Prep U Ch. 26 Management of Patients With Dysrhythmias and Conduction Problems

Which PR interval presents a first-degree heart block?

0.24 seconds 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 first-degree heart block.

The nursing instructor is discussing pacemakers with her clinical group. One of the students is caring for a client with a transvenous pacemaker. One of the students asks why this client has a transvenous pacemaker. What would be the instructor's best response?

"A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs." A transvenous pacemaker is a temporary pulse-generating device that sometimes is necessary to manage transient bradydysrhythmias such as those that occur during acute MIs or after coronary artery bypass graft surgery, or to override tachydysrhythmias.

A nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following?

"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic stimulation reduces heart rate. Administration of beta-adrenergic blocking agents decreases stimulation of the sympathetic nervous system and subsequently heart rate.

A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching?

"I can still drink coffee and tea." The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification?

"I should ask for a handheld device search when I go through airport security." At security gates at airports, government buildings, or other secured areas, the client with a permanent pacemaker should show a pacemaker ID card and request a hand (not handheld device) search. The client should obtain and carry a physician's letter about this requirement.

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."

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

"Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." A client experiencing pacemaker malfunctioning may develop bradycardia as well as signs and symptoms of decreased cardiac output. The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate. This may indicate pacemaker malfunction.

A patient is being examined for medical management of atrial flutter. The nurse reviews the ECG strip. He expects to see which of the following?

"Sawtooth" pattern to the waveform The "sawtooth pattern" is the classic waveform appearance with atrial flutter. The atrial rate is faster than the AV node can conduct. Not all atrial impulses stimulate the ventricle.

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 Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin

The nurse is caring for a client with a diagnosis of atrial fibrillation. The onset was approximately 2 to 3 days ago. The client is scheduled for a transesophageal echocardiogram this morning. The client's spouse asks what this test is for. The best response by the nurse is which of the following?

"This test will show any blood clots in the heart and if it is safe to do a cardioversion." When contemplating cardioversion for the client with atrial fibrillation, the absence of a thrombus in the atria can be confirmed by transesophageal echocardiogram.

A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond?

"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with his left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of his antiarrhythmic.

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." It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (eg, basketball, football, hockey).

The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following?

"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion

After taking an ECG on a 38-year-old woman, the nurse reports that the PR interval reflects normal sinus rhythm. The nurse has made this interpretation based on the PR interval of:

0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.

Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds?

0.2 Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second.

A patient is admitted to the emergency department (ED) with complaints of chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph (ECG) monitor. The nurse counts 9 RR intervals on the patient's 6-second rhythm tracing. The nurse correctly identifies the patient's heart rate as which of the following?

90 bpm An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90.

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?

A defibrillator

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following?

Atrial rate of 300 to 400 ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves.

You are overseeing a 62-year-old who has started to exhibit dangerous PVCs in the cardiac postoperative unit. He's been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should you be ready to do?

Adjust the IV infusion. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Do not do anything else. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient. Stay focused on the IV. Call for the physician and while waiting, adjust the IV infusion to the slowest possible rate until the physician can examine the patient.

A 26-year-old Air Force staff sergeant is returning for diagnostic follow-up to the cardiologist's office where you practice nursing. Her 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 It occurs in clients with healthy hearts as a physiologic response to strenuous exercise, anxiety and fear, pain, fever, hyperthyroidism, hemorrhage, shock, or hypoxemia. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Fever is one cause. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Shock is one cause. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart. Strenuous exercise is one cause.

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart?

Altered patterns frequently affect the heart's ability to pump blood effectively The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer.

Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?

Anticoagulant Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation. The other options may be prescribed but not expected in most situations.

A nurse is providing evening care for a patient wearing a continuous telemetry monitor. While the nurse is giving the patient a back rub, the patient'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 patient and monitor leads. The nurse should assess the patient and monitor leads first. It is important that the nurse "treat the patient, not the monitor." Ventricular asystole may often appear on the monitor when leads are displaced. The other interventions are not necessary.

The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle?

Atrial depolarization

An 83-year-old resident in the long-term care facility where you practice nursing has an irregular heart rate of around 100 beats/minute. He also has a significant pulse deficit. What component of his history would produce such symptoms?

Atrial fibrillation In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not atrial flutter. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not heart block. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not bundle branch block.

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

Atrial flutter Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?

Atrial flutter Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in shape. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.

A nurse is completing a shift assessment on a patient admitted to the telemetry unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The patient is also experiencing dizziness and shortness of breath. Which of the following medications will the nurse anticipate administering to the patient based on these clinical findings?

Atropine The patient is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias.

The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed.

Atropine sulfate Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation.

A patient tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following?

Avoid caffeinated beverages. If PACs are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the patient to avoid caffeinated beverages.

A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.)

Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation. The nurse should instruct the patient to avoid large magnetic fields such as those created by magnetic resonance imaging, large motors, arc welding, electrical substations, and so forth. Magnetic fields may deactivate the device, negating its effect on a dysrhythmia. The patient should call 911 for emergency assistance if a feeling of dizziness occurs. The patient should maintain a log that records discharges of an implantable cardioverter defibrillator (ICD). Record events that precipitate the sensation of shock. This provides important data for the physician to use in readjusting the medical regimen. Throbbing pain is not normal and should be reported immediately. An initial x-ray is indicated prior to discharge, but monthly x-rays are unnecessary.

Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker?

Avoid sources of electrical interference The nurse must instruct the patient with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the patient to avoid strenuous movement (especially of the arm on the side where the pacemaker is inserted), to keep the arm on the side of the pacemaker lower than the head except for brief moments when dressing or performing hygiene, and to delay for at least 8 weeks activities such as swimming, bowling, tennis, vacuum cleaning, carrying heavy objects, chopping wood, mowing, raking, and shoveling snow.

After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker?

Avoid undergoing magnetic resonance imaging (MRI).

You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?

Fluttering Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.

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) Commonly called flatline, ventricular asystole (Fig. 26-19) is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Ventricular asystole is treated the same as PEA, focusing on high-quality CPR with minimal interruptions and identifying underlying and contributing factors.

A 78-year-old client was just admitted to the cardiac step-down unit where you practice nursing. Upon stabilizing his condition, you begin a conversation about his symptoms and you answer his questions to the best of your ability. In your discussion of cardiac dysrhythmias, which of the following would you rule out as a likely origination point for cardiac dysrhythmias?

Bundle of His Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His. Cardiac dysrhythmias do not originate in the Bundle of His.

Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a:

Heart rate of 42 beats per minute (bpm) All answers refer to a normal sinus rhythm (NSR) except for the heart rate. A rate of 42 bpm is slow but normal when it occurs in athletes without symptoms.

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients?

Clients with recurrent life-threatening tachydysrhythmias The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect.

Which diagnostic study best evaluates different medications ability to restore normal heart rhythm?

Electrophysiology study

The nurse is asked to explain ventricular bigeminy to a patient. The nurse explains that it is a conduction defect in which:

Every other complex is a PVC. The effect of a PVC depends on its timing in the cardiac cycle and how much blood was in the ventricles when they contracted. Bigeminy is a rhythm in which every other complex is a PVC. In trigeminy, every third complex is a PVC.

Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke?

Coumadin Warfarin (Coumadin) is indicated if the patient with atrial fibrillation is at high risk for stroke. Aspirin, Lovenox, and Plavix are not indicated. If immediate anticoagulation is necessary, the patient may be placed on heparin until the warfarin level is therapeutic.

After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have?

Decreased cardiac output and decreased systolic and diastolic blood pressure As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia.

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis for this client would be which of the following?

Decreased cardic output

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. He is aware that this dysrhythmia is evident on an ECG strip by which of the following?

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

A nurse is evaluating a client with a temporary pacemaker. The patient's ECG tracing shows each P wave followed by the pacing spike. The nurse's best response is which of the following

Document the findings and continue to monitor the patient. Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the patient. Repositioning the patient, placing the patient on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape.

Jack Johnson is a 58-year-old who's been living with an internal, fixed-rate pacemaker. You're checking his readings on a cardiac monitor and notice an absence of spikes. What should you do?

Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. It's important to be careful. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Focus on the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Check the monitor. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include?

During the procedure, the arrhythmia will be reproduced under controlled conditions. During EP studies, the patient is awake and may experience symptoms related to the arrhythmia. EP studies do not always include ablation of the arrhythmia.

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client?

Elective electrical cardioversion Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure

A 65-year-old client has come to the emergency department reporting light-headedness, chest pain, and shortness of breath. As you finish your assessment, the physician enters and orders tests to ascertain what is causing the client's problems. In your client education, you explain the tests. Which test is used to identify cardiac rhythms?

Electrocardiogram

The nurse understands that asystole can be caused by several of the following. Select all that apply

Hypoxia Hypovolemia Hypothermia Acidosis Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and identifying underlying and contributing factors. The key to successful treatment is a rapid assessment to identify a possible cause, which is known as the "Hs and Ts": hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary).

A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist?

IV bolus of atropine or temporary pacing The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists.

You enter your client's room and find them pulseless and unresponsive. What would be the treatment of choice for this client?

Immediate defibrillation

A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes?

Implantable cardioverter defibrillator The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation and who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention).

A 63-year-old client is in the cardiac step-down unit where you practice nursing. In your discussions about his condition, the client is puzzled as to what causes the heart to be an effective pump. Which of the following statements would you include in your response?

Inherent rhythmicity of cardiac muscle tissue Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively.

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 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 permanent pacemaker may be necessary if the block persists

Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for an elective electrical cardioversion?

Instruct the patient to restrict food and oral intake The nurse should instruct the patient to restrict food and oral intake before the cardioversion procedure. 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. When the patient is in cardiopulmonary arrest, the nurse should facilitate CPR until the patient is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a patient with cardiac dysrhythmia.

The nurse is caring for a client with a dysrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the dysrhythmia to be which of the following?

Ischemic heart disease The nurse realizes that the most common cause of dysrhythmias is ischemic heart disease. When the heart does not obtain sufficient blood to meet demands, the heart works harder to circulate body fluids and becomes inefficient in the process. Problems with the peripheral vessels, narrowing of the aorta and plaque buildup in the vessels may be a component of the disease process but not the best answer.

A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following?

It increases the force of the myocardial contraction A positive inotropic effect increases the force of myocardial contraction. A positive chronotropic effect increases the heart rate. A positive inotropic effect will usually help slow respiratory rate and will increase blood flow through the kidneys, so fluid output will increas

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 Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation.

Your client has just been prescribed Pronestyl for their dysrhythmia. What would you teach this client about the side effects?

Lupus-like syndrome Procainamide hydrochloride (Pronestyl) can have side effects of hypotension, GI upset, and a lupus-like syndrome; With long-term use, it may cause immune system problems.

A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia?

Magnesium and potassium Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances.

Which of the following nursing interventions must a nurse perform when administering prescribed vasopressors to a patient with a cardiac dysrhythmia?

Monitor vital signs and cardiac rhythm The nurse should monitor the patient's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill patient. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a patient flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.

The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block?

More P waves than QRS complexes 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 third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?

P wave

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?

Pacer rate After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG

A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding?

Peaked T waves The patient's serum potassium level is high. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a patient's serum potassium level is high. The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient's serum potassium level is low. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria and is not affected by a patient's serum potassium level. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization, and is not affected by a patient's serum potassium level.

A healthy 46-year-old woman is seeing her health care provider for her annual physical examination. While the nurse is taking the patient's vital signs, the patient states, "Occasionally, my heart skips a beat. Is this normal?" The nurse explains that this feeling is caused by which of the following?

Premature atrial complex

A healthy 46-year-old woman is seeing her health care provider for her annual physical examination. While the nurse is taking the patient's vital signs, the patient states, "Occasionally, my heart skips a beat. Is this normal?" The nurse explains that this feeling is caused by which of the following?

Premature atrial complex A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.

Which of the following ECG waveforms characterizes conduction of an electrical impulse through the left ventricle?

QRS complex The QRS complex represents ventricular depolarization. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.

The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up?

QT interval that is 0. 46 seconds long The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal.

The nurse is caring for a client who has developed junctional tachycardia with a heart rate (HR) of 80 bpm. Which of the following actions should the nurse complete?

Request a digoxin level be ordered. The nurse should request a digoxin level be obtained. Junctional tachycardia generally does not have any detrimental hemodynamic effect; it may indicate a serious underlying condition, such as digitalis toxicity, myocardial ischemia, hypokalemia, or chronic obstructive pulmonary disease (COPD). Potassium supplements do not cause junctional tachycardia. Lidocaine is indicated for the treatment of premature ventricular contractions (PVCs). Because junctional tachycardia is caused by increased automaticity, cardioversion is not an effective treatment; in fact, it causes an increase in ventricular rate

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 view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space. V2 is the left side of the sternum, fourth intercostal space. V3 is midway between V2 and V4. V4 is at the mid-clavicular line, fifth intercostal space.

The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button?

Shouts, "All clear"

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following?

Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers

A 66-year-old female client is having cardiac diagnostic tests to determine the cause of her symptoms. In her follow-up visit to the cardiologist, she is told that she has a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia did the tests reveal?

Sinus bradycardia

A patient comes to the emergency department with complaints 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 Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy).

The registered nurse reviewed the patient's q4h vital signs recorded by the LPN. He noticed a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. The nurse, aware that bradycardia can be a side-effect of medications, checked the patient's electronic health record. Select the medication that might cause bradycardia.

Tenormin Beta-blockers can lower the heart rate. The other choices stimulate the sympathetic response.

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 licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.

When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block?

Third degree In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria. In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.

Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes:

Treating the underlying cause Sinus tachycardia occurs in response to an underlying condition and will usually resolve once that condition is corrected.

The nurse is participating in the care of a client requiring emergent defibrillation. The nurse will complete the following steps in which order?

Turn on the defibrillator and place it in "not sync" mode. Charge the defibrillator to the prescribed voltage. Apply the multifunction conductor pads to the patient's chest. Call "clear" three times ensuring patient and environmental safety. Deliver the prescribed electrical charge.

You are discussing complications of a pacemaker with a group of nursing students. One of the students asks about complications associated with use of a cardiac pacemaker. Which of the following items are considered complications of a pacemaker? Choose all that apply. a. Twiddler syndrome b. Hiccuping c. Positive Kernig's d. Local infection e. Negative Babinski

Twiddler syndrome Hiccuping Localized infection Complications associated with pacemakers include infection at entry site, pneumothorax, bleeding and hematoma, hemothorax, ventricular ectopy and tachycardia, phrenic nerve/diaphragmatic(hiccupping)/skeletal stimulation, cardiac perforation, Twiddler syndrome, and hemodynamic instability. A positive Kernig's sign is an indication of meningitis. A positive Babinski reflex is normal in neonates, but indicates a central nervous system disorder in adults.

Which of the following ECG characteristics is usually seen when a patient's serum potassium level is low?

U wave

Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion?

Valium Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as Valium.

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 The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations

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 (Coumadin) Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone (Cordarone), flecainide (Tambocor), ibutilide (Corvert), propafenone (Rythmol), or sotalol (Betapace) prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation (Fuster, Rydén et al., 2011).

The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include?

Your family and friends may want to take a CPR class. Having friends and family learn to take a pulse and perform CPR will help patients to manage their condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness are symptoms which should be reported to the provider.

Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:

occur at a rate of more than six per minute When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy

A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents:

ventricular depolarization.