Dysrhythmias

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 defibrillating a patient in ventricular fibrillation with paddles on a monophasic defibrillator. How much paddle pressure should the nurse apply when defibrillating?

20-25 lbs

_________ AV block occurs when only some of the atrial impulses are conducted through the AV node into the ventricles

Second-degree

Atrial flutter occurs in the _______ and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in appearance

atrium (P-wave)

A __________ pacemaker is asynchronous and permanent.

fixed-rate

Propranolol and other beta blockers can interfere with conduction and the client should be evaluated for _______

heart block.

Lidocaine is used for treating _________ dysrhythmias.

ventricular

Treatment for atrial fibrillation is to terminate the rhythm or to control __________ rate

ventricular A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice followed by anticoagulation with heparin and then Coumadin.

During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during

ventricular depolarization (QRS complex)

The nurse knows that synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of which of the following?

ventricular repolarization

_____ premature ventricular contraction (PVC) every other heartbeat

Bigeminy

PP interval is used to determine __________ rhythm

atrial rhythm

Pacemakers are implanted for __________

bradycardia

Hypoxemia and Hypokalemia are causes for _______

PVC's

the part of an ECG used to calculate ventricular rate and rhythm is the ______ interval

RR

Lidocaine treats _________ dysrhythmias.

ventricular

The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response?

"Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."

An emergent cardiac event requires a prompt nursing response that should begin with an efficient assessment of the patient's condition, starting with _________

(airway, breathing, circulation, and consciousness).

A client has an irregular heart rate of around 100 beats/minute and a significant pulse deficit. What component of the client's history would produce such symptoms?

A-fib

In ___________ , several areas in the right atrium initiate impulses resulting in disorganized, rapid activity.

A-fib

The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. This occurs with _________

A-fib

A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at a rate of 150 bpm, with no discernible P waves. What does the nurse determine this rhythm to be?

A-fib Atrial fibrillation results from abnormal impulse formation that occurs when structural or electrophysiological abnormalities alter the atrial tissue causing a rapid, disorganized, and uncoordinated twitching of the atrial musculature. Characteristics of Atrial fibrillation: Atrial rate is typically 300 to 600 bpm; ventricular rate is 120 to 200 bpm. The ventricular and atrial rhythms are both highly irregular. No discernable P waves. PR interval cannot be measured. P:QRS ratio = many:1.

If an elective procedure for ______ or _______, the client should receive anticoagulant therapy for 4-6 weeks preprocedure, and a transesophageal echocardiogram (TEE) should be performed to rule out clots in the atria prior to the procedure ****

A-fib or A-flutter

_________ administered IV is the antidysrhythmic medication of choice for a stable patient with ventricular tachycardia.

Amiodarone

____________ causes a rapid, disorganized, and uncoordinated twitching of *atrial* musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves.

Atrial fibrillation

________- is the medication of choice in treating symptomatic sinus bradycardia.

Atropine

_________ (can be given IV push) is used for bradycardia

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 (IV push) to treat symptomatic bradycardia

Clients who are not candidates for cardioversion and fail to respond to conventional measures may be candidates for a surgical intervention referred to as the _________ procedure.

Maze

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 Couplets are two PVCs in a row. Multifocal PVCs originate from more than one location. R-on-T phenomenon occurs when the R wave falls on the T wave.

____________ is used to treat tachyarrhythmias by delivering an electrical current that depolarizes a critical mass of myocardial cells. When the cells repolarize, the sinus node is usually able to recapture its role as the heart's pacemaker. The procedure does not destroy malfunctioning cells or "boost" the heart's electrical activity. As well, it does not replace any of the misfiring cells.

Cardioversion

__________ is used to treat tachyarrhythmias by delivering an electrical current that depolarizes a critical mass of myocardial cells. When the cells repolarize, the sinus node is usually able to recapture its role as the heart's pacemaker.

Cardioversion "will essentially 'reset' the cells in your heart that control the electrical activity"

The _______ segment is the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave.

ST

During _________, there is no electrical impulse/activity

asystole

The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action?

Defibrillation

__________ (__________) mode pacemakers self-activate when the client's pulse falls below a certain level

Demand (synchronous)

Procainamide is used to treat and prevent ________ and ________ dysrhythmias

atrial and ventricular

_______- AV block occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.

First-degree

Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ___________ are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention).

ICD

________ procedures are used for clients who are not candidates for cardiodiversion; these procedures use scar-forming techniques to eliminate rapid firing of ectopic pacemaker sites, thus restoring the normal conduction pathways in the atria.

Maze

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?

PAC (premature atrial contraction)

With this type of dysrhythmia _____________, The PR interval would be greater than 0.12 seconds but shorter than the sinus node generated P wave. The atrial impulse starts before the next normal impulse of the sinus node.

PAC's

A _______ is an impulse that starts in a ventricle before the next normal sinus impulse.

PVC

A ________ is an impulse that starts in a ventricle before the next normal sinus impulse.

PVC

During a _______, an impulse starts in a ventricle and is conducted through the ventricles before the next normal sinus impulse.

PVC

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?

PVC's - premature ventricular contraction

______ result from increased irritability of the ventricles

Premature Ventricular contractions PVC's

A __________ is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.

Premature atrial complex (PAC)

the part of an ECG that reflects the time from ventricular depolarization through repolarization is the _______ interval.

QT

________ is when PVC falls on the T wave of the preceding beat, may precipitate ventricular fibrillation

R-on-T phenomenon

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?

RR interval

________ ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain.

Radiofrequency

__________ is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin

The implantable cardioverter defibrillator (ICD)

Pronestyl treats and prevents _______ and _______ dysrhythmias.

atrial and ventricular

_______ AV block occurs when no atrial impulse is conducted through the AV node into the ventricles.

Third-degree

________ cardiac pacemakers: Involve introduction of a wire into the right ventricle, which is attached to a generator

Transthoracic

_________ pacemakers: Involve placement of a wire into the right ventricle via a central intravenous catheter

Transvenous

_____ PVS every third heartbeat

Trigeminy

_____ uniform upward or downward deflection, arising from the same ectopic focus

Unifocal PVC

__________ is a rhythm in which every other complex is a PVC

Ventricular bigeminy

____________ is a rhythm in which every other complex is a PVC

Ventricular bigeminy

________ is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.

Ventricular fibrillation

_________ is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.

Ventricular fibrillation

___________ is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern.

Ventricular fibrillation

_________ is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute

Ventricular tachycardia

Catheter _______ destroys specific cells that are the cause or central conduction route of a tachydysrhythmia. It is performed with or after an electrophysiology study.

ablation

Radiofrequency _________ destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain.

ablation

Usual indications for ________ are atrioventricular nodal reentry tachycardia, a recurrent atrial dysrhythmia (especially atrial fibrillation), or ventricular tachycardia unresponsive to previous therapy (or for which the therapy produced significant side effects).

ablation

A client experiencing pacemaker malfunctioning may develop ________ as well as signs and symptoms of decreased cardiac output.

bradycardia The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate, which may indicate pacemaker malfunction. The client needs to be evaluated to avoid cardiac output problems. Walking will not keep the heart rate at a safe level.

Cardizem is a __________ (classification) and treats atrial dysrhythmias.

calcium channel blocker

Extra pacemaker spikes that don't precede a beat may indicate failure to _________, in which the pacemaker fires but the heart doesn't conduct the beat

capture

Atropine is used for bradycardia and dobutamine is an inotropic medication used to increased __________

cardiac output.

Maze procedures are used for clients who are not candidates for ___________; these procedures use scar-forming techniques to eliminate rapid firing of ectopic pacemaker sites, thus restoring the normal conduction pathways in the atria

cardiodiversion

Atrial fibrillation also is treated with elective ________ or digitalis if the ventricular rate is not too slow.

cardioversion

Before an elective ________, the client should receive moderate sedation IV as well as an analgesic medication or anesthesia

cardioversion

In __________, the defibrillator is set to synchronize with the electrocardiogram (ECG) on the cardiac monitor so that the electrical impulse discharges during ventricular depolarization.

cardioversion

The synchronization of __________ prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in ventricular tachycardia (VT) or ventricular fibrillation.

cardioversion

The nurse should instruct the client to restrict food and oral intake before the _________ procedure.

cardioversion Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion

The patient's medication regimen is usually altered in anticipation of ___________.

cardioversion. This often includes the use of anticoagulants for a few days before the procedure. Conscious sedation, rather than general anesthetic, is the preferred technique. Cardioversion is not normally followed by pain.

The implantable ____________ is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin.

cardioverter defibrillator (ICD)

A patient converts from normal sinus rhythm at 80 beats/min to atrial fibrillation with a ventricular response at 166 beats/min. Blood pressure is 162/74. Respiratory rate is 20/min with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the primary goal of treatment is what?

control ventricular rate

The nurse is administering amiodarone to a client with atrial fibrillation. The nurse expects to observe which cardiac changes as a result of the effect of this medication?

decrease heart rate With the administration of amiodarone to a client in atrial fibrillation, the nurse will find the heart rate will decrease and become more regular. Contractility of the heart is decreased with this medication not increased. Refractory periods of the ventricles are prolonged not shortened. This medication is intended to vasodilate rather than vasoconstrict to normalize cardiovascular function.

Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent?

disrupting the heart during the critical period of ventricular repolarization similar to defibrillation- One difference is that the machine that delivers the electrical stimulation waits to discharge until it senses the appearance of an R wave.

Household appliances, such as a microwave (do or do not) interfere with the ICD

do not

The nurse must instruct the client with a permanent pacemaker to avoid sources of __________, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc.

electrical interference

A cardiac ___________ study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart.

electrophysiology

A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of

embolic stroke

In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a __________ heart block

first-degree heart block.

In failure to ________, the pacemaker doesn't fire when it should; this causes hypotension and other signs of low cardiac output accompanied by bradycardia or a heart rate slower than the pacemaker's preset rate

pace

Third-degree AV block, also known as a complete block, occurs when no atrial impulse is conducted through the AV node into the ventricles. A _______ may be necessary if the block persists.

permanent pacemaker

Advanced cardiac life support recommends early defibrillation for witnessed ventricular fibrillation. A cardioversion is used with a client who has a _________

pulse (V-fib, patient will not have a pulse)

The therapeutic goal of __________ catheter ablation is to destroy errant tissue, in hopes of allowing impulse conduction to travel over appropriate pathway

radiofrequency

A patient has a ________ block when only some of the atrial impulses are conducted through the AV node into the ventricles

second-degree

In failure to _______, the pacemaker can't _______ the client's intrinsic heartbeat; on the rhythm strip, spikes may fall on T waves, or they may fall regularly but at points at which they shouldn't appear.

sense

Catheter ablation destroys specific cells that are the cause or central conduction route of a __________

tachyarrhythmia Ablation does not "reset" sinus rhythm in the manner of defibrillation or cardioversion.

There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With _________ `AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.

third-degree

In _________ heart block there is no relationship or synchrony between the atrial and ventricular contraction.

third-degree AV Each is beating at its own inherent rate and is independent of each other, thus the cardiac output is affected

The ___________ (procedure/test) will show if the client has blood clots and help determine if it is safe to use cardioversion

transesophageal echocardiogram The transesophageal echocardiogram does not indicate which area is causing the atrial fibrillation or the need to evaluate coronary arteries, as with a cardiac catheterization.

Atrial fibrillation is treated with elective cardioversion or digitalis if the _________ rate is not too slow

ventricular