PrepU Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems

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 knows that what PR interval presents a first-degree heart block?

0.24 seconds

The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what?

Atrial rate of 300 to 400

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

A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients?

Clients with recurrent life-threatening tachydysrhythmias

After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension?

Decreased cardiac output and decreased systolic and diastolic blood pressure

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

A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next?

Question the client about alcohol and illicit drug use. Determining the cause of the tachycardia is essential.

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

The client has just been diagnosed with a dysrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm?

The sinoatrial (SA) node initiates the impulse.

The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?

Hypovolemia

A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?

Immediate CPR

A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:

Inherent rhythmicity of cardiac muscle tissue.

Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion?

Instruct the client to restrict food and oral intake

Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following?

"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."

The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply?

"The only difference is the heart rate."

The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response?

"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."

A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best?

"Warfarin prevents clot formation in the atria of clients with atrial fibrillation."

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 nurse is caring for a client who has a suspected dysrhythmia. What most appropriate intervention should the nurse use to help detect dysrhythmias?

Monitor cardiac rhythm continuously.

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?

A client with atrial dysrhythmias

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

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention?

Administer an IV bolus of Atropine

A client is scheduled for an elective electrical cardioversion for a sustained dysrhythmia lasting for 24 hours. Which intervention is necessary for the nurse to implement prior to the procedure?

Administer moderate sedation IV and analgesic medication as prescribed

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client?

Alerting the healthcare provider of the third-degree heart block

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

Anticoagulant

A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client '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 client and monitor leads

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

Atrial flutter

The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer?

Atropine sulfate

Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker?

Avoid sources of electrical interference

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?

Avoid undergoing magnetic resonance imaging (MRI)

A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?

Begin cardiopulmonary resuscitation

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)

Which is not a likely origination point for cardiac dysrhythmias?

Bundle of His. Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles.

The nurse knows that a pacemaker is the treatment of choice for what cardiac dysrhythmia?

Complete heart block

The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed?

The sinoatrial (SA) node initiates the impulse.

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

P wave

The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect?

Pacemaker site infection

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

Pacer rate

Which electrocardiogram (ECG) characteristic is usually seen when a client's serum potassium level is low?

U wave

The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm below. What dysthymia should the nurse document?

Ventricular tachycardia

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

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

QRS complex

The nurse analyzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up?

QT interval that is 0. 46 seconds long

A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have?

Sinus bradycardia

The nurse checks the synchronizer switch before using a defibrillator to terminate ventricular fibrillation for what important reason?

The defibrillator won't deliver a shock if the synchronizer switch is turned on.

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

Defibrillation

A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?

Double-check the monitoring equipment.

The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia?

Elective cardioversion

A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms?

Electrocardiogram

The nurse receives a client from the postanesthesia unit with a new onset of sinus tachycardia and a heart rate of 118 beats per minute. To which reasons does the nurse relate the increased heart rate? Select all that apply.

Fever, blood loss, anxiety

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

Fluttering

A nurse is caring for a client who has premature ventricular contractions. What sign would the nurse assess in this client?

Fluttering/heart skipping

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?

atrial fibrillation

A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation?

internal cardioverter defibrillator insertion

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

ventricular depolarization

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 to 25 lbs

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

The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse?

"The rhythm has a normal beat, then a premature beat pattern."

A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse?

"The small box will transmit the heart rhythm to the central monitor all the time."

After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm?

0.12 and 0.2 seconds

The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds?

0.2 seconds

A client has a medical diagnosis of an advanced first-degree atrioventricular block and is symptomatic. What initial treatment will the nurse be prepared to complete?

Administer an IV bolus of atropine

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?

Atrial depolarization

The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?

Atrial flutter

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

Avoid caffeinated beverages

The nurse recognizes which as being true of cardioversion?

Defibrillator should be set to deliver a shock during the QRS complex.

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

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

Diazepam (Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as diazepam.)

A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response?

Document the findings and continue to monitor the client

The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching?

During the procedure, the dysrhythmia will be reproduced under controlled conditions.

A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardiogram as an indicator of sinus tachycardia?

Heart rate of 118 bpm

The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia?

Heart rate of 42 beats per minute (bpm)

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?

Hypokalemia

Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?

Monitor vital signs and cardiac rhythm

The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as

Normal sinus rhythm

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply.

P wave, P-R interval, T wave

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

Peaked T waves

Which dysrhythmia is common in older clients?

Sinus bradycardia

When the nurse observes that the client's heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating

Sinus dysrhythmia

A patient comes to the emergency department with reports 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

A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response?

The medication increases the force of the myocardial contraction

The health care provider prescribes esmolol for a client with supraventricular tachycardia. During esmolol therapy, what should the nurse monitor?

heart rate and blood pressure