Chapter 31: Concepts of Care for Patients with Dysrhythmias

A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification would the nurse suggest to avoid further slowing of the heart rate?

"Avoid straining while having a bowel movement."

A nurse supervises an assistive personnel (AP) applying electrocardiographic monitoring. Which statement would the nurse provide to the AP related to this procedure?

"Clean the skin and clip hairs if needed."

The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, "Why do you want to know if I use cocaine?" What is the nurse's best response?

"Clients who use cocaine are at risk for fatal dysrhythmias."

After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the client's understanding. Which statement by the client indicates correct understanding of the teaching?

"I will avoid sources of strong electromagnetic fields."

A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement would the nurse include in this client's teaching?

"Minimize or abstain from caffeine."

A nurse teaches a client with a new permanent pacemaker. Which instructions would the nurse include in this client's teaching? (Select all that apply.)

- "Until your incision is healed, do not submerge your pacemaker. Only take showers." - "Report any pulse rates lower than your pacemaker settings." - "Do not lift your left arm above the level of your shoulder for 8 weeks."

A nurse is teaching a client who has premature ectopic beats. Which education would the nurse include in this client's teaching? (Select all that apply.)

- Smoking cessation - Stress reduction and management - Adverse effects of medications

A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations would the nurse assess? (Select all that apply.)

-Decrease in cardiac output - Decrease in blood pressure - Decrease in urine output

A nurse is assessing clients on a medical-surgical unit. Which client would the nurse identify as being at greatest risk for atrial fibrillation?

A 50-year-old who is post coronary artery bypass graft surgery.

A nurse assesses a client's electrocardiogram (ECG) and observes the reading shown below: How would the nurse document this client's ECG strip?

Sinus rhythm with premature ventricular contractions (PVCs)

A nurse assesses a client with atrial fibrillation. Which manifestation would alert the nurse to the possibility of a serious complication from this condition?

Speech alterations

A nurse performs an admission assessment on a 75-year-old client with multiple chronic diseases. The client's blood pressure is 135/75 mm Hg and oxygen saturation is 94% on 2 L per nasal cannula. The nurse assesses the client's rhythm on the cardiac monitor and observes the reading shown below: What action would the nurse take first?

Ask the client what medications he or she takes.

A nurse cares for a client who is on a cardiac monitor. The monitor displayed the rhythm shown below: What action would the nurse take first?

Assess airway, breathing, and circulation.

A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiogram. What action would the nurse take next?

Assess vital signs and level of consciousness.

A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which intervention is appropriate for the nurse to perform prior to defibrillating this client?

Ensure that everyone is clear of contact with the client and the bed.

The nurse is caring for a client on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below: After calling for assistance and a defibrillator, what action would the nurse take next?

Initiate cardiopulmonary resuscitation (CPR).

A telemetry nurse assesses a client who has a heart rate of 35 beats/min on the cardiac monitor. Which assessment would the nurse complete next?

Level of consciousness

A nurse prepares to discharge a client with a cardiac dysrhythmia who is prescribed home health care services. Which priority information would be communicated to the home health nurse upon discharge?

Medication orders for home

A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse?

Midsternal chest pain

A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What intervention would the nurse implement to address this client's concerns?

Schedule periods of exercise and rest during the day.

A nurse administers prescribed adenosine to a client. Which response would the nurse assess for as the expected therapeutic response?

Short period of asystole

A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. What action would the nurse take prior to the cardioversion?

Turn off oxygen therapy.

A nurse assesses a client's electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How would the nurse interpret this observation?

Ventricular and atrial depolarizations are initiated from different sites.

A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication would the nurse expect to find on this client's medication administration record to prevent a common complication of this condition?

Warfarin