Heart Rhythm Interpretation #2
A student nurse is reviewing the nursing interventions for 1st degree AV block and is concerned as to why the patient needs to be monitored further. Which of the following is the bestresponse for the nursing instructor to give the student about first degree AV heart block? "It is a precursor to 3rd degree heart block so the client needs to be monitored until then" 'It is a precursor to needing a pacemaker so the client needs to be monitored until then" "It is a harmless rhythm unless the client becomes symptomatic" "It is only important if the client is having a myocardial infarction so the client just needs to be monitored"
"It is a harmless rhythm unless the client becomes symptomatic" First degree AV heart block does not cause major complications unless the client is symptomatic.
The student nurse is attempting to identify the characteristics of a 2nd degree AV heart block type 1 and knows these would include which of the following? Select all that apply. A progressively lengthening PR interval Additional QRS complex No relation between the P wave and QRS complex A normal PR interval Wide QRS complex
A progressively lengthening PR interval The PR interval progressively lengthens with 2nd degree AV heart block type 1.
The nurse is caring for a client who is suffering from frequent premature ventricular contractions. Which of the following is true of this condition? Select all that apply. A. It may decrease the efficiency of the heart's pumping action B. The client is usually hypertensive C. It is commonly caused by a myocardial infarction D. The client may experience an irregular heartbeat E. It arises from one or more atrial ectopic foci
A, C, & D. It may decrease the efficiency of the heart's pumping action. The client may experience an irregular heartbeat. It is commonly caused by a myocardial infarction. It is commonly caused by myocardial infarction, and the client is usually normotensive. The condition arises from one or more ventricular ectopic foci. The nurse should notify the provider if the PVCs increase in frequency, are accompanied by chest pain, are multifocal, occur on the T wave or in runs of v-tach. A PVC is an irregular heartbeat, and the client will be able to feel the irregularity. The client with frequent premature ventricular contractions may have a decrease in the efficiency of the heart's pumping action, as it can reduce cardiac output.
The nurse is caring for a client who has suddenly gone into ventricular fibrillation. Which of the following is true about this condition? Select all that apply. A. Blood flow must be restored or there will be death in 1-5 minutes B. The blood pressure is usually normal C. It can be caused by a myocardial infarction D. It is the most severe of all dysrhythmias E. The client will feel an irregular heartbeat
A, C, D. It is the most severe of all dysrhythmias It can be caused by a myocardial infarction Blood flow must be restored or there will be death in 1-5 minutes Ventricular fibrillation is the most severe of all dysrhythmias and can be caused by a myocardial infarction. The client is unconscious with no blood pressure and blood flow must be restored or death will occur in 1-5 minutes.
The nurse is caring for a client. Upon assessment, the client states, "My heart is beating out of my chest!" The nurse calls for an EKG and it shows supraventricular tachycardia (SVT). What medication does the nurse anticipate to be ordered? Epinephrine Romazicon Synchronized cardioversion Adenosine
Adenosine A client with stable SVT may experience shortness of breath, dizziness, and palpitations, but will not have an altered level of consciousness or ongoing chest pain. From this scenario, we can deduce that the client has palpitations. No other symptoms are described, so this client has stable SVT. Adenosine is given to clients in stable supraventricular tachycardia to help slow the cardiac electrical activity. The first dose is 6 mg, repeated by 12 mg if needed. A client in unstable SVT would receive synchronized cardioversion.
A child with respiratory acidosis has developed supraventricular tachycardia. The healthcare staff has tried to correct the condition with vagal maneuvers without success. Which medication would the staff most likely give to correct the situation? Lisinopril Enoxaparin Clopidogrel Adenosine
Adenosine Supraventricular tachycardia (SVT) is a type of cardiac arrhythmia in which the heart beats very rapidly due to a malfunctioning node above the ventricles. The condition can sometimes be corrected by having the client perform a vagal maneuver. With infants, placement of an ice pack on the baby's face may also correct the situation. When these options are unsuccessful, administration of adenosine may convert the heart to a normal rhythm.
Which of the following EKG findings is NOT a characteristic of a complete heart block? A regular ventricular rhythm A QRS complex occurring without a P wave An irregular atrial rhythm A QRS complex of 0.16 seconds
An irregular atrial rhythm The atrial rhythm in a 3rd degree heart block is regular. It is unrelated to the ventricular rhythm, but when measured, the P waves are present at regular intervals.
The client needs cardioversion for paroxysmal atrial tachycardia. Which of the following is true about the differences between defibrillation and cardioversion? Select all that apply. A. Defibrillation involves providing an electrical shock and cardioversion does not B. In cardioversion, the synchronizer needs to be turned to "on" C. Defibrillation is done for ventricular fibrillation and cardioversion is done when there is an actual cardiac rhythm D. There are different machines used for cardioversion and defibrillation E. Defibrillation is use for frequent PVCs and cardioversion is used for ventricular fibrillation
B & C. Defibrillation is done for ventricular fibrillation and cardioversion is done when there is an actual cardiac rhythm. In cardioversion, the synchronizer needs to be turned to "on". The synchronizer is turned to "on" in a cardioversion. The provider has to call an "all clear" in both situations. Both defibrillation and cardioversion involve an electrical shock and are performed on the same machine. When comparing defibrillation and conversion, defibrillation is done for ventricular fibrillation and cardioversion is done when there is an actual rhythm. There is no synchronizing for v fib, because there is no electrical impulse with which to sync the machine.
The nurse responds to a code for a client in ventricular fibrillation. Which of the following interventions does the nurse anticipate for this situation? Select all that apply. Atropine administration Epinephrine administration Percutaneous coronary intervention Defibrillation CPR
CPR Defibrillation Epinephrine administration
A 56-year-old patient is suffering from multiple premature ventricular contractions (PVCs) that cause her to feel lightheaded and dizzy. Which drug would most likely be prescribed for the management of PVCs? Aspirin Carvedilol Calcium chloride Epinephrine
Carvedilol Carvedilol (Coreg) is a medication that may be given to regulate the heart rate when a patient has frequent premature ventricular contractions that cause symptoms, like dizziness and the feeling of being lightheaded. Carvedilol is a beta blocker that is also used for other cardiac conditions, such as heart failure, high blood pressure and angina.
The nurse is caring for a telemetry client. Upon entering the room, the nurse notices a few premature ventricular contractions on the cardiac monitor. As the nurse begins an assessment, the client goes into ventricular tachycardia on the monitor. Which of the following nursing actions is mostappropriate? Check a pulse Call a code blue Call the provider Call for help
Check a pulse The first step for a client in ventricular tachycardia is to check a pulse. If there isn't a pulse, then using the ACLS algorithm, the client would be treated with defibrillation.
A client is admitted to the emergency department. The nurse observes the client's electrocardiogram (EKG), which demonstrates that the client has just developed 3rd degree heart block. Which of the following findings are consistent with this diagnosis? Select all that apply. Lethargy Decreased LOC Wheezing Pinpoint pupils Bradycardia
Decreased LOC Bradycardia Lethargy Findings the nurse would expect in a 3rd degree heart block are related to decreased cardiac output. A decreased level of consciousness is consistent with this. A client with a 3rd degree heart block will have an expected ventricular rate of 30-40 beats per minute, which is severe bradycardia. Lethargy is a finding consistent with decreased cardiac output.
A client's rhythm strip shows a complete heart block. The nurse is mostconcerned because of which of the following manifestations of a complete heart block? A feeling of impending doom Capillary refill > 5 seconds Decreased cardiac output Chest pain
Decreased cardiac output The bottom line of a 3rd degree heart block is poor perfusion due to decreased cardiac output. When a client has this type of heart rhythm, the ventricles and atria do not have coordinated contraction, so blood is not pumping effectively and the client's output is profoundly low. This results in poor perfusion and this is a medical emergency. The client will need pacing to ensure the ventricles pump at an acceptable rate to move blood effectively through the body.
A student nurse understands there is a decrease in cardiac output during a PVC due to which of the following? Increased filling time of atria Increased filling time of ventricles Decreased filling time of ventricles Decreased filling time of atria
Decreased filling time of ventricles There is a decreased filling time of the ventricles during a PVC.
In second degree AV heart block type 1 there is a progressively prolonged PR interval and the nurse knows that there is which of the following after it keeps prolonging? Dropped QRS complex A premature atrial contraction Additional QRS complex A run of ventricular tachycardia
Dropped QRS complex There is usually a dropped QRS after prolonged PR interval.
A client with pericarditis is being evaluated for dizziness and shortness of breath. His heart rate on the monitor demonstrates supraventricular tachycardia. Which of the following interventions is most appropriate in this situation? Have the client perform the Valsalva maneuver Administer a vasopressor medication, such as epinephrine Give the patient 8 oz. of water to drink Start CPR at a rate of 100 compressions per minute
Have the client perform the Valsalva maneuver Supraventricular tachycardia (SVT) is a type of cardiac arrhythmia in which the heart beats rapidly. The rhythm originates in the atria of the heart and can cause a heart rate of up to 300 bpm. The client becomes lightheaded and dizzy because his heart is not effectively pumping blood due to the rapid rate. The initial method of management is to ask the client to "bear down", known as the Valsalva maneuver. The maneuver can also be achieved by having the client close their mouth, pinch their nose and blow against closed airways. This causes increased intrathoracic pressure, blood pressure and heart rate shifts, and may convert the arrhythmia back into a normal rhythm.
A nurse is caring for a client in the ICU who has a history of cardiac dysrhythmias. The client goes into a state of ventricular tachycardia and the nurse is unable to find a pulse. The code team arrives and delivers a shock of defibrillation to the client at 360 Joules. Which step would the nurse perform next? Provide two manual breaths with a bag and mask Assess the client's pulse Immediately resume chest compressions Administer 1 mL of IV epinephrine
Immediately resume chest compressions A client who is in ventricular fibrillation or pulseless ventricular tachycardia has a shockable rhythm and the healthcare staff can perform defibrillation. Immediately after providing the first shock to the client, the team should restart chest compressions without stopping to check a pulse. The nurse should perform CPR for 2 minutes before stopping to assess the client's heart rhythm.
A new nurse is reviewing a rhythm on a telemetry monitor and believes it might be ventricular fibrillation. Which of the following characteristics is the nurse most likely observing? Select all that apply. Ventricular heart rate of 150-250 bpm Large and tall P waves Normal PR interval P:QRS ratio that is not measurable Irregular rhythm
Irregular rhythm P:QRS ratio that is not measurable This is a characteristic of V-fib. Ventricular fibrillation is an irregular rhythm and the P: QRS ratio is nonmeasurable.
The nurse is caring for a client with a history of a 3rd degree heart block who had a permanent pacemaker placed earlier in the day. Which of the following goals is the priority outcome for the nurse? Ensure distal pulses are present Assist with gentle ROM exercises Maintain an appropriate client pain level Maintain adequate cardiac output
Maintain adequate cardiac output A 3rd degree heart block is a medical emergency in which the atria and ventricles fail to beat in succession, resulting in extreme bradycardia and a profound drop in cardiac output. A pacemaker is needed in order to restore an adequate ventricular rhythm. The priority intervention for the nurse is to ensure adequate cardiac output. This includes monitoring vital signs including blood pressure, pulse, and oxygen saturation, as well as noting any skin pallor, shortness of breath, and changes in level of consciousness. The nurse will also need to note subjective data from the client, like feelings of dizziness or anxiety.
A client has gone into ventricular fibrillation. Two nurses run into the room and one nurse tries unsuccessfully to find a pulse. The other nurse immediatelybegins CPR while the firstnurse calls a code and grabs the ambu bag. What is the mostimportant aspect of this attempted resuscitation? Immediate advanced airway placement Obtaining a STAT 12-lead ECG Initiating a hypothermia protocol as soon as ROSC is obtained Minimizing interruptions for effective compressions
Minimizing interruptions for effective compressions The most crucial aspect of resuscitation is quality compressions with minimal interruptions. It takes several compressions for blood to circulate throughout the body, and stopping compressions greatly compromises this cycle.
The student nurse is attempting to identify the characteristics of 2nd degree AV heart block type 1 and would be correct in stating that this rhythm has other names which would be which of the following? Select all that apply. Mobitz II Hays Third degree heart block Wenckebach Mobitz I
Mobitz I & Wenckebach Thes are other names for 2nd degree AV heart block type 1.
Which of the following characteristics of a client's EKG strip would most likely lead the nurse to suspect a 3rd degree heart block? No P:QRS ratio Regular R-R interval Regular P-P interval Heart rate of 50 bpm
No P:QRS ratio One defining characteristic of a 3rd degree heart block is the lack of relationship between the atrial and ventricular contractions. When there is no P:QRS ratio, there is no relationship between the P wave and the QRS complex.
The student nurse is discussing ventricular fibrillation with their nursing instructor, the student nurse needs further teaching after which of the following statements about ventricular fibrillation (V-fib) is made? Not a shockable rhythm Requires CPR When a client is in cardiac arrest Shock immediately
Not a shockable rhythm This statement requires further teaching, ventricular fibrillation is a shockable rhythm.
A nurse is observing the rhythms of multiple clients on the unit and knows that which of the following characteristics are present in a 1st degree AV heart block? Prolonged QRS complex PR interval greater than 0.2 seconds Dropped QRS complexes Absence of P waves
PR interval greater than 0.2 seconds In a 1st degree AV block, the PR interval is greater than 0.20 seconds. All other parts of the EKG strip are normal, and the client expected to be asymptomatic.
A student nurse is explaining preventricular contractions (PVCs) to their client. Which of the following statements by the student nurse would need further teaching by the nurse? Frequent PVCs can lead to Ventricular tachycardia PVCs are normal PVCs originate in the ventricles PVCs originate in the atria
PVCs originate in the atria This statement needs further teaching because premature ventricular contractions are caused from an abnormal electrical stimulus in the ventricles not the atria
A nurse is explaining to a student why a 2nd degree AV heart block type 2 is an important rhythm and why a nurse must act rapidly. Which of the following would the nurse be correct in saying about 2nd degree AV heart block type 2? The client is about to go into ventricular tachycardia The client will soon die from V-Fib The client is in cardiac arrest Predisposes a person to third degree AV heart block
Predisposes a person to third degree AV heart block A 2nd degree AV heart block type 2 predisposes a person to Third degree AV heart block
A nurse enters the room of a client and notices supraventricular tachycardia (SVT) on the telemetry monitor. After assessing the client, it is determined the client is unstable and symptomatic with a blood pressure of 60/40, altered level of consciousness, and a heart rate of 245 bpm. Which of the following should the nurse do first? Prepare for synchronized cardioversion Administer a beta blocker Administer atropine Continue to monitor
Prepare for synchronized cardioversion The nurse must follow ACLS guidelines and deliver a synchronized cardioversion since the client is unstable
A nurse is working on a telemetry unit and notices a client in 2nd degree AV heart block type 2 and knows that which of the following is the priority nursing intervention? Prepare the client for a temporary or permanent pacemaker Prepare to defibrillate the client Administer amiodarone 150 mg IV Administer adenosine IV asap
Prepare the client for a temporary or permanent pacemaker This is the priority nursing intervention when recognizing this rhythm after notifying the healthcare provider.
The telemetry nurse is reviewing a rhythm strip for a client with a 2nd degree type II heart block. The nurse notes a QRS complex of 0.16 seconds, no measurable PR interval, and a regular R to R and P to P interval. There is not a 1:1 ratio of QRS:P. The nurse assesses the client and determines the client is responsive but dizzy with a pulse rate of 50 bpm. Which action by the nurse is most appropriate? Continue to monitor Call a code blue Have the client perform a vagal maneuver Prepare the client for pacemaker insertion
Prepare the client for pacemaker insertion This client's rhythm has deteriorated from a 2nd degree heart block to a complete heart block. This is a medical emergency, and the client requires pacing. The nurse will prepare the client for pacemaker insertion, and possibly temporary pacing until a permanent pacer can be placed.
A student nurse is reviewing the characteristics of supraventricular tachycardia (SVT) and knows that which of the following are some of the characteristics? Select all that apply. Prolonged QRS Regular rhythm QRS less than 0.12 seconds Irregular rhythm Heart rate greater than 300 beats per minute
Regular rhythm QRS less than 0.12 seconds
A new nurse notices what appears to be ventricular fibrillation (V-fib) on the monitor and quickly enters the client's room to find the client sitting on the side of the bed talking. After the nurse checks the pulse and determines the client has a regular pulse of 85 beats per minute the nurse should do which of the following next? Call a code Reposition the leads and recheck the rhythm Defibrillate the client Start CPR
Reposition the leads and recheck the rhythm It may be an artifact, after determining the client is stable with a pulse, leads should be repositioned and the rhythm rechecked
Four clients in the emergency room are having chest pain. The nurse knows that which of the following accompanying chest pain would be the most concerning? Supraventricular tachycardia, BP 92/48 A seat belt sign, RR 22 Shortness of breath, SpO2 92% Atrial fibrillation, HR 96
Supraventricular tachycardia, BP 92/48 A client with supraventricular tachycardia (SVT) and chest pain is urgent because the chest pain indicates that the coronary arteries are not perfusing properly. This is the main concern with extremely fast heart rates like SVT, the heart perfuses itself during diastole - but with a high rate, the diastole period is extremely short and risks decreasing coronary perfusion. Even more concerning is the slight hypotension accompanying this rhythm. This client needs to be converted back to a sinus rhythm as soon as possible to prevent an MI or cardiac arrest.
A nurse is observing the rhythm of a client in 1st degree AV block and is explaining to a student nurse the reason for the delay, which is which of the following? The AV node delays the response to the ventricles The sinus node is firing at a slower rate The purkinje fibers are delaying the conduction The AV node is sending less signals to the ventricles
The AV node delays the response to the ventricles The AV node is delaying the impulse.
A client is in ventricular fibrillation. The nurse understands that which of the following is true of ventricular fibrillation? Select all that apply. The nurse must start CPR immediately The client experiences heart palpitations The client has no cardiac output The nurse must call for a stat EKG The ventricle rate is >160 beats per minute
The client has no cardiac output The nurse must start CPR immediately Ventricular fibrillation is a life-threatening medical emergency. The ventricles are quivering, not beating. The client has no cardiac output, and death is imminent without immediate medical intervention. Following ACLS guidelines, the nurse would check for a pulse, call for help and begin CPR right away. Early defibrillation is the only chance the client will have to get a normal sinus rhythm back.
A student nurse is reviewing 3rd degree heart blocks with the preceptor. The student is correct when stating which of the following regarding a 3rd degree heart block? The electrical impulse is delayed at the AV node, so the ventricles suddenly drop a beat, then beat with a normal PR interval on the next cycle. The electrical impulse is slowed, resulting in a pulse rate of less than 60 beats per minute. The electrical impulse is occasionally prevented from traveling to the ventricles, resulting in an occasional dropped QRS. The electrical impulse is prevented from traveling to the ventricles, so the ventricles take over with their own slow rate.
The electrical impulse is prevented from traveling to the ventricles, so the ventricles take over with their own slow rate. A 3rd degree heart block can mean that an escape rhythm comes from the AV node, the bundle of His, or the bundle branches. If the block is below the AV node, the ventricles take over with their own rate of 20-40 beats per minute.
A student nurse is explaining ventricular tachycardia to a group of students. The nurse is correct in stating which of the following? The ventricles are contracting too slow to produce an adequate cardiac output There are multiple disorganized firing in the atria The atria are contracting too slow to produce an adequate cardiac output There are multiple disorganized firing in the ventricles
There are multiple disorganized firing in the ventricles The extra electrical impulses are initiated in the ventricles and begin firing at a rapid rate - causing ventricular tachycardia.
The nurse is precepting a new graduate nurse on the telemetry floor. Which of the following statements by the new graduate nurse most correctly describes appropriate management of a 3rd degree heart block? This heart rhythm causes decreased cardiac output, and the client needs a pacemaker This heart rhythm can quickly progress to a medical emergency, so the client must wear a heart monitor at all times This client must be closely monitored for shortness of breath and chest pain, at which point oxygen must be given This client has no cardiac output, and the nurse must call a code
This heart rhythm causes decreased cardiac output, and the client needs a pacemaker The only way to correct this heart rhythm is pacemaker placement. Management includes immediate preparation for pacemaker placement, with potential temporary external pacing if needed.
The nurse places a client on the cardiac monitor and observes the heart rhythm. Which rhythm requires the most urgent intervention? Ventricular tachycardia Trigeminy Bigeminy Atrial fibrillation
Ventricular tachycardia Ventricular tachycardia (V-tach) is a life-threatening arrhythmia. The nurse will need to take immediate action to first assess whether a pulse is present. If there is a pulse, interventions include amiodarone IV, mag sulfate IV, synchronized cardioversion. If there is no pulse, CPR is initiated and the client will need defibrillation.
A nurse is attempting to determine if their client is having premature ventricular contractions (PVCs) and knows that which of the following are characteristics of PVCs? Select all that apply. PR interval is not measurable during PVC Normal QRS complex Normal PR interval during PVC Wide QRS complex Normal P:QRS ratio during PVC
Wide QRS complex PR interval is not measurable during PVC The PR interval is not measured during a PVC because there are no P waves. During a PVC the QRS complex is wider.
