Chapter 34 Care of Patients with Dysrhytmias
Which components measure ECG waveforms? a. BP and cardiac output (CO) b. Seconds and minutes c. Heart rate per minute d. Amplitude (voltage) and duration (time)
d
Which medication does an adult patient with VG or pulseless VT receive? a. Propranolol (Inderal) b. Adenosine (Adenocard) c. Diltiazem hydrochloride (Cardizem) d. Epinephrine (Adrenalin chloride)
d
The nurse is taking the initial history and vital signs on a patient with fatigue. The nurse notes a regular apical pulse of 130 beats/min. Which contributing factors does the nurse assess for? (select all that apply) a. Anxiety or stress b. Fever c. Hypovolemia d. Anemia or hypoxemia e. Hypothyroidism f. Constipation
Abcd
What other actions are essential interventions for the patient in question 65? (select all that apply) a. Providing effective CPR b. Supplying a temporary pacemaker c. Administrating epinephrine, vasopressin, and atropine, as appropriate d. Identifying and correcting the cause of the pulseless rhythm e. Providing continuous ECG monitoring
Abcd
A patient has an invasive temporary pace-maker. In what ways does the nurse ensure the patient's safety related to electrical issues with the pacemaker? (select all that apply) a. Ensure that external ends of the lead wires are insulated with rubber loves. b. Loop the wire ends and cover with non-conductive tape. c. Ensure that no electrical equipment is used in the patient's room. d. Report frayed wire to the biomedical engineering department. e. Wash hands before touching any of the wires.
Abd
A patient has no pulse and the cardiac monitor shows VF. Which drugs does the nurse prepare to administer during the resuscitation? (select all that apply) a. Lidocaine b. Epinephrine c. Calcium chloride d. Amiodarone hydrochloride (Cordarone) e. Dopamine hydrochloride (Intropin) f. Magnesium sulfate
Abdf
Traditionally, what medications will most likely be ordered for a patient with AF? (select all that apply) a Diltiazem hydrochloride (Cardizem) b. Furosemide (Lasix) c. Heparin d. Enoxaparin (Lovenox) e. Sodium warfarin (Coumadin)
Acde
The nurse is teaching a patient with a permanent pacemaker. What information about the pacemaker does the nurse tell the patient? (select all that apply) a. Report any pulse rate lower than what is set on the pacemaker. b. If the surgical incision is near the shoulder, avoid overextending the joint. c. Keep handheld cellular phones at least 6 inches away from the generator. d. Avoid sources of strong electro magnetic fields, such as magnets. e. Avoid strenuous activities that may cause the device to discharge inappropriately f. Carry a pacemaker identification card and wear a medical alert bracelet
Acdf
Which actions are the responsibilities of the monitor tech? (SATA) a. Watch the bank of monitors on a unit b. Notify the health care provider of any changes c. Print routine ECG strips d. Apply battery-operated transmitter leads to patients. e. Interpret the rhythems
Ace
Which clinical manifestations are reflections of sustained tachdysrhythmias and bradydysrhythmias? (select all that apply) a. Weakness and fatigue b. Warm, dry skin c. Dyspnea d. Hypertension e. Decreased urine output
Ace
Which descriptions are characteristic of a class III antidysrhythmic? (select all that apply) a. Lengthens the absolute refractory period b. Is a beta blocker c. Includes hypertension as a side effect d. Prolongs repolarization e. Includes bradycardia as a side effect
Ade
What is the heart rate from an ECG strip when there are 25 small blocks from one R wave to the next R wave? a. 50/minute b. 60/minute c. 70/minute d. 80/minute
B
A patient has had synchronized cardioversion for unstable VT. Which interventions does the nurse include in the patient's care after the procedure? (select all that apply) a. administer therapeutic hypothermia b. Assess vital signs and the level of consciousness. c. Administer antidysrhythmic drug therapy d. Monitor for dysrhthmias e. Monitor for loss of capture f. Assess for chest burns from electrodes
Bcdf
A patient has had a permanent pacemaker surgically implanted. What are the nursing responsibilities for the care of this patient related to the surgery? (select all that apply) a. Administer short-acting sedatives b. Assess the implantation site for bleeding c. Teach about and monitor for the initial activity restrictions d. Observe for overstimulation of the chest wall, which could lead to pneumothorax e. Monitor the ECG rhythm to check that the pacemaker is working correctly
Bce
Excessive vagal simulation can result form which activities? (select all that apply) a. Jogging b. Carotid sinus massage c. Suctioning d. Voiding e. Valsalva maneuver
Bce
The patient has sustained SVT and the health care provider orders IV adnosine. Which important actions must the nurse perform when this drug is given? ( select all that apply) a. Inject the drug slowly over one minute. b. Have emergency equipment at the bedside. c. Follow the drug injection with a normal saline bolus. d. Have injectable beta blocker drugs at the bedside. e. Monitor the patient for bradycardia, nuasea, and vomiting
Bce
The student nurse is looking at a patient's ECG rhythm strip and suspects a normal sinus rhythm (NSR) Which ECG criteria are included for NSR? (SATA) a. Rate: Atrial and ventricular rates of 40 to 120 beats/min b. Rhythm: Atrial and ventricular rhythms regular c. P waves: Present, consistent configuration, one P wave before each QRS complex d. P-R interval 0.24 second e. QRS duration: 0.04 to 0.10 second and constant
Bce
What effects does dobutamine (Dobutrex) have on the heart? (select all that apply) a. Decreases myocardial contractility b. Stimulates beta-adrenergic receptors c. Improves myocardial contractility d. Depresses stimulation of beta-adrenergic receptors e. May cause dysrhythmias
Bce
What are the risk factors for AF? (select all that apply) a. Chronic obstructive pulmonary disease (COPD) b. Hypertension c. Diabetes mellitus d. Valvular disease
Bde
A patient has an implantable cardioverter defibrillator (ICD). In cardioversion shock, the defibrillator is set in the synchronized mode to do what? a. Avoid discharging the shock during the T wave b. Discharge the shock during the R wave c. Discharge the shock during the T wave d. Avoid discharging the shock during the Q wave
a
A patient is diagnosed with torsades de pointes. The nurse prepares to administer which emergency medication? a. Magnesium sulfate b. Epinephrine (Adrenalin) c. Adesnosine (Adenocard) d. Calcium chloride
a
A patient is found pulseless and the cardiac monitor shows a rhythm that has no recognizable deflections, but instead has coarse "waves" of varying amplitudes. What is the priority ACLS intervention for this rhythm? a. Immediate defibrillation b. Administration of epinephrine IVP c. Administration of lidocaine IVP d. Noninvasive temporary pacing
a
A patient with AF suddenly develops shortness of breath, chest pain, hemoptysis, and a feeling of impending doom. The nurse recognizes these symptoms as which complication? a. Pulmonary embolism b. Embolic stroke c. Absence of atrial kick d. Increased cardiac output
a
A patient with atrial fibrillation is scheduled to have an elective cardioversion. The nurse ensures that the patient has a prescription for 4-6 week supply of which ytpe of medication? a. Anticoagulants b. Digitalis c. Diuretics d. Potassium supplements
a
A patient's ECG rhythm strip is irregular. Which method does the nurse use for an accurate assessment? a. 6-second strip method b. Memory emthod c. Big block method d. Commerical ECG rate ruler
a
Based on the prevalence and risk factors for atrial fibrillation (AF), which patient group is at highest risk for AF? a. Older adults b. Diabetics c. Substance abusers d. Pediatric cardiology patients
a
In a patient's record, the nurse notes frequent episodes of bradycardia and hypotension related to unintended vagal stimulation. Which instruction for this patient's care does the nurse relay to the unlicensed assistive personnel (UAP)? a. Avoid raising the patient's arms above the head during hygiene. b. Ambulate the patient slowly and stop frequently for brief rests c. Generously lubricate rectal thermometer probes and insert very cautiously d. Monitor the heart rate and rhythm if the patient is vomiting
a
The nurse is interviewing a patient who suddenly becomes faint, immediately loses consciousness, and becomes pulseless and apneic. There is no blood pressure, and heart sounds are absent. What does the nurse do next? a. Begin compressions. b. Defibrillate the patient c. Establish or ensure IV access d. Give supplemental oxygen
a
The nurse is performing a 12-lead ECG on a patient with chest pain. Because the positioning of the electrodes is crucial, how does the nurse place the ECG components? a. Four leads are placed on the limbs and six are places on the chest n. The negative electrode is placed on the left arm and the positive electrode is placed on the right leg c. Four leads are placed on the limbs and four are placed on the chest d. The negative electrode is placed on the right arm and the positive electrode is placed on the left leg
a
The nurse is reviewing preliminary ECG results of a patient admitted for mental status changes. The nurse alerts the health care provider about ST elevation or depression in the patient because it is an indication of which condition? a. Myocardial injury or ischemia b. Ventricular irritability c. Subarachnoid hemorrhage d. Prinzmetal's angina
a
The remote telemetry technician alerts the nurse to the presence of premature ventricular contractions (PVCs) in a newly admitted patient. How does the nurse assess whether the premature complexes perfuse to the extremities? a. Palpate peripheral arteries while observing the monitor for widened complexes. b. Auscultate for the apical heart sounds and listen for irregularities or pauses c. Check the color and temperature of extremities, and capillary refill of fingers and toes d. Assess the ECG strip for regularity and width of QRS complexes
a
What does the P wave in an ECG represent? a. Atrial depolorization b. Atrial repolarization c. Ventricular depolarization d. Ventricular repolarization
a
What is the QRS complex in an ECG normally? a Less than 0.12 second b. 0.10 to 0.16 second c. 0.12 to 0.20 second d. 0.16 to 0.24 second
a
What is the ST segment in an ECG normally? a. Isoelectric b. Elevated c. Depressed d. Biphasic
a
With the speed set for 25 mm/second, the segment between the dark lines on a monitor ECG strip represents how many seconds? a 3 b. 6 c. 10 d. 20
a
The nurse is assessing a patient's ECG rhythm strip and analyzing the P waves. Which questions does the nurse use to evaluate the P waves? (SATA) a. Are P waves present? b. Are the P waves occurring regularly? c. Does one P wave follow each QRS complex? d. Are the P waves greater than 0.20 second? e. Do all the P waves look similar? f. Are the P waves smooth, rounded, and upright in appearance?
abef
A patient is in VF. The nurse sets the biphasic defibrillator to deliver how many joules? a. 100 b. 200 c. 300 d. 360
b
A patient is in full cardiac arrest and CPR is in progress. The ECG monitor shows ventricular asystole. What does the nurse do next? a. Assist with or administer defibrillation b. Assess another ECG lead to ensure the rhythm is asystole and not fine VF c. Assist the provider with noninvasive pacing or invasive transvenous pacing d. Encourage the family's presence during the resuscitation
b
A patient reports chest pain and dizziness after exertion, and the family reports a concurrent new onset of mild confusion in the patient, as well as difficulty concentrating. What is the priority problem for this patient? a. Activity intolerance b. Decreased cardiac output c. Acute confusion d. Inadequate oxygenation
b
A patient scheduled to have elective cardioversion for AF will receive drug therapy for about 6 weeks before the procedure. What information about the drug therapy does the nurse teach the patient? a. Managing orthostatic hypotension b. Watching for bleeding signs c. Eating potassium-rich food sources d. Reporting muscle weakness or tremors
b
According to the Vaughn-Williams classification of antidysrhythmics, which class II drug controls dysrhythmias associated with excessive beta-adrenergic stimulation? b. Propranolol hydrochloride ( Inderal)
b
How does the nurse interpret the measurement of the PR interval when the interval to be measured is six small boxes on the ECG strip? a. Atrium is taking longer to repolarize b. Longer-than-normal impulse time from the SA node to the ventricles is shown. c. There is a problem with the length of time the ventricles are depolarizing d. This is the normal length fo time for the P-R interval.
b
The bedside cardiac monitor of a postoperative patient who becomes confused shows sinus rhythm, but there is no palpable pulse. How does the nurse interpret these findings? a. ECG monitor artifact or dysfunction b. Pulseless electrical activity with inadequate perfusion c. A paced rhythm with hypotension d. Idioventricular rhythm as seen in the dying heart
b
The heart monitor of a patient shows a rhythm that appears as a wandering or fuzzy baseline. What is the priority action for the nurse? a. Immediately obtain a 12-lead ECG to assess the actual rhythm b. Assess the patient to differentiate artifact from actual lethal rhythms c. Check to see if the patient has a DNR order d. Ask the patient care technician to take vital signs on the patient
b
The nurse discovers a patient is unconscious and without palpable pulses and immediately initiates CPR. For what reason is CPR started on this patient? a. To identify the underlying heart rhythm b. For the rapid return of a pulse, blood pressure, and consciousness c. To prevent rib fractures or lacerations of the liver and spleen d. To mimic cardiac function until the defibrillator arrives
b
The nurse has four patients on telemetry monitors and is analyzing the ECG rhythm strips a. Analyze the P waves b. Determine the heart rate c. Measure the QRS duration d. Measure teh PR interval
b
The nurse hears in report that a patient has sinus arrhythmia. In order to validate that this is associated with the changes in intrathoracic pressure, what does the nurse do next? a. Count the respiratory and pulse rate at rest and then count both rates after moderate exertion b. Observe that the heart rate increases slightly during inspiration and decreases slightly during exhalation. c. Ask the patient to hold the breath and take an apical pulse; then have the patient resume normal breathing. d. Have the patient take a deep breath and count the patient apical pulse rate while the patient slowly exhales
b
The nurse is assessing a patient's ECG rhythm strip and checking the regularity of the atrial rhythm. What is the correct technique? a. Place one caliper point on a QRS complex; place the other point on the precise spot on the next QRS complex b. Place one caliper point on a P wave; place the other point on the precise spot on the next P Wave c. Place one caliper point at the beginning of the P wave; place the other point at the end of the P-R segment d. Place one caliper point at the beginning of the QRS complex; place and the other point where the S-T segment begins
b
The nurse is assisting the provider to perform temporary pacing for a patient who has atropine-refractory symptomatic bradycardia. What is the desired outcome for this patient as evidenced by the cardiac monitor? a. No spike, but a complete QRS complex indicating atrial depolarization b A spike followed by a QRS complex indicating ventricular depolarization c. Two spikes, followed by a QRS complex indiccating ventricular depolarization d. A spike before and after a QRS complex indicating atrial depolarization
b
The nurse is reviewing a patient's ECG and interprets a wide distorted QRS complex of 0.14 second followed by a P wave. What does this finding indicate? a. Wide but normal complex, and no cause for concern b. Premature ventricular contraction c. Problem with the speed set on the ECG machine d. Delayed time for the electrical impulse through the ventricles
b
The nurse is teaching a community group how to use an AED. What is the first step for using the AED that the nurse teaches? a. Rescuer presses the "analyze" button on the machine b. Place the patient on a firm, dry surface c. Rescuer stops CPR and directs anyone present to move away d. Place two large adhesive-patch electrodes on the patient's chest
b
The primary pacemaker of the heart, the sinoatrial (SA) node, is functional if a patient's pulse is at what regular rate? a. Fewer than 60 beats/min b. 60 to 100 beats/min c. 80 to 100 beats/min d. Greater than 100 beats/min
b
The remote telemetry technician calls the nurse to report that a patient's ECG signal transmission is not very clear. What does the nurse do to enhance the transmission? a. Clean the skin with povidone-iodine solution before applying the electrodes b. Ensure that the area for the electrode placement is dry and nonhairy c. Apply tincture of benzoin to the electrode sites and allow it to dry d. Abrade the skin by rubbing briskly with a rough washcloth
b
The respiratory therapist (RT) and the medical student are ventilating a patient in cardiac arrest, while the nurse and provider are preparing the patient and equipment for intubation. At which point does the nurse intervene? a. The RT inserts an oropharyngeal airway b. The medical student sets the oxygen flow meter at 2 L/min c. The RT ventilates with a manual resuscitation bag and mask d. The medical student uses the chin-lift position on the patient
b
What does stimulation of the sympathetic nervous system produce? a. Delayed electrical impulse that causes hypotension and bradypnea b. Contractility and dilation of coronary vessels and increased heart rate. c. Virtually no effect on the ventricles of the heart or vital signs d. A slowed AV conduction time that results in a slow heart rate
b
Which definition best describes the synchronous (demand) pacing mode? a. The pacemaker continues to fire at a fixed rate as set on the generator b. The pacemaker's sensitivity is set to sense the patient's own beats c. Electrical pulses are transmitted through two large external electrodes then transcutaneously to stimulate ventricular depolarization d. External battery-operated pulse generator on one end and wires in contact with the heart on the other end
b
Which drug for symptomatic bradycardia does the nurse prepare to administer to a patient with bradydysrhythmia? a. Epinephrine b. Atropine c. Calcium d. Lidocaine
b
Which dysrhythmia causes the ventricles to quiver, resulting in absence of cardiac output? a. Ventricular tchycardia b. Ventricular fibrillation c. Asystole d. Third-degree heart block
b
A patient in the telemetry unit is having continuous ECG monitoring. The patient is scheduled for a test in the radiology department. Who is responsible for determining when monitoring can be suspended? a. Telemetry technician b. Charge nurses c. Health care provider dd. Primary nurse
c
AED electrodes are placed on a patient who is unconscious and pulseless. The nurse prepares to immediately defibrillate if the monitor shows which cardiac anomaly? a. Third-degree heart block b. Pulseless electrical activity c. VF d. Idioventricular rhythm
c
After advanced cardiac life support (ACLS) is performed, a patient who experienced VF has a return of spontaneous circulation. To protect the patient's nervous system, which intervention does the nurse anticipate with be performed? a. Neurologic checks every 4 hours b. Administration of IV mannitol c. Application of a cooling blanket d. Continuous ECG monitoring
c
Cardiac dysrhythmias are abnormal rhythms of the heart's electrical system. How does this affect the heart's function? a. It cannot oxygenate the blood throughout the body b. It cannot remove carbon dioxide from the body c. It cannot effectively pump oxygenated blood throughout the body d. It cannot effectively conduct impulses with increased acitivyt
c
The nurse in the telemetry unit must perform transcutaneous pacing. How does the nurse position the electrodes? a. One over breast tissue on the right side and one over breast tissue on left side b. One on the upper chest to the left of the sternum and one beneath the left scapula c. One on the upper chest to the right of the sternum and one over the heart apex. d. One over the sternum and one on the left anterior lateral chest
c
The nurse is caring for a patient with coronary artery disease (CAD). The patient reports palpitations and chest discomfort and the nurse notes a tachydysrhythmia on the EG monitor. What does the nurse do next? c. Give supplemental oxygen
c
The nurse is caring for several patients who have dysrhythmia. What does the nurse instruct these patients to do? a. Stay at least 4 feet away from a microwave oven that is operating b. Avoid electronic metal detectors, such as those at airports c. Learn the procedure for assessing the pulse. d. Purchase an automatic external defibrillator (AED) for home use
c
The nurse is interviewing a patient with spontaneous VT who may be a possible candidate for an ICD. The nurse senses that the patient is anxious. What is the nurse's most therapeutic response? a "Your feelings are natural; patients report psychological distress related to ICD." b. "ICD is similar to defibrillation, which saved your life during the last episode" c. "You see anxious. What are your concerns about having this treatment?" d. "Would you like to talk to the doctor about the details of the procedure?"
c
The nurse is performing external defibrillation. Which step is most vital in this procedure? a. Place the gel pads anterior over the apex and posterior for better conduction b. Do not administer a second shock fro 1 minute to allow for recharging c. No-one must touch the patient at the time a shock is delivered d. Continuously ventilate the patient via endotracheal tube during the defibrillation
c
The nurse is performing the shift assessment on a cardiac patient. In order to determine if the patient has a pulse deficit, what does the nurse do? Assess the apical and radial pulses for a full minute and observe for differences.
c
The nurse is placing the electrodes on a patient for cardioversion. What is the correct placement for the electrodes? a. One electrode is placed on the upper left chest and the other is placed on the lower left chest in a midaxillary line b. One electrode is placed the upper right chest below the clavicle and the other is placed on the back c. One electrode is placed to the left of the precordium, and the other is placed on the right next to the sternum and below the clavicle. d. One electrode is placed on the sternum and the other is placed on the lower left chest in a midaxillary line
c
The nurse is reviewing ECG results of a patient admitted for fluid and electrolyte imbalances. The T waves are tall and peaked. The nurse reports this finding to the provider and obtains an order for which serum level tests? a. Sodium b. Glucose c. Potassium d. Phosphorus
c
The nurse is reviewing the monitored rhythms of several patients in the cardiac stepdown unit. The patient with which cardiac anomaly has the greatest need of immediate attention? a. Chronic atrial fibrillation b. Paroxysmal supraventricular tachycardia (SVT) that is suddenly terminated c. Sustained rapid ventricular response d. Sinus tachycardia with premature atrial complexes
c
The nurse is taking vital signs ad reviewing the electrocardiogram (ECG) of a patient who is training for a marathon. The heart rate is 45 beats/min and the ECG shows sinus bradycardia. How does the nurse interpret this data? a. A rapid filling rate that lengthens diastolic filling time and leads to decreased cardiac output b. The body's attempt to compensate for a decreased stroke volume by decreasing the heart rate c. An adequate stroke volume that is associated with cardiac conditioning d. A common finding in the health adult that would be considered normal
c
The nurse is teaching a patient with an ICD. What instruction does the nurse emphasize to the patient? a. Rest for several hours after an internal defibrillator shock before resuming activities b. Have family members step away during the internal defibrillator shock for safety c. Expect that the shock may feel like a thud or a painful kick in the chest. d. Report any pulse rate higher than what is set on the pacemaker
c
The provider has completed the placement f lead wires for the invasive temporary pace-maker in a patient who is asystolic. In turning on a pacing unit, which setting does the nurse use? a. Synchronous pacing mode b. Demand pacing mode c. Asynchronous pacing mode d. Temporary pacing mode
c
What is the heart rate shown on a 6-second ECG strip when the number of R-R intervals is 5? What is this rhythm? a. 30/minute bradycardia b. 40/minute bradycardia c. 50/minute bradycardia d. 60/minute normal
c
What is the normal measurement of the PR interval in an ECG? a. Less than 0.11 second b. 0.06 to 0.10 second c. 0.12 to 0.20 second d. 0.16 to 0.26 second
c
Which dysrhythmia results in asynchrony of atrial contraction and decreased cardiac output? a. Sinus tachycardia b. Atrial flutter c. Atrial fibrillation d. First-degree atrioventricular block
c
A patient is about to undergo elective cardioversion. The nurse sets the defibrillator for synchronized mode so that the electrical shock is not delivered on the T wave. This is done to avoid which complication? a. Electrical burns to the skin b. Ventricular standstill c. Arcing from the electrodes d VF
d
A patient is diagnosed with recurrent SVT. What does the nurse do in order to accomplish the preferred treatment? a. Place the patient on the cardiac monitor and perform carotid massage b. Give oxygen and establish IV access for antidysrhythmic drugs c. Assist the provider in attempting atrial overdrive pacing d. Provide information about radiofrequency catheter ablation therapy.
d
The nurse is assessing a patient's ECG rhythm strip and notes that occasionally the QRS complex is missing. How does the nurse interpret this finding? a. A junctional impulse b. A supraventricular impulse c. Ventricular tachycardia d. A dysrhythmia
d
The nurse is caring for several patients in the telemetry unit who are being remotely watched by a monitor technician. What is the nurse's primary responsibility in the monitoring process of these patients? a. Watching the bank of monitors on the unit b. Printing ECG rhythm strips routinely and as needed c. Interpreting rhythm d. Assessment and management
d
The nurse is notified y the telemetry monitor technician about a patient's heart rate. Which method does the nurse use to confirm the technician's report? a. Count QRS complexes in a 6-second strip and multiply by 10 b. Analyze an ECG rhythm strip by using an ECG cliper c. Run an ECG rhythm strip and use the memory emthod d. Assess the patient's heart rate directly by taking an apical pulse
d
The nurse is taking a history and vital signs on a patient who has come to the clinic for a routine checkup. The patient has a pulse rate of 50 beats/min, but denies any distress. What does the nurse do next? a. Give supplemental oxygen b. Establish IV access c. Complete the health history d. Check the blood pressure
d
What does the T wave on an ECG represent? A. Ventricular depolarization b. Atrial repolarization c. Atrial depolarization d. Ventricular repolarization
d
What is the primary significance of ventricular tachycardia (VT) in a cardiac patient? a. It increases the ventricular filling time, therefore increaseing cardiac output b. It signals that the patient needs potassium supplement for replacement c. It warrants immediate initiation of cardiopulmonary resuscitation. d. It is commonly the initial rhythm before deterioration into ventricular fibrillation (VF)
d
What is the total time required for ventricular depolarization and repolarization as represented on the ECG? a. PR interval b. QRS complex c. ST segment d. QT interval
d
