Ch 35 - Dysrhythmias - MedSurg Nursing
the ECG pattern of a patient with a regular HR reveals 20 small squares between each R-R interval. what is the patient's heart rate?
75bpm
a patient with a regular heart rate has four QRS complexes between every 3-second marker on the ECG paper. calculate the patient's heart rate
80bpm
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. Teaching for this patient would include information about a. anticoagulant therapy. b. permanent pacemakers. c. emergency cardioversion. d. IV adenosine (Adenocard).
ANS: A Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria. Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information does not indicate that the patient has a slow heart rate. DIF: Cognitive Level: Apply (application) REF: 766
After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the drug has been effective? a. Increase in the patient's heart rate b. Increase in strength of peripheral pulses c. Decrease in premature atrial contractions d. Decrease in premature ventricular contractions
ANS: A Atropine will increase the heart rate and conduction through the AV node. Because the drug increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The patient does not have premature atrial or ventricular contractions. DIF: Cognitive Level: Apply (application) REF: 763
Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin? a. Explain the association between dysrhythmias and syncope. b. Instruct the patient to call for assistance before getting out of bed. c. Teach the patient about the need to avoid caffeine and other stimulants. d. Tell the patient about the benefits of implantable cardioverter-defibrillators.
ANS: B A patient with fainting episodes is at risk for falls. The nurse will plan to minimize the risk by having assistance whenever the patient is up. The other actions may be needed if dysrhythmias are found to be the cause of the patient's syncope but are not appropriate for syncope of unknown origin. DIF: Cognitive Level: Apply (application) REF: 777
A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a. notify the health care provider immediately. b. document the finding and monitor the patient. c. give atropine per agency dysrhythmia protocol. d. prepare the patient for temporary pacemaker insertion.
ANS: B First-degree atrioventricular block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary. DIF: Cognitive Level: Apply (application) REF: 767
A patient has ST segment changes that suggest an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient? a. I b. II c. V2 d. V6
ANS: B Leads II, III, and AVF reflect the inferior area of the heart and the ST segment changes. Lead II will best capture any electrocardiographic changes that indicate further damage to the myocardium. The other leads do not reflect the inferior part of the myocardial wall and will not provide data about further ischemic changes in that area. DIF: Cognitive Level: Analyze (analysis) REF: 758
A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action should the nurse take first? a. Give epinephrine (Adrenalin) IV. b. Perform immediate defibrillation. c. Prepare for endotracheal intubation. d. Ventilate with a bag-valve-mask device.
ANS: B The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, begin chest compressions. The other actions may also be appropriate but not first. DIF: Cognitive Level: Analyze (analysis) REF: 771
Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as telemetry technicians on the cardiac care unit? a. Decide whether a patient's heart rate of 116 requires urgent treatment. b. Observe heart rhythms for multiple patients who have telemetry monitoring. c. Monitor a patient's level of consciousness during synchronized cardioversion. d. Select the best lead for monitoring a patient admitted with acute coronary syndrome.
ANS: B UAP serving as telemetry technicians can monitor heart rhythms for individuals or groups of patients. Nursing actions such as assessment and choice of the most appropriate lead based on ST segment elevation location require RN-level education and scope of practice. DIF: Cognitive Level: Apply (application) REF: 760
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? a. Turn the synchronizer switch to the "off" position. b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device.
ANS: B When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned "on" for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this patient. DIF: Cognitive Level: Apply (application) REF: 772
A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/min. a. 15 to 20 b. 20 to 40 c. 40 to 60 d. 60 to 100
ANS: C If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60 beats/minute. The slower rates are typical of the bundle of His and Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60 to 100 beats/min. DIF: Cognitive Level: Understand (comprehension) REF: 760
Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter? a. The procedure prevents or minimizes the risk for sudden cardiac death. b. The procedure uses cold therapy to stop the formation of the flutter waves. c. The procedure uses electrical energy to destroy areas of the conduction system. d. The procedure stimulates the growth of new conduction pathways between the atria.
ANS: C Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and tachydysrhythmias. All other statements regarding the procedure are incorrect. DIF: Cognitive Level: Apply (application) REF: 765
A patient reports dizziness and shortness of breath for several days. During heart monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as a. junctional escape rhythm. b. accelerated idioventricular rhythm. c. third-degree atrioventricular (AV) block. d. sinus rhythm with premature atrial contractions (PACs).
ANS: C The inconsistency between the atrial and ventricular rates and the variable PR interval indicate that the rhythm is third-degree AV block. Sinus rhythm with PACs will have a normal rate and consistent PR intervals with occasional PACs. An accelerated idioventricular rhythm will not have visible P waves. DIF: Cognitive Level: Apply (application) REF: 768
A patient's heart monitor shows sinus rhythm, rate 64. The PR 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? a. Place the transcutaneous pacemaker pads on the patient. b. Give atropine sulfate 1 mg IV per agency dysrhythmia protocol. c. Call the health care provider before giving scheduled metoprolol (Lopressor). d. Document the patient's rhythm and assess the patient's response to the rhythm.
ANS: C The patient has progressive first-degree atrioventricular (AV) block, and the -blocker should be held until discussing the drug with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic. DIF: Cognitive Level: Analyze (analysis) REF: 767
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? a. Prepare to perform electrical cardioversion. b. Have the patient perform the Valsalva maneuver. c. Obtain the patient's vital signs including O2 saturation. d. Prepare to give a -blocker medication to slow the heart rate.
ANS: C The patient has sinus tachycardia, which may have multiple etiologies such as pain, dehydration, anxiety, and myocardial ischemia. Further assessment is needed before determining the treatment. Vagal stimulation or -blockade may be used after further assessment of the patient. Electrical cardioversion is used for some tachydysrhythmias but would not be used for sinus tachycardia. DIF: Cognitive Level: Analyze (analysis) REF: 763
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 teaching about the care of patients with ICDs? a. The nurse administers amiodarone (Cordarone) to the patient. b. The nurse helps the patient fill out the application for obtaining a Medic Alert device. c. The nurse encourages the patient to do active range of motion exercises for all extremities. d. The nurse teaches the patient that sexual activity can be resumed when the incision is healed
ANS: C The patient should avoid moving the arm on the ICD insertion site until healing has occurred to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient. DIF: Cognitive Level: Apply (application) REF: 772
The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next and divide into 1500.
ANS: C 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. DIF: Cognitive Level: Analyze (analysis) REF: 759
When analyzing the rhythm of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n) a. isoelectric ST segment. b. PR interval of 0.18 second. c. QT interval of 0.38 second. d. QRS interval of 0.14 second.
ANS: D Because the normal QRS interval is less than 0.12 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The PR interval and QT interval are within normal range and ST segment should be isoelectric (flat). DIF: Cognitive Level: Apply (application) REF: 761
Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose of 243 mg/dL b. Serum chloride of 92 mEq/L c. Serum sodium of 134 mEq/L d. Serum potassium of 2.9 mEq/L
ANS: D Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values are also abnormal, they are not likely to be the etiology of the patient's PVCs and do not require immediate correction. DIF: Cognitive Level: Analyze (analysis) REF: 768
To determine whether there is a delay in impulse conduction through the ventricles, the nurse will measure the duration of the patient's a. P wave. b. Q wave. c. PR interval. d. QRS complex.
ANS: D The QRS complex represents ventricular depolarization. The P wave represents the depolarization of the atria. The PR interval represents depolarization of the atria, atrioventricular node, bundle of His, bundle branches, and the Purkinje fibers. The Q wave is the first negative deflection following the P wave and should be narrow and short. DIF: Cognitive Level: Understand (comprehension) REF: 759
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 with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin (Coumadin) due b. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating c. A patient who is in a sinus rhythm, rate 98 and regular, recovering from an elective cardioversion 2 hours ago d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone (Cordarone) due
ANS: D The frequent firing of the ICD indicates that the patient's ventricles are very irritable and the priority is to assess the patient and give the amiodarone. The other patients can be seen after the amiodarone is given. DIF: Cognitive Level: Analyze (analysis) REF: 773
A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which action should the nurse take next? a. Recheck the heart rhythm and BP in 5 minutes. b. Have the patient perform the Valsalva maneuver. c. Give the scheduled dose of diltiazem (Cardizem). d. Apply the transcutaneous pacemaker (TCP) pads.
ANS: D The patient is experiencing symptomatic bradycardia and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate and the diltiazem should be held. The Valsalva maneuver will further decrease the rate. DIF: Cognitive Level: Apply (application) REF: 775
a patient on the cardiac telemetry unit goes into ventricular fibrillation and is unresponsive. following initiation of the emergency call system (code blue), what is the next priority for the nurse in caring for this patient? a. begin cpr b. get the crash cart c. administer amiodarone IV d. defibrillate with 360 joules
ans: a
a patient with no history of heart disease has a rhythm strip that shows an occasional distorted P wave followed by normal AV and ventricular conduction. about what should the nurse question the patient? a. the use of caffeine b. the use of sedatives c. any aerobic training d. holding of breath during exertion
ans: a
a patient's rhythm strip indicates a normal HR and rhythm with normal P waves and QRS complexes, but the PR interval is 0.26 sec. what is the most appropriate action by the nurse? a. continue to assess the patient b. administer atropine per protocol c. prepare the patient for synchronized cardioversion d. prepare the patient for placement of a temporary pacemaker
ans: a
what action is included in the nurse's responsibilities in preparing to administer defribrillation? a. applying gel pads to the patient's chest b. setting the defibrillator to deliver 50 joules c. setting the defibrillator to a synchronized mode d. sedating the patient with midazolam before defribrillation
ans: a
a patient with an acute myocardial infarction (MI) develops the following ECG pattern: atrial rate of 82 and regular; ventricular rate of 46 and regular; P wave and QRS complex are normal but there is no relationship between the P wave and the QRS complex. what dysrhythmia does the nurse identify this as and what treatment is expected? a. sinus bradycardia treated with atropine b. third-degree heart block treated with a pacemaker c. atrial fibrillation treated with electrical cardioversion d. type I second-degree AV block treated with observation
ans: b
in the patient with a dysrhythmia, which assessment indicates decreased cardiac output? a. hypertension and bradycardia b. chest pain and decreased mentation c. abdominal distension and hepatomegaly d. bounding pulses and a ventricular heave
ans: b
what describes the refractory phase? a. abnormal electrical impulses b. period in which heart tissue cannot be stimulated c. areas of the heart do not repolarize at the same rate because of depressed conduction d. sodium migrates rapidly into the cell, so it is positive compared to the outside of the cell
ans: b
which rhythm abnormality has an increased risk of ventricular tachycardia and ventricular fibrillation? a. PAC b. PVC on the T wave c. accelerated idioventricular rhythm d. premature ventricular contraction (PVC) couplet
ans: b
while providing discharge instructions to the patient who has had an implantable cardioverter-defribrillator (ICD) inserted, the nurse teaches the patient that if the ICD fires, it is important that he or she should do what? a. lie down b. call the cardiologist c. push the reset button on the pulse generator d. immediately take his or her antidysrhythmic meds
ans: b
a patient with chest pain that is unrelieved by nitroglycerin is admitted to the coronary care unit for observation and diagnosis. while the patient has continuous ECG monitoring, what finding would most concern the nurse? a. occasional PVCs b. QRS complex change c. ST segment elevation d. a PR interval of 0.18 second
ans: c
the nurse is evaluating the telemetry ECG rhythm strip. how should the nurse document the distorted P wave causing an irregular rhythm? a. atrial flutter b. sinus bradycardia c. premature atrial contraction (PAC) d. paroxysmal supraventricular tachycardia (PSVT)
ans: c
the use of radiofrequency catheter ablation therapy to "burn" areas of the cardiac conductionsystem is indicated for the treatment of a. sinus arrest b. heart blocks c. tachydysrhythmias d. premature ventricular beats
ans: c
the patient is brought to the emergency department with acute coronary syndrome (ACS). what changes should the nurse expect to see on the ECG if only myocardial injury has occurred? a. absent P wave b. a wide QT interval c. tall, peaked T wave d. ST-segment elevation
ans: d
the patient's PR interval comprises six small boxes on the ECG graph. what does the nurse determine that this indicates? a. a normal finding b. a problem with ventricular depolarization c. a disturbance in the repolarization of the atria d. a problem with conduction from the SA node to the ventricular cells
ans: d
what describes the SA node's ability to discharge an electrical impulse spontaneously? a. excitability b. contractility c. conductivity d. automaticity
ans: d
A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54 mm Hg, and the student denies any health problems. What action by the nurse is most appropriate? a. Allow the student to participate on the soccer team. b. Refer the student to a cardiologist for further testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the student's family health history.
ANS: A In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the family's health history. Dyspnea during an aerobic activity such as soccer is normal. DIF: Cognitive Level: Apply (application) REF: 763
Which action by a new registered nurse (RN) who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias? a. Prepares defibrillator settings at 360 joules for a patient whose monitor shows asystole. b. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia c. Turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation d. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second degree AV block
ANS: B Adenosine must be given over 1 to 2 seconds to be effective. The other actions indicate a need for more teaching about treatment of heart dysrhythmias. The RN should hold the diltiazem until discussing it with the health care provider. The treatment for asystole is immediate CPR. The synchronizer switch should be "off" when defibrillating. DIF: Cognitive Level: Analyze (analysis) REF: 765
A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic, and has no palpable pulses. What action should the nurse take next? a. Perform synchronized cardioversion. b. Start cardiopulmonary resuscitation (CPR). c. Give atropine per agency dysrhythmia protocol. d. Provide supplemental O2 via non-rebreather mask.
ANS: B The patient's clinical manifestations indicate pulseless electrical activity, and the nurse should immediately start CPR. The other actions would not be of benefit to this patient. DIF: Cognitive Level: Apply (application) REF: 763
The nurse notes that a patient's heart 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? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Multifocal premature ventricular contractions
ANS: B Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the premature ventricular contractions are multifocal or that the R-on-T phenomenon is occurring. DIF: Cognitive Level: Apply (application) REF: 768
A patient who is on the telemetry 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? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the patient's vital signs including O2 saturation.
ANS: C Because this patient has dyspnea and chest pain in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by starting with O2 administration. The other actions are also important and should be implemented rapidly. DIF: Cognitive Level: Analyze (analysis) REF: 765 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
A 19-yr-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 unifocal premature ventricular contractions (PVCs). What action should the nurse take next? a. Insert an IV catheter for emergency use. b. Start supplemental O2 at 2 to 3 L/min via nasal cannula. c. Ask the patient about current stress level and caffeine use. d. Have the patient taken to the nearest emergency department (ED).
ANS: C In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. The patient is hemodynamically stable, so there is no indication that the patient needs supplemental O2, an IV, or to be seen in the ED. DIF: Cognitive Level: Apply (application) REF: 768
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/min. Which action should the nurse take next? a. Immediately notify the health care provider. b. Document the rhythm and continue to monitor the patient. c. Prepare to give IV amiodarone per agency dysrhythmia protocol. d. Perform synchronized cardioversion per agency dysrhythmia protocol.
ANS: C 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 should notify the health care provider after the medication is started. Cardioversion is not indicated given that the patient has returned to a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation. DIF: Cognitive Level: Analyze (analysis) REF: 766
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval regular, and QRS complex wide and distorted, and QRS duration of 0.18 second. The nurse interprets the patient's cardiac rhythm as a. atrial flutter. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia
ANS: D The absence of P waves, wide QRS, rate greater than 150 beats/min, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration. DIF: Cognitive Level: Apply (application) REF: 764
The nurse knows that discharge teaching about the management of a new permanent pacemaker has been most effective when the patient states a. "It will be several weeks before I can return to my usual activities." b. "I will avoid cooking with a microwave oven or being near one in use." c. "I will notify the airlines when I make a reservation that I have a pacemaker." d. "I won't lift the arm on the pacemaker side until I see the health care provider."
ANS: D The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period. DIF: Cognitive Level: Apply (application) REF: 775
which rhythm pattern finding is indicative of PVCs a. a QRS complex greater than 0.12 second followed by a P wave b. continuos wide QRS complexes with a ventricular rate of 160bpm c. P waves hidden in QRS complexes with a regular rhythm of 120bpm d. saw-toothed P waves with no measurable PR interval and an irregular rhythm
ans: a
a patient with a sinus node dysfunction has a permanent pacemaker inserted. before discharge, what should the nurse include when teaching the patient? a. avoid cooking with microwave b. avoid standing near antitheft devices in doorways c. use mild analgesics to control the chest spasms caused by the pacing current d. start lifting the arm above the shoulder right away to prevent a "frozen shoulder"
ans: b
a patient with an acute MI is having multifocal PVCs and couplets. he is alert and has a blood pressure (BP) reading of 118/78 mm Hg with an irregular pulse of 86 bpm. what is the priority nursing action at this time? a. continue to assess the patient b. ask the patient to perform valsalva maneuver c. prepare to administer antidysrhythmic drugs per protocol d. be prepared to administer cardiopulmonary resuscitation (CPR)
ans: c
in the patient experiencing ventricular fibrillation (VF), what is the rationale for using cardiac defibrillation? a. enhance repolarization and relaxation of ventricular myocardial cells b. provide electrical impulse that stimulates normal myocardial contractions c. depolarize the cells of the myocardium to allow the SA node to resume pacemaker function d. deliver an electrical impulse to the heart at the time of ventricular contraction to convert the heart to a sinus rhythm
ans: c
what accurately describes electrocardiographic (ECG) monitoring? a. depolarization of the cells in the ventricles produces the T wave on the ECG b.an abnormal cardiac impulse that arises in the atria, ventricles, or atrioventricular (AV) junction can create a premature beat that is known as an artifact c. lead placement for V1 includes one lead each for right arm, right leg, left arm, and left leg with the fifth lead on the fourth intercostal space to the right of the sternal border d. if the sinoatrial (SA) node fails to discharge an impulse or discharges very slowly, a secondary pacemaker in the AV node is able to discharge at a rate of 30 to 40 times per min.
ans: c
a 54yr old patient who has no structural heart disese has an episode of syncope. a head up tilt test is performed to rule out neurocardiogenic syncope. the nurse explains to the patient that if neurocardiogenic syncope is the problem, the patient will experience what? a. no change in HR or BP b. palpitations and dizziness c. tachydysrhythmias and chest pain d. marked bradycardia and hypotension
ans: d
a patient with an acute MI has sinus tachycardia of 126 bpm. the nurse recognizes that if this dysrhythmia is not treated, what is the worst thing the patient is likely to experience? a. hypertension b. escape rhythms c. ventricular tachycardia d. an increase in infarct size
ans: d
after defibrillation, the advanced cardiac life support (ACLS) nurse says that the patient has pulseless electrical activity (PEA). What is most important for the nurse to understand about this rhythm? a. the heart rate is 40 to 60 bpm b. hypoxemia and hypervolemia are common with PEA c. there is dissociated activity of the ventricle and atrium d. there is electrical activity with no mechanical response
ans: d
the nurse plans close monitoring for the patient during electrophysiologic study (EPS) because this study a. requires the use of dyes that irritate the myocardium b. causes myocardial ischemia, resulting in dysrhythmias c. involves the use of anticoagulants to prevent thrombus and embolism d. induces dysrhythmias that may require cardioversion or defibrillation to correct
ans: d
what should the nurse reading the monitor strip call a rhythm with a regular PR interval but a blocked QRS complex? a. asystole b. atrial fibrillation c. first-degree AV block d. type II second-degree AV block
ans: d
what accurately describes the PR interval (select all that apply) a. 0.16 sec b. <0.12 sec c. 0.06 to 0.12 sec d. 0.12 to 0.20 sec e. time of depolarization and repolarization of ventricles f. measured from beginning of P wave to beginning of QRS complex
ans: d, f
