UNIT 5- CH 26 PREPU w/ rationales

A client's 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. elevated temperature shock strenuous exercise

All options are correct. Explanation: There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart, including fever, shock, and strenuous exercise.

A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker? Avoid sources of electrical interference. Keep the arm on the side of the pacemaker higher than the head. Delay activities such as swimming and bowling for at least 3 weeks. Keep moving the arm on the side where the pacemaker is inserted.

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

A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? Elective electrical cardioversion Chemical cardioversion Mace procedure Elective electrical defibrillation

Elective electrical cardioversion Explanation: 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.

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

Fluttering Explanation: 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 identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? Hypokalemia Alkalosis Hypovolemia Bradycardia

Hypokalemia Explanation: PVCs can be caused by - cardiac ischemia or infarction, - increased workload on the heart (e.g., exercise, fever, hypervolemia, heart failure, tachycardia), - digitalis toxicity, - acidosis, - or electrolyte imbalances, especially hypokalemia.

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? Date and time of insertion Location of the generator Model number Pacer rate

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

Which is not a likely origination point for cardiac dysrhythmias? bundle of His ventricles atria atrioventricular node

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

The nurse is admitting a client to a telemetry unit with an atrial dysrhythmia. What symptoms will the nurse further evaluate? chest pain hypertension leg pain hypocarbia

chest pain Explanation: Clients with atrial dysrhythmias may have - chest pain, shortness of breath, and low blood pressure. Leg pain is not common with atrial dysrhythmias. Hypocarbia is seen with reduced carbon dioxide, not common with chr pulmonary disease.

The nurse participates in the care of a client requiring emergent defibrillation. Arrange the steps in the order the nurse should complete them. All options must be used. 1Apply the multifunction conductor pads to the client's chest. 2Turn on the defibrillator and place it in "not sync" mode. 3Charge the defibrillator to the prescribed voltage. 4Call "clear" three times ensuring client and environmental safety. 5Deliver the prescribed electrical charge.

1.Apply the multifunction conductor pads to the client's chest. 2.Turn on the defibrillator and place it in "not sync" mode. 3.Charge the defibrillator to the prescribed voltage. 4.Call "clear" three times ensuring client and environmental safety. 5.Deliver the prescribed electrical charge.

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." "I should avoid large magnetic fields, such as an MRI machine or large motors." "I should avoid contact sports." "I'll watch the incision for swelling or redness and will report if either occurs."

"I should ask for a handheld device search when I go through airport security." Explanation: 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." "I can't wait to get back to my football league." "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." "I need to stay at least 10 inches away from the microwave."

"I'll keep a log of each time my ICD discharges." Explanation: The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD.

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." "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers."

"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and - represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers.

The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response? "The F waves are flutter waves representing atrial activity." "The F waves are flutter waves representing ventricular activity." "The F waves are normal parts of the heart conduction system" "The F waves are most likely caused by the new medication."

"The F waves are flutter waves representing atrial activity." Explanation: F waves = flutter waves = atrial activity. F waves are not representative of ventricular activity, nor are they normal parts of the heart's conduction system. F waves can be caused by: chronic pulmonary disease, valvular disease, thyrotoxicosis, and open heart surgery; they are not caused by medication.

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 P waves will be shaped differently." "The QRS complex will be smaller in sinus bradycardia." "The P-R interval will be prolonged in sinus bradycardia."

"The only difference is the heart rate." Explanation: All characteristics of sinus bradycardia are the same as those of normal sinus rhythm except for the rate, which will be below 60 in sinus bradycardia. The P waves will be shaped differently in other dysrhythmias. The QRS is the same voltage for sinus rhythms. The P-R interval is prolonged in atrioventricular blocks.

The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? "It is when the heart conduction is primarily from the atrioventricular node." "The rhythm has a normal beat, then a premature beat pattern." "The rhythm is regular but fast." "The heart rate is between 150 to 250 bpm."

"The rhythm has a normal beat, then a premature beat pattern." Explanation: Bigeminy is a rhythm in which every other complex is a (PVC). In trigeminy, every third complex is a PVC. The rhythm is not regular and the rate should not be 150-250 bpm.

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." "When your spouse needs help, an alarm will go off at the desk." "The box is recording the heart's electrical activity, and a physician will review the tracing later." "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute."

"The small box will transmit the heart rhythm to the central monitor all the time." Explanation: In telemetry, a small box transmits the client's heart rhythm to the central unit for constant monitoring. Telemetry has nothing to do with the client needing help. A Holter monitor is a device that records the heart's electrical activity and for later review by a physician. The telemetry transmits the heart rhythm regardless of the client's heart rate.

The nurse is working with a client with a new onset of atrial fibrillation during a 3-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? "The doctor wants to see if your heart will switch back to its normal rhythm by itself." "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." "There is a long list of clients in line to be cardioverted."

"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Explanation: 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. The doctor will not wait for a change in rhythm. Resting the heart will not change the rhythm. There is no delay but safer for the clots to be dissolved with the anticoagulant.

A client with type 2 diabetes and persistent atrial fibrillation is prescribed atenolol. Which actions will the nurse take when providing the medication to the client? Select all that apply. Monitor heart rate. Assess blood pressure. Track liver function studies. Monitor blood glucose level. Evaluate renal function studies.

-Monitor HR. -Assess BP. -Monitor BG level. Beta-blockers are classified as Class II antiarrhythmic medications. This classification of medication decreases automaticity and conduction to treat atrial arrhythmias, however, it has the potential for adverse effects such as bradycardia, therefore the heart rate should be monitored. Because it can cause hypotension, the blood pressure should be assessed. The medication also affects blood glucose level. Since the client has type 2 diabetes, the blood glucose level should be monitored. This medication does not affect liver or renal function.

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? Assessing the client's blood pressure and heart rate frequently Identifying the client's code level status Maintaining the client's intravenous fluids Alerting the healthcare provider of the third-degree heart block

Alerting the healthcare provider of the third-degree heart block Explanation: The client may experience low cardiac output with third-degree AV block. The healthcare provider needs to intervene to preserve the client's cardiac output. Monitoring the blood pressure and heart rate are important, but not the priority. The identification of a code status during a heart block is not appropriate. The IV fluids are not helpful if the heart is not perfusing.

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia

Atrial flutter Explanation: 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 3 or more PVCs in a row, occurring at a rate exceeding 100 bpm

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 Prepare for endotracheal intubation Provide electrical cardioversion Administer intravenous epinephrine

Begin cardiopulmonary resuscitation Explanation: In the acute care setting, when ventricular fibrillation is noted, 1. the nurse should call for assistance and defibrillate the client as soon as possible. 2. If defibrillation is not readily available, CPR is begun until the client can be defibrillated, 3. followed by advanced cardiovascular life support (ACLS) intervention, which includes endotracheal intubation and administration of epinephrine. X - Electrical cardioversion is not indicated for a client in ventricular fibrillation.

A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client's blood glucose level. Which medication is the client most likely taking? Procainamide Carvedilol Amiodarone Diltiazem

Carvedilol Explanation: The nurse must monitor blood glucose levels closely in clients with type 2 diabetes who are taking beta-adrenergic blockers such as carvedilol, because beta-adrenergic blockers may mask the signs of hypoglycemia. The nurse should monitor QRS duration in clients taking procainamide and pulmonary function in clients taking amiodarone (because the drug may cause pulmonary fibrosis). Diltiazem may cause an increased PR interval or bradycardia.

The nurse recognizes which as being true of cardioversion? Amount of voltage used should exceed 400 watts/second. Electrical impulse can be discharged during the T wave. Defibrillator should be set to deliver a shock during the QRS complex. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.

Defibrillator should be set to deliver a shock during the QRS complex. Explanation: Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation.

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? A variable heart rate, usually fewer than 60 bpm An irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden with the QRS complex

Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds).

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. Do nothing; there is no cause for alarm. Suggest the need for a new beta-blocker to the doctor. Measure the client's blood pressure.

Double-check the monitoring equipment. Explanation: One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

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. The procedure will occur in the operating room under general anesthesia. The procedure takes less time than a cardiac catheterization. After the procedure, the dysrhythmia will not recur.

During the procedure, the dysrhythmia will be reproduced under controlled conditions. Explanation: During EP studies, the patient is awake and may experience symptoms related to the dysrhythmia. The client does not receive general anesthesia. The EP procedure time is not easy to determine. EP studies do not always include ablation of the dysrhythmia.

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 Administer digitalis and diuretics 24 hours before cardioversion Facilitate CPR until the client is prepared for cardioversion Monitor blood pressure every 4 hours

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

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe? Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches

Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers Explanation: The correct sequence of conduction through the normal heart is the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers.

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 bradycardia Ventricular tachycardia Normal sinus rhythm Sinus tachycardia

Sinus tachycardia Explanation: 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 nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed? Heart rate between 60 and 150 beats per minute. Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 seconds. The ventricles depolarize in 0.5 seconds or less. The sinoatrial (SA) node initiates the impulse.

The sinoatrial (SA) node initiates the impulse. Explanation: The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats per minute; the SA node initiates the impulse; the impulse travels to the AV node in 0.12 to 0.2 seconds; the ventricles depolarize in 0.12 seconds or less; and each impulse occurs regularly.

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 normal sinus rhythm. sinus bradycardia. sinus dysrhythmia. sinus tachycardia.

sinus dysrhythmia. Explanation: Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm. Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway. Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.

A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? "I will drink coffee with only two of my meals." "I will cut back on my smoking and drinking alcohol." "If I take my metoprolol daily, I will be able to control my heart rate." "I will take my levothyroxine daily."

"I will drink coffee with only two of my meals." Explanation: Stimulation of the sympathetic nervous system with caffeinated beverages, smoking, and drinking alcohol increases heart rate. The client is still drinking caffeine with two meals, increasing the risk for a fast heart rate. Taking medications such as metoprolol and levothyroxine will help the client maintain a normal heart rate by decreasing stimulation of the sympathetic nervous system.

The nurse is providing teaching to a client with an implanted cardiac device. Which client statement indicates that teaching has been effective? "I will stop using the microwave oven." "I will not place my cell phone in my chest pocket." "I can safely have an MRI in the future if I need one." "I will not be able to fly with a pacemaker."

"I will not place my cell phone in my chest pocket." Explanation: 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. An ICD has a generator about the size of a pack of chewing gum that is implanted in a subcutaneous pocket, usually in the upper chest wall. Because of this, electronic devices should not be placed near the implanted generator as this could cause electromagnetic interference. There is no reason for the client to stop using the microwave oven. Since the MRI is a large magnetic field, MRIs should not be done in the future. A client is not restricted from flying due to having a pacemaker..

The nurse is providing discharge teaching with a client about pacemaker surveillance. Which client statement indicates a need for further teaching? "I will take acetaminophen prior to the appointment to lessen the interrogation pain." "If possible, I would like to use the transtelephonic method for a follow-up." "The surveillance frequency of the follow-up varies with each person." "The surveillance checks will determine how much battery life is available."

"I will take acetaminophen prior to the appointment to lessen the interrogation pain." Explanation: Pacemaker surveillance is painless, so there is no need to take any acetaminophen for the appointment. The surveillance can be done by transtelephonic transmission. The frequency of the surveillance appointments varies with each client. During the surveillance, battery life will be determined for client safety.

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 new myocardial infarction client A client with poor kidney perfusion A client with third-degree heart block A client with atrial arrhythmias

A client with atrial arrhythmias Explanation: The nurse is correct to identify a client with atrial arrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker.

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

Anticoagulant Explanation: 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.

The registered nurse reviewed the patient's vital signs and noted a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. What medication will cause bradycardia? Aminophylline Atropine Atenolol Epinephrine

Atenolol Explanation: Atenolol is a beta-blocker that can lower the heart rate. The other medications (Aminophylline, Atropine, Epinephrine) stimulate the sympathetic response which will increase heart rate.

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 Early ventricular repolarization Ventricular depolarization Ventricular repolarization

Atrial depolarization Explanation: The P wave = atrial depolarization. The QRS complex = ventricular depolarization. The T wave = ventricular repolarization. The ST segment = early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave.

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 patient may have a throbbing pain that is normal The patient will have to schedule monthly chest x-rays to make sure the device is patent.

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 postimplantation instruction must a nurse provide to a client with a permanent pacemaker? Keep the arm on the side of the pacemaker higher than the head Delay activities such as swimming and bowling for at least 3 weeks Keep moving the arm on the side where the pacemaker is inserted Avoid sources of electrical interference

Avoid sources of electrical interference Explanation: The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the client 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.

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? Stay at least 5 feet away from microwave ovens. Never engage in activities that require vigorous arm and shoulder movement. Avoid going through airport metal detectors. Avoid undergoing magnetic resonance imaging (MRI).

Avoid undergoing magnetic resonance imaging (MRI). Explanation: A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector.

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 Reposition the extremity and turn the client to left side Obtain a 12-lead ECG and a portable chest x-ray Check the security of all connections and increase the milliamperage

Document the findings and continue to monitor the client Explanation: 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 client. Repositioning the client, placing the client 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.

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. QRT wave P wave S-Q segment P-R interval T wave

P wave P-R interval T wave The EKG cardiac complex waves include the P wave, the QRS complex, the T wave, and possibly the U wave. The intervals and segments include the PR interval, the ST segment, and the QT interval.

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. QRT wave P wave S-Q segment P-R interval T wave

P wave P-R interval T wave The EKG cardiac complex waves include the P wave, the QRS complex, the T wave, and possibly the U wave. The intervals and segments include the PR interval, the ST segment, and the QT interval.

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? P wave PR interval QRS complex T wave

P wave = atrial depolarization Explanation: The P wave depicts atrial depolarization, or spread of the electrical impulse from the SA node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The T wave depicts the relative refractory period, representing ventricular repolarization.

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 medication causes the kidneys to retain fluid and increase intravascular volume. The medication increases the heart rate. The medication helps the kidneys produce more urine.

The medication increases the force (POSITIVE INOTROPIC) of the myocardial contraction. Explanation: A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine.

A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? The need to have regular blood levels drawn The importance of taking the medication 1 hour before or 2 hours after a meal The need to sit upright for 30 minutes after taking the medication The importance of adequate fluid intake

The need to have regular blood levels drawn Explanation: One drawback of warfarin therapy is the need to have blood levels drawn on a regular basis. The medication does not need to be taken on an empty stomach, and the client does not have to sit upright. Adequate fluid intake is useful in a general way, but the need for fluids is not increased by taking warfarin.

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 stating to administer digoxin The registered nurse administering atropine sulfate intravenously The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute The registered nurse stating to administer all medications except those which are cardiotonics

The registered nurse administering atropine sulfate intravenously Explanation: 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.

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 tachycardia Atrial fibrillation Third-degree heart block Ventricular fibrillation

Ventricular fibrillation Explanation: 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.

The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first? Sustained asystole Supraventricular tachycardia Atrial fibrillation Ventricular fibrillation

Ventricular fibrillation Explanation: Ventricular fibrillation is called the rhythm of a dying heart. It is the rhythm that needs attention first because there is no cardiac output, and it is an indication for CPR and immediate defibrillation. Sustained asystole either is from death, or the client is off of the cardiac monitor. Supraventricular tachycardia and atrial fibrillation are monitored and reported to the physician but are not addressed first.

A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? Adenosine Amiodarone Warfarin Atropine

Warfarin Explanation: 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, flecainide, ibutilide, propafenone, or sotalol 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 instructions for a client with a new arrhythmia. Which statement should the nurse include? Your family and friends may want to take a CPR class. It is not necessary to learn how to take your own pulse. If you miss a dose of your antiarrhythmic medication, double up on the next dose. Do not be concerned if you experience symptoms of lightheadedness and dizziness.

Your family and friends may want to take a CPR class. Explanation: Having friends and family learn to perform CPR will help the client manage the arrhythmia. - Monitoring pulse rate at home also helps the client manage the condition. - Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness should be reported to the provider.

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 prepare the client for a cardioversion administer an IV bolus of furosemide prepare client for a cardiac catheterization

administer an IV bolus of atropine Explanation: 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. Cardioversion is done with a fast heart rate. Furosemide will be given for fluid overload. Cardiac catheterization is administered for chest pain.

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 atrial flutter heart block bundle branch block

atrial fibrillation Explanation: 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 flutter, heart block, and bundle branch block would not produce these symptoms

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. request sublingual nitroglycerin. apply supplemental oxygen. lie down and elevate the feet.

avoid caffeinated beverages. Explanation: If premature atrial complexes (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 client to avoid caffeinated beverages.

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

embolic stroke. Explanation: Intervention is implemented to prevent the development of an embolic event/stroke. Clients with a history of previous stroke, transient ischemic attack (TIA), embolic event, mitral stenosis, or prosthetic heart valve and who develop atrial fibrillation are at significant risk of developing an embolic stroke. Antithrombotic therapy is indicated for all clients with atrial fibrillation, especially those at risk of an embolic event, such as a stroke, and it is the only therapy that decreases cardiovascular mortality. These client are often placed on warfarin, in contrast to clients who have no risk factors, and who are often prescribed 81 to 325 mg of aspirin daily.

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. inherent rhythmicity of all muscle tissue. sufficient blood pressure. inherent electrons in muscle tissue.

inherent rhythmicity of cardiac muscle tissue. Explanation: 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.