has a recurrent, life-threatening arrhythmia originating either supraventricularly or ventricularly, ablation therapy is an option for treatment. What does ablation therapy do?
Beta-blockers, such as metoprolol
Which antiarrhythmic medication works by blunting the effect of sympathetic nervous system stimulation on the heart?
Sympathetic nervous system
A 20-year-old college student, with no past medical history, arrives at the emergency room complaining of severe palpitations and dizziness that started this morning following a night of studying. The student is very upset that this is happening because the final exams are the following day. The cardiac monitor shows a heart rate of 110, regular rhythm with occasional premature ventricular complexes. The nurse explains to the student that this can happen in healthy hearts and is usually caused by stimulation of:
Holter monitoring
A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting ECG reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which diagnostic method is the best choice to investigate the suspicion?
myocardial infarction
A client arrives at the doctor's office reporting severe indigestion that has been intermittent; however, the pain is now constant and feels like a vise. The nurse does an ECG and recognizes that the situation is possibly emergent due to ST-segment elevation, which could indicate:
A symptomatic bradyarrhythmia
A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 and blood pressure of 86/50. The cardiac monitors show regular rhythm as above. The client states his physician has been running blood work to rule out hypothyroidism. Based on the rhythm, what does the nurse report the client has?
Prolonged periods of systole demonstration on an electrocardiogram
A client experiencing a sinus arrest would experience what symptoms or findings?
45 to 50 beats/minute
A client has a myocardial infarction (MI) that has damaged the right atrium, which results in interference with the SA node. The compensatory mechanism, the AV node, becomes the pacemaker of the heart and beats how many times per minute?
Third-degree heart block
A client has been diagnosed with Stokes-Adams attacks and has been having "dizziness and fainting spells." Which rhythm does the nurse expect to observe on the monitor?
An atrial heart rate above 240 beats/min
A client has been diagnosed with atrial flutter. Which assessment finding correlates with this diagnosis?
sinus dysrhythmia
A college student is in pre-op area prior to knee surgery. The nurse attaches the cardiac monitor and notes a gradual lengthening and shortening between the R waves. The nurse realizes that this rhythm is most often found in people with healthy hearts. This rhythm is a respiratory:
decreased ventricular filling time.
A group of nursing students is discussing ventricular dysrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to:
Paroxysmal
A monitored hospitalized client with a pulmonary embolism has been in atrial fibrillation (AF) for 4 days. The nurse observes the rhythm spontaneously convert to a normal sinus rhythm. Which form of AF is this?
"Avoid bearing down while having a bowel movement."
A nurse is caring for a client with an average heart rate of 56 beats/min. The client has no adverse symptoms associated with this heart rate and is receiving no treatment. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?
Sinoatrial node (SA), internodal pathways, atrioventricular (AV) node, AV bundle, Purkinje fibers
A nurse is explaining the conduction system of the heart to a client who is experiencing an dysrhythmia. Which would be the most accurate explanation?
PR interval >0.20 seconds
A nurse is monitoring the electrocardiogram (ECG) of a client with a recent right ventricular infarction. The ECG reveals a first-degree atrioventricular (AV) block, which is characterized by:
"The client is experiencing premature atrial contractions (PACs)."
A nurse is observing a client's cardiac status by telemetry monitoring. On the monitor, the P wave changes shape and an impulse frequently occurs before the next expected sinoatrial (SA) node impulse. The nurse interprets this rhythm by stating:
Monitor the client and document the findings.
A nurse notes that the PR interval on a client's electrocardiogram tracing is 0.22 seconds. Which action should the nurse take?
Inherent spontaneous action-potential
Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?
Intrathoracic pressure changes that occur with respiration
Respiratory sinus dysrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus dysrhythmia, what is the variation in cardiac cycles related to?
Monitor the child's ECG for bradycardia.
Sick sinus syndrome is suspected in the case of a child who is postoperative following cardiac surgery. Which nursing action is most appropriate?
Immediate defibrillation
The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priority intervention at this time?
R wave
The nurse is assisting with a synchronized cardioversion for a client with atrial fibrillation (AF). Which waveform does the nurse understand the discharge of electrical energy should be synchronized with?
Atrial fibrillation
The purpose of a cardioversion device is the treatment of which cardiac disorder?
Beta-adrenergic blockers
Which cardiac drug classification decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?
The client with sinus arrest
Which client will the nurse prioritize to assess first?
Ventricular fibrillation
Which dysrhythmia is considered to be the most fatal and requires immediate treatment?
Transcutaneous
Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?
It is important to keep a diary of activities and symptoms.
A client is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which action is important for the nurse to tell the client to ensure accuracy in correlating dysrhythmias with symptoms?
Sinus tachycardia
A client is seen in the emergency department complaining of chest discomfort, productive cough, and a fever of over 101°F (38.3°C) for 3 days. The nurse performs an electrocardiogram and observes a rate of 110 beats per minute (bpm) with a normal P wave and a PR interval of 0.12 second preceding each QRS complex. What does the nurse determine the rhythm to be?
Defibrillate the client
A client's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The client is unconscious and without a pulse. Which priority intervention should the nurse take?