NU310 (prepU: arrhythmias and conduction problems)
The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? A) Hypovolemia B) Hypokalemia C) Alkalosis D) Bradycardia
B) Hypokalemia
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? A) Pacer rate B) Model number C) Location of the generator D) Date and time of insertion
A) Pacer rate
Which is not a likely origination point for cardiac arrhythmias? A) bundle of His B) atrioventricular node C) atria D) ventricles
A) bundle of His
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? A) Antihypertensive B) Anticoagulant C) Potassium supplement D) Diuretic
B) Anticoagulant
A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? A) Mace procedure B) Elective electrical cardioversion C) Chemical cardioversion D) Elective electrical defibrillation
B) Elective electrical cardioversion
A client scheduled for a catheter ablation procedure confides to the nurse that he is worried about having some of his heart cells destroyed. The best response by the nurse is which of the following? A) "Everything will turn out fine; do not worry about your heart cells." B) "Only the specific cells causing your dysrhythmia are destroyed; your heart will function better without these cells." C) "Don't worry. All resuscitation equipment is kept nearby when these procedures are being done." D) "The doctor knows best; just let her worry about which heart cells to destroy."
B) "Only the specific cells causing your dysrhythmia are destroyed; your heart will function better without these cells."
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? A) Quality of the pulse B) "Spike" on the rhythm strip C) Scar on the chest D) Vibration under the skin
B) "Spike" on the rhythm strip
The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation? A) The client is sedated before the procedure. B) It is used to eliminate ventricular arrhythmias. C) It uses less electrical energy than cardioversion. D) It is a scheduled procedure 1 to 10 days in advance.
B) It is used to eliminate ventricular arrhythmias.
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? A) T wave B) P wave C) QRS complex D) PR interval
B) P wave
The nurse is proving discharge instructions for a client with a new arrhythmia. Which statement should the nurse include? A) It is not necessary to learn how to take your own pulse. B) Your family and friends may want to take a CPR class. C) If you miss a dose of your antiarrhythmic medication, double up on the next dose. D) Do not be concerned if you experience symptoms of lightheadedness and dizziness.
B) Your family and friends may want to take a CPR class.
A client's electrocardiogram reveals an irregular rhythm of 75 bpm with a normal QRS and P wave. The nurse who is caring for the client should anticipate: A) a bolus of warmed normal saline. B) no immediate treatment. C) administration of a beta-adrenergic blocker. D) administration of epinephrine.
B) no immediate treatment.
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as A) sinus tachycardia. B) normal sinus rhythm. C) first-degree atrioventricular block. D) junctional tachycardia.
B) normal sinus rhythm.
The nurse knows that what PR interval presents a first-degree heart block? A) 0.16 seconds B) 0.18 seconds C) 0.24 seconds D) 0.14 seconds
C) 0.24 seconds
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? A) Premature ventricular contraction B) Ventricular fibrillation C) Atrial flutter D) Asystole
C) Atrial flutter
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? A) Ventricular fibrillation B) Atrial fibrillation C) Atrial flutter D) Ventricular tachycardia
C) Atrial flutter
A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? A) "If I take my metoprolol daily, I will be able to control my heart rate." B) "I will cut back on my smoking and drinking alcohol." C) "I will take my levothyroxine daily." D) "I will drink coffee with only two of my meals."
D) "I will drink coffee with only two of my meals."
The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? A) "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width." B) "The two look very much alike; it is difficult to tell the difference." C) "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal." D) "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."
D) "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."
The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? A) Send the client to the cardiac catheterization laboratory. B) Review the client's medication record. C) Prepare to client for cardioversion. D) Administer an IV bolus of atropine.
D) Administer an IV bolus of atropine.
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? A) Potassium supplement B) Antihypertensive C) Diuretic D) Anticoagulant
D) Anticoagulant
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? A) Ventricular repolarization B) Ventricular depolarization C) Early ventricular repolarization D) Atrial depolarization
D) Atrial depolarization
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? A) Normal PR interval B) Regular rhythm C) P wave resent before each QRS D) Atrial rate of 300 to 400
D) Atrial rate of 300 to 400
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? A) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute B) The registered nurse stating to administer all medications except those which are cardiotonics C) The registered nurse stating to administer digoxin D) The registered nurse administering atropine sulfate intravenously
D) The registered nurse administering atropine sulfate intravenously
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first? A) Atrial fibrillation B) Sustained asystole C) Supraventricular tachycardia D) Ventricular fibrillation
D) Ventricular fibrillation
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? A) Atropine B) Adenosine C) Amiodarone D) Warfarin
D) Warfarin
The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? A) "We will be getting rid of our microwave oven so it will not affect my pacemaker." B) "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." C) "I will avoid any large magnets that may affect my pacemaker." D) "I will call the doctor if my incision becomes swollen and red."
A) "We will be getting rid of our microwave oven so it will not affect my pacemaker."
The nurse is providing teaching to a client with an implanted cardiac device. Which client statement indicates that teaching has been effective? A) "I will not place my cell phone in my chest pocket." B) "I will not be able to fly with a pacemaker." C) "I can safely have an MRI in the future if I need one." D) "I will stop using the microwave oven."
A) "I will not place my cell phone in my chest pocket."
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? A) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." B) "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." C) "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." D) "You should avoid tennis; basketball or football would be a good substitute."
A) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as A) 90 bpm. B) 70 bpm. C) 100 bpm. D) 80 bpm.
A) 90 bpm.
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? A) Atrial flutter B) Ventricular tachycardia C) Atrial fibrillation D) Ventricular fibrillation
A) Atrial flutter
The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? A) Avoid undergoing magnetic resonance imaging (MRI). B) Never engage in activities that require vigorous arm and shoulder movement. C) Avoid going through airport metal detectors. D) Stay at least 5 feet away from microwave ovens.
A) Avoid undergoing magnetic resonance imaging (MRI).
The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation? A) It is used to eliminate ventricular arrhythmias. B) It uses less electrical energy than cardioversion. C) The client is sedated before the procedure. D) It is a scheduled procedure 1 to 10 days in advance.
A) It is used to eliminate ventricular arrhythmias.
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? A) Lead wire dislodgement B) Sensitivity is too low C) Fracture of the lead wire D) Faulty generator
A) Lead wire dislodgement
A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? A) Obtain a 12-lead ECG and a portable chest x-ray B) Reposition the extremity and turn the client to left side C) Document the findings and continue to monitor the client D) Check the security of all connections and increase the milliamperage
C) Document the findings and continue to monitor the client
The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation? A) It is a scheduled procedure 1 to 10 days in advance. B) The client is sedated before the procedure. C) It is used to eliminate ventricular arrhythmias. D) It uses less electrical energy than cardioversion.
C) It is used to eliminate ventricular arrhythmias.
The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse's pressing the discharge button? A) Checking the ECG rhythm B) Placing gel on the chest C) Shouting "Clear!" D) Stating "Charging."
C) Shouting "Clear!"
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? A) The importance of taking the medication 1 hour before or 2 hours after a meal B) The need to sit upright for 30 minutes after taking the medication C) The need to have regular blood levels drawn D) The importance of adequate fluid intake
C) The need to have regular blood levels drawn
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? A) assessing blood pressure and heart rate frequently B) identifying a code-level status C) alerting the healthcare provider of the third-degree heart block D) maintaining intravenous fluids
C) alerting the healthcare provider of the third-degree heart block
A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardiogram as an indicator of sinus tachycardia? A) QRS duration of 0.16 seconds B) PR interval of 0.1 seconds C) heart rate of 118 bpm D) Q wave of 0.04 seconds
C) heart rate of 118 bpm
A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? A) Administer intravenous epinephrine B) Prepare for endotracheal intubation C) Provide electrical cardioversion D) Begin cardiopulmonary resuscitation
D) Begin cardiopulmonary resuscitation
A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? A) Clients with recurrent life-threatening bradycardias B) Clients with sinus tachycardia C) Clients with ventricular bradycardia D) Clients with recurrent life-threatening tachydysrhythmias
D) Clients with recurrent life-threatening tachydysrhythmias
The nurse recognizes which as being true of cardioversion? A) Defibrillator should be set to deliver a shock during the QRS complex. B) Electrical impulse can be discharged during the T wave. C) Amount of voltage used should exceed 400 watts/second. D) Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.
D) Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.
The nurse assesses a client returning from the post anesthesia unit with a new onset of sinus tachycardia with a heart rate of 138 beats per minute and a blood pressure of 128/80mmHg after elevating the head of the bed. What intervention does the nurse consider? A) Removing anti-embolism stockings B) Assessing blood glucose level C) Decreasing intravenous fluids D) Evaluating laboratory values
D) Evaluating laboratory values