Chapter 26
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
90 bpm.
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?
heart rate of 118 bpm
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?
hypovolemia
A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:
inherent rhythmicity of cardiac muscle tissue.
A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as
Atrial flutter
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?
Atrial flutter
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what?
Atrial rate of 300 to 400
A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings?
Atropine
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia?
Atropine
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?
Clients with recurrent life-threatening tachydysrhythmias
Which dysrhythmia is common in older clients?
Sinus bradycardia
After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension?
Decreased cardiac output and decreased systolic and diastolic blood pressure
The nurse recognizes which as being true of cardioversion?
Defibrillator should be set to deliver a shock during the QRS complex.
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication?
Delayed conduction, producing a prolonged PR interval
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?
Delayed conduction, producing a prolonged PR interval
The nurse analyzes the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The client's ECG strip demonstrates PR intervals that measure 0.24 seconds. What is the nurse's most appropriate action?
Document the findings and continue to monitor the patient
A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?
Double-check the monitoring equipment.
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?
Fluttering
The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia?
Heart rate of 42 beats per minute (bpm).
The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?
Hypokalemia
A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?
Immediate CPR
The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation?
In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output.
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first?
Initiate transcutaneous pacing
The nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhythmias?
Monitor cardiac rhythm continuously.
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?
Pacer rate
Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration?
Paroxysmal atrial tachycardia
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition?
Premature atrial complex
A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next?
Question the client about alcohol and illicit drug use.
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1?
Right side of sternum, fourth intercostal space
An operating room nurse is caring for a client who is having a pacemaker implanted. The health care provider has requested a demand mode pacemaker for this client. What is this type of pacemaker?
Self-activated
The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse's pressing the discharge button?
Shouting "Clear!"
A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?
Sinus tachycardia
A client has a medical diagnosis of an advanced first-degree atrioventricular block and is symptomatic. What initial treatment will the nurse be prepared to complete?
administer an IV bolus of atropine
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?
alerting the healthcare provider of the third-degree heart block
The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer?
atropine sulfate
A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute with a regular interval between 0.12 and 0.20 seconds. What type of dysrhythmia does the client have?
sinus bradycardia
During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during
ventricular depolarization.
The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document?
ventricular tachycardia
A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching?
"I will drink coffee with only two of my meals."
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?
"I'll keep a log of each time my ICD discharges."
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?
"Spike" on the rhythm strip
The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply?
"The only difference is the heart rate."
The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse?
"The rhythm has a normal beat, then a premature beat pattern."
A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse?
"The small box will transmit the heart rhythm to the central monitor all the time."
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?
"We will be getting rid of our microwave oven so it will not affect my pacemaker."
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?
"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse?
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm?
0.12 and 0.2 seconds.
The nurse knows that what PR interval presents a first-degree heart block?
0.24 seconds
The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?
A client with atrial dysrhythmias
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?
Administer an IV bolus of atropine.
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart?
All options are correct.
A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response?
Assess the client and monitor leads.
The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?
Avoid undergoing magnetic resonance imaging (MRI).
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?
Begin cardiopulmonary resuscitation
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse?
Begin cardiopulmonary resuscitation (CPR)
The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor of the client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record?
Bigeminy
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?
Document the findings and continue to monitor the client
The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching?
During the procedure, the dysrhythmia will be reproduced under controlled conditions.
A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient?
Insertion of a pacemaker
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?
It is used to eliminate ventricular dysrhythmias.
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?
Lead wire dislodgement
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?
P wave
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?
QRS complex
The nurse is preparing to administer adenosine for a patient diagnosed with atrial flutter. How should the nurse administer this medication?
The dose is administered rapid IV push.
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?
The need to have regular blood levels drawn
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi?
Warfarin
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?
The registered nurse administering atropine sulfate intravenously
The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed?
The sinoatrial (SA) node initiates the impulse.
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?
Ventricular fibrillation
A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to
avoid caffeinated beverages.
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms?
electrocardiogram