Iggy Study Guide Ch. 31: Concepts of Care for Patients with Dysrhythmias

Which ECG strip pattern is evidence to the nurse that a client's temporary transvenous pacemaker has successfully depolarized the ventricles? A. A pacer spike followed by a QRS complex B. Two spikes followed by a QRS complex C. A pacer spike before and after the QRS complex D. No pacer spike but regular QRS complexes

A. A pacer spike followed by a QRS complex

Which actions are essential nursing care for a client immediately after elective cardioversion? Select all that apply. A. Administer oxygen. B. Assess vital signs and level of consciousness. C. Provide sips of water or ice chips. D. Monitor for dysrhythmias. E. Maintain an open airway. F. Document the results of the cardioversion.

A. Administer oxygen. B. Assess vital signs and level of consciousness. D. Monitor for dysrhythmias. E. Maintain an open airway. F. Document the results of the cardioversion.

To determine if a client has a pulse deficit, what procedure would the nurse follow? A. Assess the apical and radial pulses for a full minute and calculate the difference. B. Check the client's blood pressure for a full minute and calculate the difference. C. Take the client's pulse rate while supine, then in a standing position. D. Assess the radial pulse for a minute, have the client rest, then check the radial pulse again.

A. Assess the apical and radial pulses for a full minute and calculate the difference.

Which are nursing responsibilities for the care of a client with a newly implanted permanent pacemaker? Select all that apply. A. Assess the implantation site for bleeding, swelling, redness, tenderness, or infection. B. Administer short-acting sedatives as needed and prescribed. C. Monitor the ECG rhythm strip to ensure that the pacemaker is working correctly. D. Observe the overstimulation of the chest wall, which might cause pneumothorax. E. Assess that the implantation site dressing is clean and dry. F. Teach the client about initial activity restrictions.

A. Assess the implantation site for bleeding, swelling, redness, tenderness, or infection. C. Monitor the ECG rhythm strip to ensure that the pacemaker is working correctly. E. Assess that the implantation site dressing is clean and dry. F. Teach the client about initial activity restrictions.

After calling for help, when the nurse finds a client in his or her room without a pulse, apneic and unconscious, which action should be taken next? A. Begin cardiac compressions. B. Establish IV access. C. Give supplemental oxygen. D. Defibrillate the client.

A. Begin cardiac compressions.

Which causes would the nurse recognize as leading to increased atrial irritability and premature atrial contractions (PACs) in a client's myocardium? Select all that apply. A. Caffeine intake B. Anxiety C. Syncope D. Stress in life E. Infection F. Pulmonary hypotension

A. Caffeine intake B. Anxiety D. Stress in life E. Infection

Which questions would the nurse use to assess a client's P wave on an ECG rhythm strip? Select all that apply. A. Do all P waves look similar? B. Are P waves present? C. Does one P wave follow each QRS complex? D. Are P waves occurring regularly? E. Are the P waves greater than 0.20 second? F. Are P waves smooth, rounded, and upright?

A. Do all P waves look similar? B. Are P waves present? D. Are P waves occurring regularly? F. Are P waves smooth, rounded, and upright?

Which actions would the nurse take when the monitor technician states that a client's telemetry ECG signal transmission is not very clear? Select all that apply. A. Ensure that the fee on each electrode is moist and fresh. B. Clean the skin and clip hairs if necessary. C. Abrade the skin by rubbing briskly with a rough washcloth. D. Make sure that the skin is free of lotion or any other substance. E. Clean the skin with povidone-iodine before applying electrodes. F. Check to be sure that electrodes are not placed over scar tissue.

A. Ensure that the fee on each electrode is moist and fresh. B. Clean the skin and clip hairs if necessary. D. Make sure that the skin is free of lotion or any other substance. F. Check to be sure that electrodes are not placed over scar tissue.

Which signs and symptoms would the nurse expect to assess in a client with sinus tachycardia? Select all that apply. A. Fatigue B. Shortness of breath C. Decreased oxygen saturation D. Decreased blood pressure E. Anginal pain F. Widened QRS complexes

A. Fatigue B. Shortness of breath C. Decreased oxygen saturation D. Decreased blood pressure E. Anginal pain

Which waveform does the nurse recognize as atrial depolarization when a client is placed on a cardiac monitor? A. P wave B. PR segment C. QRS complex D. T wave

A. P wave

Which ECG waveforms and intervals are the normal measurements or positions? Select all that apply. A. PR interval 0.12-0.20 second B. QRS complex 0.6-0.10 second C. PR segment isoelectric line D. QT interval less than half of the R to R interval E. U wave follows T wave if present F. TP segment one block above isoelectric line

A. PR interval 0.12-0.20 second B. QRS complex 0.6-0.10 second C. PR segment isoelectric line D. QT interval less than half of the R to R interval E. U wave follows T wave if present

Which conditions would the nurse suspect when a client's telemetry ECG rhythm strip shows ST elevation of 1.5 mm (1.5 small blocks)? Select all that apply. A. Pericarditis B. Hypokalemia C. Myocardial infarction D. Ventricular hypertrophy E. Endocarditis F. Hyperkalemia

A. Pericarditis C. Myocardial infarction F. Hyperkalemia

Which important teaching points would the nurse discuss with a client who receives a new permanent pacemaker? Select all that apply. A. Report any pulse rate that is lower than the rate set on the pacemaker. B. Avoid sources of strong electromagnetic fields such as magnets. C. If the surgical incision is near the shoulder, be sure to perform daily range of motion. D. Carry a pacemaker identification card and wear a medical alert bracelet. E. Avoid tight clothing to prevent pressure over the pacemaker generator. F. It is safe to go through airport security because the pacemaker will not set off the alarms.

A. Report any pulse rate that is lower than the rate set on the pacemaker. B. Avoid sources of strong electromagnetic fields such as magnets. D. Carry a pacemaker identification card and wear a medical alert bracelet. E. Avoid tight clothing to prevent pressure over the pacemaker generator.

Which actions are responsibilities of the monitor technician? Select all that apply. A. Report client rhythm and significant changes to the nurse. B. Notify the health care provider of any pertinent changes. C. Print routine ECG strips for each monitored client. D. Apply battery-operated transmitter leads to clients. E. Watch the bank of cardiac monitors on a client care unit. F. Interpret rhythm strips for each monitored client.

A. Report client rhythm and significant changes to the nurse. C. Print routine ECG strips for each monitored client. E. Watch the bank of cardiac monitors on a client care unit. F. Interpret rhythm strips for each monitored client.

Where will the nurse place the leads on a client for a five-lead continuous monitoring system? Select all that apply. A. Right arm electrode just below the right clavicle B. Left arm electrode just below the left clavicle C. Right leg electrode on the highest palpable rib, on the left midclavicular line D. Left leg electrode on the lowest palpable rib, on the left midclavicular line E. Fifth electrode placed to obtain one of the six chest leads F. Left arm electrode just above the left clavicle

A. Right arm electrode just below the right clavicle B. Left arm electrode just below the left clavicle D. Left leg electrode on the lowest palpable rib, on the left midclavicular line E. Fifth electrode placed to obtain one of the six chest leads

What effect does the nurse expect a Class IV drug to have on a client's cardiac conduction system? A. Slow the flow of calcium into the cell during depolarization to depress automaticity B. Stabilize membranes to decrease myocardial contractility C. Decrease heart rate and conduction velocity D. Lengthen the absolute refractory period and prolong repolarization

A. Slow the flow of calcium into the cell during depolarization to depress automaticity

Which beta-blocker drug approved for treating dysrhythmias is also a Class III antidysrhythmic drug? A. Sotalol B. Esmolol C. Propranolol D. Acebutolol

A. Sotalol

Which risk factors for atrial fibrillation would the nurse monitor for in client? Select all that apply. A. Peripheral vascular disease B. Hypertension C. Chronic obstructive pulmonary disease D. Diabetes mellitus E. Excessive alcohol intake F. Mitral valve disease

B. Hypertension D. Diabetes mellitus E. Excessive alcohol intake F. Mitral valve disease

Which normal heart rates does the nurse expect to be initiated by the primary pacemaker of the heart (SA Node) in clients when the heart rate is regular? Select all that apply. A. 55 beats/min B. 62 beats/min C. 74 beats/min D. 86 beats/min E. 98 beats/min F. 110 beats/min

B. 62 beats/min C. 74 beats/min D. 86 beats/min E. 98 beats/min

What is the priority action for the nurse when the monitor technician states that a client's telemetry monitor shows a rhythm that appears as a wandering of fuzzy baseline? A. Check to see if the client has a do-not-resuscitate order. B. Assess the client to differentiate artifact from an actual lethal rhythm. C. Immediately obtain a 12-lead ECG to assess the actual rhythm. D. Ask the assistive personnel (AP) to take a set of vital signs on the client.

B. Assess the client to differentiate artifact from an actual lethal rhythm.

What is the first step when the nurse analyzes a client's ECG rhythm strip? A. Analyze the P waves B. Determine the heart rate C. Measure the QRS complex D. Assess for ST-segment elevation

B. Determine the heart rate

Which procedure would the nurse provide teaching about to a client who has chronic atrial fibrillation and is at increased risk for a stroke, but is not a candidate for anticoagulation? A. Radiofrequency catheter ablation (RCA) B. Left arial appendage (LAA) occlusion C. Biventricular pacing D. Surgical maze procedure

B. Left arial appendage (LAA) occlusion

Which descriptions are characteristics of Class III antidysrhythmic drugs? Select all that apply. A. Increase force of contraction B. Lengthen absolute refractory period C. Include hypertension as a side effect for some drugs D. Include bradycardia as a side effect for some drugs E. Prolong QT interval F. Prolong repolarization

B. Lengthen absolute refractory period D. Include bradycardia as a side effect for some drugs F. Prolong repolarization

Which statements about permanent pacemakers are accurate? Select all that apply. A. Permanent pacemakers are powered by lithium batteries that last over 20 years. B. Permanent pacemakers are available as pacemaker/defibrillator devices. C. Biventricular pacemakers allow synchronized depolarization of the ventricles. D. Permanent pacemakers are used to treat disorders such as complete heart block. E. A client with a new pacemaker should avoid lifting his or her arm over the head for at least 6 months. F. The pulse generator for a permanent pacemaker is usually implanted in the left subclavian area.

B. Permanent pacemakers are available as pacemaker/defibrillator devices. C. Biventricular pacemakers allow synchronized depolarization of the ventricles. D. Permanent pacemakers are used to treat disorders such as complete heart block. F. The pulse generator for a permanent pacemaker is usually implanted in the left subclavian area.

Which serum electrolyte would the nurse check after noting tall and peaked T waves on a client's ECG? A. Sodium B. Potassium C. Magnesium D. Chloride

B. Potassium

How would the nurse best interpret the electrocardiogram (ECG) of a younger athletic client which shows sinus bradycardia with a rate of 54 beats/min? A. It is the body's attempt to compensate for a decreased stroke volume by decreasing heart rate. B. The sinus bradycardia provides an adequate stroke volume that is associated with cardiac conditioning. C. The client has a rapid filling rate that lengthens diastolic filling time and leads to decreased cardiac output. D. This is a common finding in healthy adults of all ages and would be considered a normal finding.

B. The sinus bradycardia provides an adequate stroke volume that is associated with cardiac conditioning.

To best perform a 12-lead ECG on a client, how does the nurse place the leads on the client? A. Four leads are placed on the limbs and four are placed on the chest. B. The negative electrode is placed on the left arm and the positive electrode is placed on the right leg. C. Four leads are placed on the limbs and six are placed on the chest. D. The negative electrode is placed on the right arm and the positive electrode is placed on the left leg.

C. Four leads are placed on the limbs and six are placed on the chest.

What does the nurse determine is the client's heart rate when assessing a 6-second telemetry ECG strip with five QRS complexes? A. 30 beats/min, bradycardia B. 40 beats/min, bradycardia C. 50 beats/min, bradycardia D. 60 beats/min, normal

C. 50 beats/min, bradycardia

Which would be the best method for the nurse to confirm a report from the monitor technician about the change in a monitored client's heart rate? A. Count QRS complexes in a 6-second strip and multiply by 10. B. Analyze the ECG rhythm strip using an ECG caliper. C. Assess the client's heart rate directly by checking the apical pulse. D. Request that the monitor technician run an ECG strip for a minute.

C. Assess the client's heart rate directly by checking the apical pulse.

Which criteria support the nurse's assessment that a client's ECG rhythm strip shows a normal sinus rhythm (NSR)? A. PR interval is 0.24 second B. Atrial and ventricular rates are 58 beats/min C. Atrial and ventricular rates are regular. D. P waves are present before every QRS complex. E. QRS duration is consistent at 0.08 second. F. Atrial and ventricular rates are 82 beats/min.

C. Atrial and ventricular rates are regular. D. P waves are present before every QRS complex. E. QRS duration is consistent at 0.08 second. F. Atrial and ventricular rates are 82 beats/min.

Which safety precaution must be taken before defibrillating a client with ventricular fibrillation (VF)? A. Make sure that the defibrillator is set on the synchronous mode. B. Be sure to hyperventilate the client before the defibrillation. C. Command all health care team members to stand clear of the client's bed. D. Disconnect the monitor leads to prevent electrical shocks to the client.

C. Command all health care team members to stand clear of the client's bed.

Which nursing actions have priority when a client with acute supraventricular tachycardia (SVT) is to be administered adenosine by the health care provider? Select all that apply. A. Have injectable beta-blocker drugs at the bedside. B. Give the drug slowly over 1-2 minutes. C. Ensure that emergency equipment is at the bedside. D. Follow the drug injection with a normal saline bolus. E. Monitor the client for bradycardia, nausea, and vomiting. F. Prepare for synchronized cardioversion after giving the adenosine.

C. Ensure that emergency equipment is at the bedside. D. Follow the drug injection with a normal saline bolus. E. Monitor the client for bradycardia, nausea, and vomiting.

Which drug does the nurse prepare to administer to a client diagnosed with the dysrhythmia torsades de pointes? A. Calcium chloride B. Epinephrine C. Magnesium sulfate D. Adenosine

C. Magnesium sulfate

Which condition is indicated when the nurse notes ST segment elevation or one to two small blocks on a client's ECG? A. Ventricular irritability B. Subarachnoid hemorrhage C. Myocardial injury or ischemia D. Malfunction of the SA node

C. Myocardial injury or ischemia

When would the telemetry unit nurse use temporary transcutaneous pacing for a client? Select all that apply. A. Only when a client's ECG shows a bradydysrhythmia and the client is asymptomatic. B. When a client's ECG strip shows atrial fibrillation with a rapid ventricular response. C. Only as a temporary emergency measure until invasive pacing method can be started. D. When a client is experiencing syncope, dizziness and fainting. E. Only until the client's heart rhythm returns to normal. F. When invasive pacing is not immediately available.

C. Only as a temporary emergency measure until invasive pacing method can be started. E. Only until the client's heart rhythm returns to normal. F. When invasive pacing is not immediately available.

Which priority concept does the nurse focus on when a client is diagnosed with a dysrhythmia? A. Clotting B. Fluid and electrolyte balance C. Perfusion D. Acid-base balance

C. Perfusion

How does the nurse interpret a client's telemetry ECG strip that shows four successive premature ventricular contractions (PVCs)? A. The monitor is showing two PVC couplets in a row. B. This rhythm is ventricular asystole as seen in a dying heart. C. The client had an episode of nonsustained ventricular tachycardia (NSVT). D. The nurse must check the client for loose leads and artifact.

C. The client had an episode of nonsustained ventricular tachycardia (NSVT).

For which cardiac dysrhythmia(s) would an automatic external defibrillator (AED) instruct the nurse to immediately defibrillate an unconscious client at an outpatient clinic? Select all that apply. A. Paroxysmal supraventricular tachycardia B. Pulseless electrical activity C. Ventricular fibrillation D. Pulseless ventricular tachycardia E. Nonsustained ventricular tachycardia F. Atrial fibrillation with rapid ventricular reponse

C. Ventricular fibrillation D. Pulseless ventricular tachycardia

Which client assessment takes priority when the nurse begins his or her shift? A. Client with chronic atrial fibrillation and ventricular rate of 72 beats/min B. Client with sinus tachycardia and occasional premature atrial contractions (PACs) C. Client with paroxysmal supra ventricular tachycardia (PSVT) that terminated D. Client with atrial fibrillation and sustained rapid ventricular response

D. Client with atrial fibrillation and sustained rapid ventricular response

What does the nurse suspect when assessing a client's telemetry ECG strip and noting a wide distorted QRS complex of 0.14 second followed by a P wave? A. Delayed time of the impulse through the ventricles B. Problem with speed set on the ECG telemetry monitor C. Wide but normal complex with no cause for concern D. Premature ventricular complex followed by atrial contraction

D. Premature ventricular complex followed by atrial contraction

Which definition best describes the electrophysiologic property called automaticity of myocardial pacemaker cells? A. The ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, causing sufficient pressure to push blood forward through the heart. B. The ability to send an electrical stimulus from cell membrane to cell membrane. C. The ability of non pacemaker heart cells to respond to an electrical impulse that begins in pacemaker cells. D. The ability of cardiac cells to generate an electrical impulse spontaneously and repetitively.

D. The ability of cardiac cells to generate an electrical impulse spontaneously and repetitively.

Which dysrhythmia does the nurse consider life threatening because it causes the ventricles to quiver and results in the absence of cardiac output for a client? A. Asystole B. Ventricular tachycardia C. Atrial fibrillation D. Ventricular fibrillation

D. Ventricular fibrillation

When a client has been in atrial fibrillation for 3 days and is scheduled for an elective cardioversion, what priority teaching does the nurse provide to the client? A. Consume potassium-rich food sources such as bananas. B. Report muscle tremors or weakness to the health care provider. C. Get up slowly when getting out of bed or a chair. D. Watch for any sign of bleeding and report this to your health care provider.

D. Watch for any sign of bleeding and report this to your health care provider.