Dysrythmias ( questions)

Call the health care provider before giving the next dose of metoprolol (Lopressor).

A patient's cardiac monitor shows sinus rhythm, rate 64. The P-R interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next?

Magnesium sulfate to terminate ventricular tachycardia pattern called torsades de pointes that was noted on the ECG strip

In order to correctly manage ventricular dysrhythmias, the nurse would expect to implement which treatment?

"Use a stool softener." Correct: Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps to prevent this

In teaching clients at risk for bradydysrhythmias, what information does the nurse include?

50 There are 1500 small blocks in a minute, and the nurse will divide 1500 by 30.

When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ____.

Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia

Which action by a new registered nurse (RN) who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias?

Atrial rate runs 300 to 500 with an unequal ratio of P to QRS.

Which criteria will the nurse use when assessing for atrial fibrillation on the ECG strip?

administer a sedative before the procedure is begun. Rationale: When a patient has a non-emergency cardioversion, sedation is used just before the procedure.

A patient with supraventricular tachycardia (SVT) is hemodynamically stable and requires cardioversion. The nurse will plan to

Continue to monitor the patient's cardiac status.

A patient's cardiac monitor shows a rate of 89 with a PR interval of 0.2 second and a QRS of 0.10 second. What is the most important nursing action?

apical radial heart rate. Rationale: It is important to assess the patient's apical-radial pulse rate because PVCs often do not generate a sufficient ventricular contraction to result in a peripheral pulse, which can lead to a pulse deficit.

During change-of-shift report, the nurse learns that a patient with a large myocardial infarction has been having frequent PVCs. When monitoring the patient for the effects of PVCs, the nurse will check the patient's

Avoid contact sports and blows to the chest.

Which teaching is essential for a client who has had a permanent pacemaker inserted?

temporary pacemaker Mobitz type 11 AV block is associated with a large anterior myocardial infarction and a high mortality rate.

The nurse recognizes second-degree AV block, type 11 (Mobitz 11), and intervenes appropriately by:

Perform neurologic checks every 4 hours.

A 58-year-old female is admitted with the following new onset rhythm. With complications related to this rhythm in mind, priority nursing assessment would be to:

Continue monitoring the patient Sinus bradycardia can be a normal finding for athletes or patients when they sleep.

A patient's electrocardiogram (ECG) has changed from a normal sinus rhythm to the following rhythm. A nurse goes to assess the patient. The patient is sleeping, respirations are 16 and unlabored, and the blood pressure has dropped from 110/70 to 104/68. The nurse should:

QRS complexes in 6 seconds and multiply by 10

A patient's monitor strip shows an irregular rhythm. Which method of estimating the rate would be best for the nurse to use? The nurse should count the number of:

Administer epinephrine 1 mg IV push. Epinephrine should be given first for the treatment of asystole in addition to CPR.

CPR is started on a patient who has developed ventricular fibrillation. The patient is defibrillated once with the resulting rhythm. Which intervention should the nurse implement next?

Ventricular fibrillation Defibrillation always is indicated in the treatment of ventricular fibrillation.

For which dysrhythmia is defibrillation primarily indicated?

Perform cardiopulmonary resuscitation (CPR) Treatment consists of immediate initiation of CPR and advanced cardiac life support (ACLS), with the use of defibrillation and definitive drug therapy (e.g., epinephrine, vasopressin [Pitressin]).

The ECG monitor of a patient in the cardiac care unit after a myocardial infarction indicates ventricular fibrillation. What would be the nurse's immediate action?

A. Palpitations C. Chest discomfort E. Hypotension

The nurse is caring for a client with heart rate of 143. For which manifestations should the nurse observe?

B. Excessive alcohol use C. Advancing age D. High blood pressure

The nurse teaches a client with new-onset atrial fibrillation that risk factors for this dysrhythmia may include which? Select all that apply.

Give a sedative before cardioversion is implemented.

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg?

The nurse assists the patient to do active range of motion exercises for all extremities.

Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs?

An increase in heart rate to 80 bpm

Which patient response indicates that the patient has had a favorable response to atropine?

third-degree atrioventricular (AV) block.

A patient reports dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as

"I won't lift the arm on the pacemaker side up very high until I see the doctor."

After providing a patient with discharge instructions on the management of a new permanent pacemaker, the nurse knows that teaching has been effective when the patient states

"The cardioversion was successful." The patient has converted to a normal sinus rhythm (NSR).

After synchronized cardioversion, a patient's electrocardiogram (ECG) tracing reveals the following. Which statement by a nurse is accurate?

The monitor shows sinus rhythm. Correct: Sinus rhythm presents with heart rates from 60 to 100 beats/min; by definition, the bradydysrhythmia has resolved.

How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia?

PR interval. Rationale: The PR interval represents depolarization of the atria, AV node, bundle of His, bundle branches, and the Purkinje fibers, up to the point of depolarization of the ventricular cells.

In analyzing a patient's electrocardiographic (ECG) rhythm strip, the nurse uses the knowledge that the time of the conduction of an impulse through the Purkinje fibers is represented by the

Sinus rhythm with first-degree atrioventricular (AV) block Correct: These are the characteristics of sinus rhythm with first-degree AV block.

The client's rhythm strip shows a heart rate of 76 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.24 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip?

calcium Renal failure is a common cause of hypocalcemia, and a value of 7.0 mg/dL is low, which can cause more cardiac dysrhythmias.

The nurse is caring for a client with a history of renal failure and a new myocardial infarction and dysrythmias. The nurse is reviewing laboratory results, and would call the physician to report which of the following results?

1. The shock is synchronized with the QRS complex. 2. The shock will occur on the R wave. 3. A sedative will be provided before the procedure. 4. Pain medication will be provided before the procedure.

The nurse is reviewing synchronized cardioversion with a new graduate. What will the nurse include when reviewing this procedure?

1. The first downward deflection after the P wave is the Q wave. 2. The first upward deflection after the P wave is the R wave. 3. The first downward deflection after the R wave is the S wave. 4. It usually measures less than 0.12 seconds or less than 3 small boxes.

The nurse is reviewing the characteristics of a normal QRS complex on a patient's cardiac rhythm strip. What will the nurse identify as characteristics of this complex?

Assessing the patient for dyspnea Because the patient is awake and responsive, the next action should be to further assess him for stability and the possible cause of the dysrhythmia.

The nurse responds to a cardiac monitor alarm and notes that the atrial flutter has developed. The patient is responsive, awake, and sitting up in bed. Which action should the nurse take first?

P wave. The P wave represents the depolarization of the atria.

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patient's

Report nosebleeds to your provider immediately. Correct: Warfarin causes decreased ability to clot; a nosebleed could be indicative of excessive dosing.

What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin?

1. Monitor neurological status every 4 hours. 2. Administer anticoagulants as ordered to minimize risk for an embolic event. 4. Administer beta blockers (atenolol) and calcium channel blockers (diltiazem) to lower heart rate in order to maximize cardiac output.

What will the nurse include in the plan of care for a patient with atrial fibrillation?

QRS interval of 0.14 second. Rationale: Because the normal QRS interval is 0.04 to 0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged.

When analyzing the waveforms of a patient's ECG, the nurse will need to investigate further upon finding a

1. Myocarditis 2. Degenerative heart disease 4. Digitalis toxicity 5. Currently being treated for acute myocardial infarction

When evaluating the health history of a patient with complete heart block, what would be considered as potential causes for this condition?

The digoxin level is 2.8 mg/dL. Correct: The therapeutic range for digoxin is 0.8 to 2.0 ng/mL; hold the medication because this client has digoxin toxicity.

Which information would cause the nurse to withhold digoxin in the client with atrial fibrillation and heart failure?

1) P wave is not visible. 2) PR interval is not measurable. 3) Rhythm is irregular.

While monitoring a patient with premature ventricular contraction (PVC), what types of ECG findings is a nurse is likely to observe? Select all that apply.

The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min Correct: This client has a stable, asymptomatic dysrhythmia, which usually requires no treatment; this client can be managed by a nurse with less cardiac dysrhythmia training.

You are the charge nurse on the telemetry unit and are responsible for making client assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit?

Atropine 1 mg IVP

A patient is experiencing chest pain, shortness of breath, and lethargy. The patient's vital signs are BP 88/58, HR 40, RR 20. Which nursing action is a priority for this patient?

Defibrillate at 200 J. Correct: Defibrillating is of priority before any other resuscitative measures according to Advanced Cardiac Life Support protocols.

A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action should the nurse take next?

Anticoagulation Correct: Because of the risk for thromboembolism, anticoagulation is necessary.

A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88. For which additional therapy does the nurse plan?

Ask the patient about current stress level and caffeine use.

A 19-year-old student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take next?

Progressive lengthening of the PR interval until a QRS is dropped

A patient is demonstrating second-degree heart block (Wenkebach [type I]). The nurse realizes this rhythm is characterized by:

Give supplemental O2 at 2 to 3 L/min via nasal cannula.

A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first?

Sinus bradycardia

The nurse is analyzing a 6-second ECG rhythm strip with the following findings: P to QRS ratio is 1:1; four regular R waves were present; QRS width was 0.10 second; PR interval was 0.18 second. The nurse documents this rhythm as:

Increase in the patient's heart rate Rationale: Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness.

After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective?

LOC and BP Sinus bradycardia may be well tolerated in some clients

On assessing sinus bradycardia at a rate of 45 bpm, the nurse should do which of the following?

B. QT interval C. Heart rate and rhythm D. Magnesium level

The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug?

every other QRS complex is wide and starts prematurely. Rationale: Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking.

The nurse determines that a patient has ventricular bigeminy when the rhythm strip indicates that

1. Regular heart rhythm 2. Heart rate 110 beats per minute 3. 1:1 P to QRS ratio 4. PR interval 0.16 second

The nurse determines that a patient is experiencing sinus tachycardia. What did the nurse assess on the patient's ECG rhythm strip?

Sinus tachycardia This rhythm strip shows sinus tachycardia because the rate on this strip is above 101, and it displays normal P wave, PR interval, and QRS complex.

The nurse has obtained this rhythm strip from the patient's monitor. Which description of this ECG is correct?

A patient whose ICD fired three times today who is scheduled for a dose of amiodarone (Cordarone) Rationale: The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone.

The nurse has received change-of-shift report about all of these patients on the telemetry unit. Which patient should the nurse see first?

1. Three premature ventricular contractions in rapid succession 2. Heart rate 150 beats per minute 3. Absent P waves 4. Absent PR interval

The nurse identifies that a patient is experiencing ventricular tachycardia. What did the nurse assess on the patient's ECG rhythm strip?

Continue to monitor. Correct: The client is displaying sinus rhythm with first-degree atrioventicular heart block; this is usually asymptomatic and does not require treatment.

The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60; a P wave precedes each QRS complex, and the PR interval is 0.24 second. Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. The following medications are available on the medication record. What action should the nurse take?

paced beats Paced beats shown on the monitor indicate the pacer is functioning.

The nurse is caring for a client who had a permanent pacemaker inserted due to complete heart block. The nurse determines that which of the following client outcomes indicates a successful procedure?

A. Bearing down for a bowel movement B. Possible inferior wall myocardial infarction (MI) E. Diltiazem (Cardizem) administered an hour ago

The nurse is caring for a client who has developed a bradycardia. Which possible causes should the nurse investigate?

Defibrillation Correct: Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over: in asystole, there is no rhythm to interrupt; therefore this intervention is not used.

The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the new graduate when the graduate offers to perform which intervention?

Heparin Correct: Clients with atrial fibrillation are prone to blood pooling in the atrium, clotting, then embolizing. Heparin is used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke).

The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer?

A P wave precedes every QRS complex. Correct: A P wave is generated by the SA node and represents atrial depolarization.

The nurse is determining whether the client's rhythm strip demonstrates proper firing of the sinoatrial (SA) node. Which waveform indicates proper function of the SA node?

Heart rate is between 150 and 250 beats per minute., The P wave is hidden in the preceding T wave; therefore, the PR interval cannot be measured, and the increased rate can start abruptly and cease quickly when viewing a cardiac monitor to validate its presence.

The nurse is interpreting an ECG strip. What would describe paroxysmal supraventricular tachycardia (PSVT)? Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Conduction of the impulse penetrates the atrioventricular valves. 2. Conduction of the impulse bifurcates into the right and left bundle branches. 3. Conduction of the impulse continues to the Purkinje fibers.

The nurse is reviewing normal cardiac conduction with a new graduate nurse. What will the nurse teach when the impulse reaches the bundle of His?

Pacemaker spikes are noted, but no P wave or QRS complex follows. Correct: Loss of capture occurs when the pacing stimulus (spike) is not followed by the appropriate response, either P wave or QRS complex, depending on placement of the pacing electrode.

The nurse receives in report that the client with a pacemaker has experienced loss of capture. Which situation is consistent with this?

Setting the defibrillator to the synchronized mode Correct: Setting the defibrillator to the synchronized mode ensures discharging the shock during the vulnerable period on the T wave, which may cause ventricular fibrillation.

The nurse recognizes that which intervention provides safety during cardioversion?

Ventricular fibrillation Ventricular fibrillation is a life-threatening dysrhythmia that requires immediate intervention

The nurse recognizes which cardiac dysrhythmia as life-threatening and necessitating immediate intervention?

the client is instructed to breathe deeply through the mouth. Correct: Normal breathing is required or artifact will be observed, perhaps leading to inaccurate interpretation of the ECG.

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student?

Continue to observe the patient and the ECG rhythm

What action is appropriate for the nurse to implement when monitoring the ECG of a patient with a transvenous ventricular demand pacemaker? The ECG strip shows QRS complexes without pacer spikes.

anticoagulants

What medication should a client be taking 4-6 weeks prior to cardioversion?

60 Rationale: There are 1500 small blocks in a minute, and the nurse will divide 1500 by 25.

When analyzing an ECG rhythm strip of a patient with a regular cardiac rhythm, the nurse finds there are 25 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ______.

No consistent P waves, only an erratic and wavy baseline between normally configured QRS waves

When teaching a class of new nursing graduates, the nurse would expect the students to describe atrial fibrillation on an ECG strip as having:

Heart rate decreased to 80

Which assessment finding indicates a patient has had a favorable response to adenosine (Adenocard)?

releases chemicals When the body is exposed to stress, the adrenal glands secrete epinephrine and norepinephrine.

The provider has told the client that the amount of stress must be reduced because it is having a negative effect on the client's heart. When the provider leaves the room, the client asks the nurse why stress would affect the heart. The nurse best responds by explaining

"I won't lift the arm on the pacemaker side up very high until I see the doctor." Rationale: The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads.

A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse,

document the finding and continue to monitor the patient .Rationale: First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block.

A patient has a normal cardiac rhythm strip except that the PR interval is 0.34 seconds. The appropriate intervention by the nurse is to

stimulate a heart beat if the patient's own heart rate drops too low. Rationale: The permanent pacemaker will discharge when the ventricular rate drops below the set rate.

A patient has a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response. The nurse teaches the patient that the pacemaker will

Allow the student to participate on the swim team. Rationale: In an aerobically trained individual, sinus bradycardia is normal.

A 19-year-old student has a mandatory ECG before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate?

Question the patient about current stress level and coffee use. Rationale: In a patient with a normal heart, occasional PVCs are a benign finding.

A 21-year-old college student arrives at the student health center at the end of the quarter complaining, "My heart is skipping beats." The nurse obtains an ECG and notes the presence of occasional PVCs. What action should the nurse take first?

ECG An electrocardiogram records electrical activity of the heart and would be the diagnostic tool of choice to determine why the client's heart rate is irregular.

The nurse is caring for a client whose heart rate suddenly becomes irregular. When notifying the physician, the nurse anticipates an order for what diagnostic study?

Assessing the incision for any redness, swelling, or discharge After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site.

The nurse is caring for a patient who is 24 hours post-pacemaker insertion. Which nursing intervention is most appropriate at this time?

use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. Rationale: This is the quickest way to determine the ventricular rate for a patient with a regular rhythm.

When needing to estimate the ventricular rate quickly for a patient with a regular heart rhythm using an ECG strip, the nurse will

Rate 200 beats/min; P wave not visible VT is associated with a rate of 150 to 250 beats/min; the P wave normally is not visible.

Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)?

Instruct the patient to call for assistance before getting out of bed.

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin?

The procedure will use electrical energy to destroy areas of the conduction system.

Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter?

Observe cardiac rhythms for multiple patients who have telemetry monitoring.

Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as a telemetry technician on the cardiac care unit?

Check lead placement on the patient.

While assessing a patient in the CCU, the nurse observes the following rhythm on the monitor. The patient is alert and oriented and denies any complaints at present. The nurse should:

Normally the patient in asystole cannot be resuscitated successfully.

A patient in asystole is likely to receive which drug treatment?

Start oxygen at 2 L/min via nasal cannula and Give adenosine 6 mg IVP.

A patient in the emergency department is in supraventricular tachycardia. What are appropriate nursing actions for this patient?

1. Failure to pace 2. Failure to capture 3. Failure to sense 4. Oversensing

The nurse is assessing the rhythm strip of a patient for pacemaker malfunctions. What will the nurse assess when analyzing this patient's rhythm strip?

Heart rate Correct: The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand.

The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication?

Check the client for a pulse. Correct: The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first?

Check the client for a pulse. Correct: The nurse needs to assess the pulse and client stability before proceeding with further interventions; pulseless ventricular tachycardia is treated with defibrillation.

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first?

1. Digoxin 2. Dopamine 3. Epinephrine

The nurse is reviewing the list of a patient's prescribed scheduled and prn medications. Which of them will affect cardiac contractility?

I no longer need my heart pills."' Correct: All discharge medications are still needed after the pacemaker is implanted.

The nurse is teaching the client with a new permanent pacemaker. Which statement by the client indicates the need for further discharge education?

Assess the patient.

The nurse receives the following ECG strip at shift report. Which action is most appropriate for this patient?

Give atropine 0.5 mg IV. Rationale 2: Because this patient is complaining of shortness of breath and mild chest discomfort, he is considered to be unstable. For the unstable patient, the treatment of choice for this rhythm (second-degree type I block) is atropine 0.5 to 1 mg IV.

A 57-year-old male patient is admitted to the telemetry unit with new onset of weakness and fatigue. The following rhythm is now seen on the monitor and the patient is now complaining of shortness of breath and mild chest discomfort. Which medication would be appropriate for this patient?

Perform a 12-lead ECG and compare it to previously recorded ECGs. Rationale 1: This patient is in atrial fibrillation. From the information given, it sounds as if he has a history of atrial fibrillation. It would be correct to perform a 12-lead ECG and compare it to previous tracings.

A 67-year-old male patient complaining of "feeling tired" has the following cardiac rhythm. The patient states that he has a history of an irregular heartbeat. His vital signs are BP 134/78; RR 17; SaO2 97% on room air. He denies other complaints at present. The priority action for this patient would be to:

Heart rate of 42 and BP 78/60 A heart rate of 42 and a BP of 78/60 are not adequate and indicate that the patient is unstable with third-degree heart block.

A 78-year-old patient has the following rhythm. Which assessment finding identifies a need for further treatment?

Apply the transcutaneous pacemaker (TCP) pads.

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which actions should the nurse take next?

a. EGC b. energy settings e. skin condition

A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? (select all)

Prolonged QT interval Prolonged QT interval is a cause for concern.

A nurse is monitoring a patient on a wireless electrocardiogram (ECG) monitor. Which observation is a cause for concern?

the atria are not contracting The P wave is an indication of atrial contraction and absence of this wave would mean that the atria either are not contracting or are fibrillating and the fibrillation wave is so small as to not be seen on that particular lead.

A nurse is observing the client's rhythm strip on the cardiorespiratory monitor when the P wave suddenly disappears. The nurse interprets this to mean that

pacemaker

A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. The nurse should anticipate that which of the following management strategies will be used for this client?

a. metabolic alkalosis d. COPD e. stent placement

A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? select all

The heart rate can be calculated from an ECG by counting the number of R-R intervals in 6 seconds and multiplying that number by 10.

A nurse, while reading the ECG of a patient, finds that there are 8 R-R intervals in a span of 6 seconds. What would be the heart rate of this patient? Record your answer in a whole number. __ beats/minute.

third-degree AV block. Rationale: The inconsistency between the atrial and ventricular rates and the variable PR interval indicate that the rhythm is third-degree AV block.

A patient experiences dizziness and shortness of breath for several days. During cardiac monitoring in the ED, the nurse obtains the following ECG tracing. The nurse interprets this cardiac rhythm as

MCL1 Rationale: Leads II and MCL1 are the best leads for visualization of P waves, which reflect atrial activity.

A patient has a dysrhythmia that requires careful monitoring of atrial activity. Which lead will be best to use for continuous monitoring?

Sinus tachycardia Sinus tachycardia inhibits the vagus nerve or stimulates the sympathetic nervous system.

A patient has a heart rate of 150 beats per minute. An electrocardiogram shows a normal P wave preceding each QRS complex. The nurse recognizes that the patient is most likely experiencing what condition?

40-60 If the SA node fails to discharge, the junction will automatically discharge at the normal junctional rate of 40 to 60.

A patient has a junctional escape rhythm on the monitor. The nurse would expect the patient to have a pulse rate of ____ beats/min.

document the finding and continue to monitor the patient. Rationale: first-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block.

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to

Preparing to assist with a head-up tilt-test In patients without structural heart disease, the head-up tilt-test is a common component of the diagnostic workup following episodes of syncope.

A patient has sought care following a syncopal episode of unknown etiology. Which nursing action should the nurse prioritize in the patient's subsequent diagnostic workup?

Stroke A risk of atrial fibrillation is clot formation in the atria caused by altered blood flow through the heart.

A patient is admitted complaining of heart palpitations and dizziness for the past three days. The electrocardiogram (ECG) shows the following rhythm. The nurse identifies that the patient is at risk for:

if the ICD fires and the patient loses consciousness, 911 should be called. Rationale: If the ICD fires and the patient continues to have symptoms of cardiac arrest, activation of the emergency response system is indicated.

A patient who has a history of sudden cardiac death has an ICD inserted. When performing discharge teaching with the patient, it is important for the nurse to instruct the patient and family that

"You had a serious abnormal heart rhythm, which treatment was able to reverse." Rationale: This response honestly describes what happened to the patient while avoiding unnecessarily increasing the patient's anxiety level. More information may be given by the nurse if the patient asks further questions.

A patient who has been successfully resuscitated after developing ventricular fibrillation asks the nurse about what happened. The most appropriate response by the nurse is,

Obtain the patient's vital signs including oxygen saturation.

A patient who is complaining of a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next?

Obtain further information about possible causes for the heart rate. Rationale: The patient has sinus tachycardia, which may be caused by multiple stressors such as pain, dehydration, or myocardial ischemia; further assessment is needed before determining the treatment.

A patient who is complaining of a "racing" heart and nervousness comes to the emergency department. The patient's blood pressure (BP) is 102/68. The nurse places the patient on a cardiac monitor and obtains the following ECG tracing. Which action should the nurse take next?

Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.

A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next?

Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol. Rationale: The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes.

A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next?

Start cardiopulmonary resuscitation (CPR).

A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take?

anticoagulant therapy with warfarin (Coumadin). Rationale: Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 to 4 weeks before attempting cardioversion; this is done to prevent embolization of clots from the atria

A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that further treatment of the patient will require

anticoagulant therapy.

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about

increase in the patient's heart rate. Rationale: Atropine will increase the heart rate and conduction through the AV node.

A patient with myocardial infarction develops symptomatic hypotension. The monitor shows a type 1, second-degree AV block with a heart rate of 30. The nurse administers IV atropine as prescribed. The nurse determines that the drug has been effective on finding a(n)

Experiencing a myocardial infarction ST elevation is a manifestation of a myocardial infarction (MI).

A patient's ECG tracing has changed from sinus tachycardia (ST) to the following rhythm. The nurse should notify the primary health care provider because the patient is ___.

Perform immediate defibrillation The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate.

A patient's cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first?

. Hold the ordered metoprolol (Lopressor) and call the health care provider. Rationale: The patient has progressive first-degree AV block, and the -blocker should be held until discussing the medication with the health care provider.

A patient's sinus rhythm rate is 62. The PR interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 12:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take?

they cannot be in contact with the client and equipment to prevent the student from getting shocked as well.

A student nurse is observing a cardioversion procedure and hears the team leader call out, "stand clear". The student should recognize the purpose of this action is to alert personnel that

start basic cardiopulmonary resuscitation (CPR). Rationale: The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; therefore, the initial actions include calling for help, and initiating CPR until defibrillation is possible.

The nurse hears the cardiac monitor alarm and notes that the patient has a cardiac pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious with no pulse or respirations. After calling for assistance, the nurse should

hemoptysis Chest pain and hemoptysis are classic symptoms of pulmonary embolism, a serious complication of atrial fibrillation.

The nurse is discharging a client to home with a new diagnosis of atrial fibrillation. The nurse explains that which of the following is the most important symptom to report to the physician?

Too much hair under the electrodes Artifact is caused by muscle activity, electrical interference, or insecure leads and electrodes that could be caused by excessive chest wall hair.

The nurse is seeing artifact on the telemetry monitor. Which factors could contribute to this artifact?

Atrial flutter Atrial flutter is an atrial tachydysrhythmia identified by flutter (F) waves, a sawtoothed pattern, with a 200-350 beats/minute atrial rate.

The nurse monitoring the electrocardiogram (ECG) of a patient with hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial rate 250 beats/minute. How should the nurse document this pattern?

administer IV antidysrhythmic drugs per protocol. Rationale: The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes.

The nurse reviews data from the cardiac monitor indicating that a patient with a myocardial infarction experienced a 50-second episode of ventricular tachycardia before a sinus rhythm and a heart rate of 98 were re-established. The most appropriate initial action by the nurse is to

Between 150 and 220 beats/min Paroxysmal supraventricular tachycardia (PSVT) is characterized by a heart rate of 150 to 220 beats/min.

The nurse notes that a patient has a history of paroxysmal supraventricular tachycardia. What heart rate characterizes this dysrhythmia?

Ventricular bigeminy Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking.

The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm?

ventricular tachycardia. Rationale: The absence of P waves, wide QRS, rate >150, and the regularity of the rhythm indicate ventricular tachycardia.

The nurse obtains a monitor strip on a patient admitted to the coronary care unit with a myocardial infarction and makes the following analysis: P wave not apparent; ventricular rate 162, R-R interval regular; PR interval not measurable; and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as

ventricular tachycardia. The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate ventricular tachycardia.

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as

Defibrillation is the treatment of choice to end ventricular fibrillation. Defibrillation is the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia.

The nurse prepares to deliver an electrical shock to a patient in a cardiac crisis. The nurse knows that defibrillation differs from synchronized cardioversion in which of these aspects?

Synchronized cardioversion Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response).

The patient has atrial fibrillation with a rapid ventricular response. The nurse knows to prepare for which treatment if an electrical treatment is planned for this patient?

. Check the patient for a pulse and continue CPR if one is not present.

The patient in pulseless ventricular tachycardia is defibrillated twice and received appropriate meds given per ACLS protocol. The following rhythm is now present. What should the nurse do next?

Myocardial ischemia The ST depression and T wave inversion on the ECG of a patient diagnosed with ACS indicate myocardial ischemia from an inadequate supply of blood and oxygen to the heart

The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST segment depression and T wave inversion. What should the nurse know that this indicates?

Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer.

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use?

Atropine 0.5 mg IV Atropine would be questioned because atropine is the drug of choice for unstable bradycardia, not ventricular irritability.

A patient arrives in the emergency department for chest pain, lightheadedness, and shortness of breath (SOB). The cardiac monitor shows sinus rhythm with the presence of multifocal PVCs. Which order would the nurse question?

Call the primary health care provider The ECG tracing is showing ST elevation indicative of a myocardial infarction (MI).

A patient calls a nurse complaining of jaw pain. The nurse reviews the patient's electrocardiogram (ECG). This is the present tracing. The nurse should:

Decreased cardiac output The patient's ECG tracing is a paroxysmal supraventricular tachycardia (PSVT).

A patient complains of suddenly feeling dizzy. The ECG tracing is the following. A nurse understands the dizziness is most likely a result of:

Obtain and apply the transcutaneous pacemaker (TCP). Rationale: The patient is experiencing symptomatic bradycardia and treatment with TCP is appropriate.

A patient develops sinus bradycardia at a rate of 32 beats/min, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take?

hypokalemia. Rationale: Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation.

A patient with diabetes mellitus is admitted unresponsive to the emergency department (ED). Initial laboratory findings are serum potassium 2.8 mEq/L (2.8 mmol/L), serum sodium 138 mEq/L (138 mmol/L), serum chloride 90 mEq/L (90 mmol/L), and blood glucose 628 mg/dl (34.9 mmol/L). Cardiac monitoring shows multifocal PVCs. The nurse understands that the patient's PVCs are most likely caused by

A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first? a.A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago