Perfusion - Chapter 35
a 20-year-old patient has a mandatory ECG before participating on a college soccer team and is found to have sinus bradycardia, rate 52 bpm. blood pressure is 115/54, 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
a. allow the student to participate on the soccer team
after the nurse give IV atropine to a patient with symptomatic type 1, second-degree AV block, which finding indicates that the drug has been effective? a. increase in patient's heart rate b. increase in strength of peripheral pulses c. decrease in premature atrial contractions d. decrease in premature ventricular contractions
a. increase in patient's heart rate
when preparing to defibrillate a patient, in which order will the nurse perform the following steps? a. turn the defibrillator on b. deliver the electrical charge c. select the appropriate energy level d. place the hands-free, multifunctional defibrillator pads on the patient's chest e. check the location of the other staff and call out "all clear"
a. turn the defibrillator on c. select the appropriate energy level d. place the hands-free, multifunctional defibrillator pads on the patient's chest e. check the location of the other staff and call out "all clear" b. deliver the electrical charge a. --> c. --> d. --> e. --> b.
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 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
c. use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10
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 b. serum chloride of 92 c. serum sodium of 134 d. serum potassium of 2.9
d. serum potassium of 2.9 hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation. 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 intervention.
the nurse obtains a rhythm strip on a patient who has had a MI and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162 bpm, R-R interval regular, and QRS complex wide and distorted, and QRS duration of 0.18 seconds. the nurse interprets the patient's cardiac rhythm as a. atrial flutter b. sinus tachycardia c. ventricular fibrillation d. ventricular tachycardia
d. ventricular tachycardia
when analyzing an ECG rhythm strip of a patient with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. the nurse calculates the patient's heart rate as
50 there are 1500 small blocks in one minute, and the nurse will divide 1500 by 30
which nursing action can the RN delegate to experience unlicensed assistive personnel (UAP) working as telemetry technicians on the cardiac care unit? a. decide whether a patient's heart rate of 116 bpm 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
b. observe heart rhythms for multiple patients who have telemetry monitoring
a patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECD pattern. the patient is unconscious, apneic, and pulseless. which action should the nurse take first? a. give epinephrine IV b. perform immediate defibrillation c. prepare for endotracheal intubation d. ventilate with a valve-bag-mask device
b. perform immediate defibrillation the patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate
a patient whose heart monitor shows sinus tachycardia, rate 132 bpm, is apneic, and has no palpable pulses. which action should the nurse take next? a. perform synchronized cardioversion b. start CPR c. give atropine per agency dysrhythmia protocol d. provide supplemental oxygen via non-rebreather mask
b. start CPR the patient's clinical manifestations indicate pulseless electrical activity
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
a. anticoagulant therapy atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion
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
b. ventricular bigeminy
a patient has ST segment changes that suggest an acute inferior wall MI. which lead would be best for monitoring the patient? a. I b. II c. V2 d. V6
b. II leads II, III, and AVF reflect the inferior area of the heart and the ST segment changes. lead II will best capture any ECG changes that indicate further damage to the myocardium
a patient has a sinus rhythm and a heart rate of 72 bpm. 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
b. document the finding and monitor the patient first-degree AV 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.
which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and who has a blood pressure of 110/66? a. turn the synchronizer switch to the "off" position b. give a sedative before cardioversion is implemented c. set the defibrillator/cardioverter to 360 J d. provide assisted ventilations with a bag-valve-mask device
b. give a sedative before cardioversion is implemented
which action by a new RN who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias? a. prepares defibrillator settings at 360 J for a patient whose monitor shows asystole b. injects IV adenosine over 2 seconds to a patient with SVT c. turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation d. gives the prescribed dose of diltiazem to a patient with new-onset type II second-degree AV block
b. injects IV adenosine over 2 seconds to a patient with SVT adenosine must be given over 1 to 2 seconds to be effective
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
b. instruct the patient to call for assistance before getting out of bed
a patient has a junctional escape rhythm on the monitor. the nurse will expect the patient to have a heart rate of a. 15 to 20 bpm b. 20 to 40 bpm c. 40 to 60 bpm d. 60 to 100 bpm
c. 40 to 60 bpm if the SA node fails to discharge, the AV node will automatically discharge at the normal rate of 60 to 100 bpm.
a 19-year-old student comes to the student health center at the end of the semester complaining that, "my heart is skipping beats." an ECG shows occasional unifocal PVCs. what action should the nurse take next? a. insert an IV catheter for emergency use b. start supplemental oxygen 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
c. ask the patient about current stress level and caffeine use in a patient with a normal heart rate, occasional PVCs are a benign finding. the timing of the PVCs suggests stress or caffeine as etiologic factors. the patient is hemodynamically stable.
a patient's heart monitor shows sinus rhythm, heart rate 64 bpm. the PR interval is 0.18 seconds at 0100, 0.22 seconds at 1430, and 0.28 seconds at 1600. 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 d. document the patient's rhythm and assess the patient's response to the rhythm
c. call the health care provider before giving scheduled metoprolol the patient has progressive first-degree AV block, and the beta blocker should be held until discussing the drug with the health care provider. the patient with first-degree AV block usually is asymptomatic
a patient who is on the telemetry unit develops atrial flutter, rate 150 bpm, 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 ECG b. notify the health care provider of the change in rhythm c. give supplemental oxygen at 2 to 3 L/min via nasal cannula d. assess the patient's vital signs including oxygen saturation
c. give supplemental oxygen at 2 to 3 L/min via nasal cannula
a patient who was admitted with a MI experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 bpm. 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
c. prepare to give IV amiodarone per agency dysrhythmia protocol
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 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
c. the nurse encourages the patient to do active range of motion exercises for all extremities the patient should avoid moving the arm on the ICD insertion site until healing has occurred to prevent displacement of the ICD leads.
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 formulation 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
c. the procedure uses electrical energy to destroy areas of the conduction system
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"
d. "I won't lift the arm on the pacemaker side until I see the health care provider" the patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads
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
d. QRS complex the QRS complex represents vintricular depolarization. the P wave represents the depolarization of the atria. the PR interval represents depolarization of the atria, AV node, bundle of His, bundle branches, and the Purkinje fibers. the Q wave is the first negative deflection following the P wave (should be narrow and short).
when analyzing the rhythm of a patient's ECG, the nurse will need to investigate further upon finding a. isoelectric ST segment b. PR interval of 0.18 seconds c. QT interval of 0.38 seconds d. QRS interval of 0.14 seconds
d. QRS interval of 0.14 seconds the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged
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 bpm and irregular, who has a dose of warfarin due b. a patient with second-degree AV block, type 1, rate 60 bpm, who is dizzy when ambulating c. a patient who is in a sinus rhythm, rate 98 bpm and regular, recovering from an elective cardioversion 2 hours ago d. a patient whose ICD fired twice today and has a dose of amiodarone due
d. a patient whose ICD fired twice today and has a dose of amiodarone due the frequent firing of the ICD indicates that the patient's ventricles are very irritable
a patient develops sinus bradycardia at a rate of 32 bpm, has a blood pressure of 80/42, and is complaining of feeling faint. which action should the nurse take next? a. recheck the heart rhythm and blood pressure in 5 minutes b. have the patient perform the Valsalva maneuver c. give the scheduled dose of diltiazem d. apply the transcutaneous pacemaker pads
d. apply the transcutaneous pacemaker pads
