PATHO Module 5 Chapter 28: Disorders of Cardiac Conduction and Rhythm

A client who will be undergoing a Holter monitor examination would be given which instruction?

"Keep a diary of your activities and symptoms throughout the examination."

When explaining a new diagnosis of complete heart block to a client and family, the nurse should include which statement?

"One consequence of this type of block is a very slow heart rate that limits circulation to the brain."

The nurse is caring for a woman who just delivered a healthy 7-pound baby 8 hours ago and is experiencing episodes of palpitations, heart rate is fluctuating between 90 and 120, blood pressure is 100/70. The client is questioning the nurse about her palpitations. What would be the most accurate response?

Palpitations are sometimes felt with fast heart rates and are often nonpathological.

A client presents with uncharacteristic chest pain, and his ECG reveals T-wave elevation. This finding suggests an abnormality with which aspect of the cardiac cycle?

Ventricular repolarization

Which client will the nurse prioritize to assess first?

client with sinus arrest

A new intensive care unit nurse is taking a cardiac dysrhythmia course in preparation for working in the unit. Which abnormality could cause a client to develop sinus arrest rhythm? Select all that apply.

1. Acute bacterial myocarditis 2. K+ greater than 6 3. K+ less than 3

A client with a medical history of idiopathic cardiomyopathy is undergoing placement of an automatic implantable cardioverter defibrillator (AICD) due to episodes of non-sustained ventricular tachycardia (V-tach). When the nurse attaches the cardiac monitor, the presenting rhythm is V-tach by verifying which components on ECG? Select all that apply.

1. Heart rate of 80 2. Monomorphic QRS complexes 3. QRS complexes > 0.14 seconds

Which statement describes phase 4 of the action potential of cells in the sinoatrial (SA) node?

A slow depolarization occurs because of the particular permeability of the cellular membranes.

A client has been diagnosed with atrial flutter. Which assessment finding correlates with this diagnosis?

An atrial heart rate above 240 beats/min

The purpose of a cardioversion device is the treatment of which cardiac disorder?

Atrial fibrillation

Paroxysmal supraventricular tachycardia arises from which form of reentry?

Atrioventricular (AV) nodal

Which cardiac drug classification decreases sympathetic outflow to the heart and is the is the cornerstone of therapy for catecholaminergic polymorphic ventricular tachycardia (CPVT)?

Beta-adrenergic blockers

Which antiarrhythmic medication works by blunting the effect of sympathetic nervous system stimulation on the heart?

Beta-blockers, such as metoprolol

The nurse is caring for a client who suffered a massive myocardial infarction and is scheduled for an immediate permanent pacemaker insertion due to severe ischemia and damage to both SA and AV nodes. The nurse would expect which of the following?

Bradycardia with rate of 20-40

A client's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The client is unconscious and without a pulse. Which priority intervention should the nurse take?

Defibrillate the client

The nurse is assisting a client who had a myocardial infarction 2 days ago during a bath. The client suddenly lost consciousness and the nurse was unable to feel a pulse. Cardiopulmonary resuscitation was begun and the client was connected to the monitor with a gross disorganization without identifiable waveforms or intervals observed. What is a priority intervention at this time?

Immediate defibrillation

Nursing students who are studying for their upcoming cardiac exam are discussing how the heart could possibly continue to beat once removed from the body. One of the students explains that this phenomenon is directly related to automaticity. What is automaticity?

Inherent spontaneous action-potential

A nurse is monitoring a client with sick sinus syndrome who is experiencing lightheadedness, dizziness, and syncope. Which treatment will the nurse anticipate for this client?

Insertion of a pacemaker

Respiratory sinus dysrhythmia is considered a more optimal rhythm than a rhythm where all RR intervals are equal. In respiratory sinus dysrhythmia, what is the variation in cardiac cycles related to?

Intrathoracic pressure changes that occur with respiration

When a client has a recurrent, life-threatening arrhythmia originating either supraventricularly or ventricularly, ablation therapy is an option for treatment. What does ablation therapy do?

Isolates and destroys arrhythmogenic cardiac tissue

A client is scheduled to have a Holter monitor for 48 hours to detect disturbances in conduction. Which action is important for the nurse to tell the client to ensure accuracy in correlating dysrhythmias with symptoms?

It is important to keep a diary of activities and symptoms.

A 28-year-old client is admitted to the hospital for severe dehydration following a marathon, with fatigue the only complaint. Admission vital signs include a heart rate of 38, blood pressure 98/60, RR 16. Cardiac monitor reveals regular QRS complexes preceded by normal P waves. Which of the following does the nurse determine is the most likely cause for the bradycardia?

Large stroke volume

A nurse notes that the PR interval on a client's electrocardiogram tracing is 0.22 seconds. Which action should the nurse take?

Monitor the client and document the findings.

ECG monitoring has been found to be more sensitive than a client's report of symptoms when identifying transient ongoing myocardial ischemia. Why is this?

Most ECG-detected ischemic events are clinically silent.

Considering the PQRST complex of an electrocardiogram (ECG), which letter designation represents atrial depolarization?

P wave

The nurse assesses the electrocardiogram for depolarization of the atria. What portion of the ECG will the nurse be assessing?

P wave above the baseline

The nurse is evaluating a client with cardiac problems and notes that the client's peripheral pulse is different than the apical pulse. To which physiologic response would the nurse attribute the difference in rates?

Premature beats not following normal conduction pathways

The nurse is interpreting an electrocardiogram of a 65-year-old woman. Which should the nurse recognize as representing ventricular depolarization?

QRS complex

A 28-year-old marathon runner comes to the clinic to obtain a physical exam for a new job. The nurse assesses a regular pulse rate of 52 beats per minute (bpm). Which common dysrhythmia is the nurse aware this client most likely has related to maintaining a large stroke volume?

Sinus bradycardia

A client with supraventricular tachycardia has received a dose of verapamil to slow the heart rate. Which explanation describes the effect of this drug on the heart?

Slows the sinoatrial (SA) node pacemaker and inhibits conduction in the atrioventricular (AV) node

In which atrioventricular (AV) conduction disorder does the link between the atria and ventricles get lost, resulting in atrial and ventricular depolarization being controlled by separate pacemakers?

Third-degree AV block

Which type of pacing involves the placement of large patch electrodes on the anterior and posterior chest wall that can be connected by a cable to an external pulse generator?

Transcutaneous

A client with a 2-week history of hyperthyroidism due to a virus is admitted for nonemergent cardioversion. The client states that she has been experiencing intermittent episodes of palpitations over the past week along with shortness of breath and fatigue. The nurse attaches the client to a cardiac monitor and notes that the client is in normal sinus rhythm with frequent episodes of atrial fibrillation. The nurse anticipates which of the following to be ordered prior to the cardioversion to avoid a possible stroke?

Transesophageal echocardiography

Which class of cardiac antiarrhythmic drugs extends the action potential and refractoriness of the heart's contraction?

class III

A college student is in pre-op area prior to knee surgery. The nurse attaches the cardiac monitor and notes a gradual lengthening and shortening between the R waves. The nurse realizes that this rhythm is most often found in people with healthy hearts. This rhythm is a respiratory:

sinus dysrhythmia.

A client experiencing a sinus arrest would demonstrate which symptom or finding?

Prolonged periods of asystole demonstrated on an electrocardiogram

A group of nursing students is discussing ventricular dysrhythmias and one student is unsure why a client with frequent premature ventricular complexes (PVCs) has an irregular radial pulse. One of the other students explains that premature ventricular complexes often do not produce a palpable pulse due to:

decreased ventricular filling time.

An 80-year-old male client arrives for his yearly physical without any complaints, and following the checkup the physician explains that he has noted atrial fibrillation (AF) on the client's ECG. Before the physician can explain the disorder, the client becomes very upset and states he thinks he is going to die. The physician explains that atrial fibrillation involves the top chambers of the heart and that:

many people live with atrial fibrillation without even knowing they have it.

A client arrives at the emergency room with dizziness and a near syncopal episode. Vital signs include a heart rate of 46 beats/min and blood pressure of 86/50 mm Hg. The cardiac monitors show regular rhythm as above. The client states the health care provider has been running blood work to rule out hypothyroidism. Based on the rhythm, what does the nurse report the client has?

symptomatic bradyarrhythmia