Advanced SOLE CH 7
Interpret the following rhythm: When the R wave of a PVC falls on the T wave of a normal beat
R-on-T phenomenon
Interpret the following rhythm: heart rate less than 60 beats per minute.
Sinus bradycardia
The normal width of the QRS complex is which of the following? (Select all that apply.)
0.06 to 0.10 seconds. 1.5 to 2.5 small boxes.
Electrocardiogram (ECG) paper contains a standardized grid where the horizontal axis measures time and the vertical axis measures voltage or amplitude. The nurse must understand that each horizontal box indicates:
40 milliseconds or 0.04 seconds duration.
The normal rate for the SA node when the patient is at rest is:
60 to 100 beats per minute.
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P wave and 20 small boxes between each R wave. What is the ventricular rate?
75 beats/min
Interpret the following rhythm: more critical type of heart block that requires early recognition and intervention. There is no progressive lengthening of the PR interval, which remains the same throughout with the exception of the dropped beat(s).
Second-degree AV block Mobitz II
Interpret the following rhythm: represented on the ECG as a progressive lengthening of the PR interval until there is a P wave without a QRS complex. In first-degree AV block, a P wave precedes every QRS complex, and every P wave is followed by a QRS. S
Second-degree AV block Mobitz I (Wenckebach phenomenon)
Interpret the following rhythm: arises from multiple chaotic quivering of the atria and ineffectual atrial contraction. The AV node is bombarded with hundreds of atrial impulses and conducts these impulses in an unpredictable manner to the ventricles.
Atrial Fibrillation
Interpret the following rhythm: used to mimic normal conduction and to produce atrial contraction, thus providing atrial kick.
Atrial pacing
The patient is in chronic junctional escape rhythm with no atrial activity noted. Studies have demonstrated normal AV node function. This patient may be a candidate for which type of pacing?
Atrial pacing
The patient is scheduled to have a permanent pacemaker implanted. The patient asks the nurse, How long will the battery in this thing last? The nurse should answer,
Battery life varies depending on usage, but it can last up to 10 years.
Sinus bradycardia is a symptom of which of the following? (Select all that apply.)
Calcium channel blocker medication Beta-blocker medication Athletic conditioning Hypothermia
Interpret the following rhythm: Atrial and ventricular rates are the same and range from 60 to 100 beats per minute. Rhythm is regular or essentially regular. PR interval is 0.12 to 0.20 seconds. QRS interval is 0.06 to 0.10 seconds. P and QRS waves are consistent in shape.
Normal sinus rhythm
Interpret the following rhythm:allows for stimulation of both atria and ventricles as needed to synchronize the chambers and mimic the normal cardiac cycle.
Dual-chamber pacing
Interpret the following rhythm:occurs when the pacemaker fails to initiate an electrical stimulus when it should fire. The problem is noted by absence of pacer spikes on the rhythm strip
Failure to pace.
Interpret the following rhythm: manifests as pacer spikes that fall too closely to the patients own rhythm, earlier than the programmed rate. The most common cause is displacement of the pacemaker electrode wire.
Failure to sense.
Which of the following are common causes of sinus tachycardia? (Select all that apply.)
Hyperthyroidism Hypovolemia Heart Failure
Interpret the following rhythm: escape rhythm that is generated by the Purkinje fibers. This rhythm emerges only when the SA and AV nodes fail to initiate an impulse.
Idioventricular rhythm
Interpret the following rhythm: If P wave precedes QRS, it is inverted or upside down; the P wave may not be visible, or it may follow the QRS. If a P wave is present before the QRS, the PR interval is shortened to less than 0.12 milliseconds. The normal intrinsic rate for the AV node and junctional tissue is 40 to 60 beats per minute, but rates can accelerate.
Junctional rhythm
Because of the location of the AV node, the possible P waveforms that are associated with junctional rhythms include which of the following? (Select all that apply.)
No P wave Inverted P wave Shortened PR interval P wave after the QRS complex
Interpret the following rhythm: single ectopic beat arising from atrial tissue, not the sinus node. The PAC occurs earlier than the next normal beat and interrupts the regularity of the underlying rhythm.
Sinus rhythm with PACs
Interpret the following rhythm: PVCs may occur in a predictable pattern, such as every other beat (bigeminal)
Sinus rhythm with bigeminal premature ventricular contractions
Interpret the following rhythm: P and QRS waves are consistent in shape. P waves are small and rounded. A P wave precedes every QRS complex, which is followed by a T wave. PR interval is prolonged and is greater than 0.20 seconds. QRS complex and QT/QTc measurements are normal.
Sinus rhythm with first-degree AV block
Interpret the following rhythm:. Waveforms of PVCs arising from multiple foci are not identical
Sinus rhythm with multifocal premature ventricular contractions
Interpret the following rhythm: Two PVCs in a row
Sinus rhythm with paired premature ventricular contractions (couplets)
Interpret the following rhythm:A single ectopic focus produces PVC waveforms that look alike
Sinus rhythm with unifocal premature ventricular contractions
Interpret the following rhythm: SA node fires faster than 100 beats per minute.
Sinus tachycardia
The nurse is caring for a patient who has atrial fibrillation. Sequelae that place the patient at greater risk for mortality/morbidity include which of the following? (Select all that apply.)
Stroke Pulmonary emboli Decreased cardiac output
Which of the following is true about a patient diagnosed with sinus arrhythmia?
The heart rate varies, dependent on vagal tone and respiratory pattern.
Interpret the following rhythm: often called complete heart block because no atrial impulses are conducted through the AV node to the ventricles.
Third-degree AV block (complete heart block)
Interpret the following rhythm: The P waves are called flutter waves and may have a sawtooth appearance. The ventricular response may be regular or irregular based on how many flutter waves are conducted through the AV node.
Ventricular fibrillation
Interpret the following rhythm: stimulates ventricular depolarization and is commonly used in emergency situations or when pacing is required infrequently.
Ventricular pacing
The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient is on digitalis medication at home. The nurse should expect that:
a digitalis level would be ordered upon admission.
The patient is in third-degree heart block (complete heart block) and is symptomatic. The treatment for this patient is which of the following? (Select all that apply.)
transcutaneous pacemaker. temporary transvenous pacemaker. permanent pacemaker.
The patients heart rate is 70 beats per minute, but the P waves come after the QRS complex. The nurse correctly determines that the patients heart rhythm is:
an accelerated junctional rhythm.
The nurse is working on the night shift when she notices sinus bradycardia on the patients cardiac monitor. The nurse should:
assess for hemodynamic instability.
The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex. The nurse should:
assess the patient and the electrical leads.
The patient is admitted with sinus pauses causing periods of loss of consciousness. The patient is asymptomatic, awake and alert, but fatigued. He answers questions appropriately. When admitting this patient, the nurse should first:
assess the patients medication profile.
The nurse is reading the cardiac monitor and notes that the patients heart rhythm is extremely irregular and there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is hemodynamically stable. The nurse realizes that the patients rhythm is:
atrial fibrillation.
The patient is alert and talking when the nurse notices the following rhythm. The patients blood pressure is 90/44 mm Hg. The nurse should
treat with intravenous amiodarone or lidocaine.
The nurse notices ventricular tachycardia on the heart monitor. When the patient is assessed, the patient is found to be unresponsive with no pulse. The nurse should:
begin cardiopulmonary resuscitation and advanced life support.
The patient is admitted with a condition that requires cardiac rhythm monitoring. To apply the monitoring electrodes, the nurse must first:
clip chest hair if needed.
The patients heart rate is 165 beats per minute. His cardiac monitor shows a rapid rate with narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patients blood pressure has dropped from 124/62 to 78/30. His skin is cold and diaphoretic and he is complaining of nausea. The nurse prepares the patient for:
emergent cardioversion.
The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS complexes following the spikes. The nurse realizes this as:
failure to capture.
The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min. The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes. The nurse realizes this as:
failure to pace.
The nurse is examining the patients cardiac rhythm strip in lead II and notices that all of the P waves are upright and look the same except one that has a different shape and is inverted. The nurse realizes that the P wave with the abnormal shape is probably:
from some area in the atria other than the SA node.
The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse first:
identifies the markers on the ECG paper that indicate a 6-second strip.
The QT interval is the total time taken for ventricular depolarization and repolarization. Prolongation of the QT interval:
increases the risk of lethal dysrhythmias.
The patients heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and understands that the rhythm is due to the:
loss of sinus node activity.
The nurse notices that the patient has a first-degree AV block. Everything else about the rhythm is normal. The nurse should:
monitor the rhythm and patients condition.
The nurse understands that in a third-degree AV block:
none of the P waves are conducted to the ventricles.
The nurse notes the following rhythm on the heart monitor. The patient is unresponsive and not breathing. The nurse should
provide emergent basic and advanced life support.
One of the functions of the atrioventricular (AV) node is to:
slow the impulse arriving from the SA node.
The nurse is caring for a patient who is on a cardiac monitor. The nurse realizes that the sinus node is the pacemaker of the heart because it is:
the fastest pacemaker cell in the heart.
The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute. The nurse realizes that:
the pacemaker will pace only if the patients intrinsic heart rate is less than 60 beats per minute.
The patient is having premature ventricular contractions (PVCs). The nurses greatest concern should be:
the proximity of the R wave of the PVC to the T wave of a normal beat.
The patient is admitted with a fever and rapid heart rate. The patients temperature is 103 F (39.4 C).The nurse places the patient on a cardiac monitor and finds the patients atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is regular, and blood pressure is normal. The nurse should focus on providing:
treatment to lower temperature.
When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to understand that the electrical activity is viewed in relation to the positive electrode of that particular lead. When an electrical signal is aimed directly at the positive electrode, the inflection will be:
upright.
