AHT 3 - Cardiac Dysrhythmia - ATI, Lewis, Evolve. MOD 4- Exam 1

A patient in asystole is likely to receive which drug treatment? A Epinephrine and atropine B Lidocaine and amiodarone C Digoxin and procainamide D β-adrenergic blockers and dopamine

A Epinephrine and atropine Normally the patient in asystole cannot be successfully resuscitated. However, administration of epinephrine and atropine may prompt the return of depolarization and ventricular contraction. Lidocaine and amiodarone are used for PVCs. Digoxin and procainamide are used for ventricular rate control. β-adrenergic blockers are used to slow heart rate, and dopamine is used to increase heart rate.

The patient has hypokalemia, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm; the P wave is 0.06 seconds (sec) and normal shape; the PR interval is 0.24 sec; the QRS is 0.09 sec. How should the nurse document this rhythm? A First-degree AV block B Second-degree AV block C Premature atrial contraction (PAC) D Premature ventricular contraction (PVC)

A First-degree AV block

A patient has sought care following a syncopal episode of unknown etiology. Which nursing action should the nurse prioritize in the patient's subsequent diagnostic workup? A Preparing to assist with a head-up tilt-test B Preparing an IV dose of a β-adrenergic blocker C Assessing the patient's knowledge of pacemakers D Teaching the patient about the role of antiplatelet aggregators

A Preparing to assist with a head-up tilt-test In patients without structural heart disease, the head-up tilt-test is a common component of the diagnostic workup following episodes of syncope. IV β-blockers are not indicated although an IV infusion of low-dose isoproterenol may be started in an attempt to provoke a response if the head-up tilt-test did not have a response. Addressing pacemakers is premature and inappropriate at this stage of diagnosis. Patient teaching surrounding antiplatelet aggregators is not directly relevant to the patient's syncope at this time.

A client's ECG tracing shows a run of sustained ventricular tachycardia. What is the first action that the nurse will take? Assess the client's airway, breathing, and level of consciousness. Administer verapamil IV push. Defibrillate the client. Begin cardiopulmonary resuscitation (CPR).

Assess the client's airway, breathing, and level of consciousness.

The nurse is doing discharge teaching with the patient and spouse of the patient who just received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates to the nurse that the patient needs more teaching? A "I will call the cardiologist if my ICD fires." B "I cannot fly because it will damage the ICD." C "I cannot move my left arm until it is approved." D "I cannot drive until my cardiologist says it is okay."

B "I cannot fly because it will damage the ICD." The patient statement that flying will damage the ICD indicates misunderstanding about flying. The patient should be taught that informing TSA about the ICD can be done because it may set off the metal detector and if a hand-held screening wand is used, it should not be placed directly over the ICD. The other options indicate the patient understands the teaching.

The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead there are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. The nurse correctly interprets this rhythm as what? A Sinus tachycardia B Atrial fibrillation C Ventricular fibrillation D Ventricular tachycardia

B Atrial fibrillation Atrial fibrillation is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not truly contracting, just fibrillating. Sinus tachycardia is a sinus rate above 100 beats/minute with normal P waves. Ventricular fibrillation is seen on the ECG without a visible P wave; an unmeasurable heart rate, PR or QRS; and the rhythm is irregular and chaotic. Ventricular tachycardia is seen as three or more premature ventricular contractions (PVCs) that have distorted QRS complexes with regular or irregular rhythm, and the P wave is usually buried in the QRS complex without a measurable PR interval.

The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? A Myocardia injury B Myocardial ischemia C Myocardial infarction D A pacemaker is present.

B Myocardial ischemia The ST depression and T wave inversion on the ECG of a patient diagnosed with ACS indicate myocardial ischemia from inadequate supply of blood and oxygen to the heart. Myocardial injury is identified with ST-segment elevation. Myocardial infarction is identified with ST-segment elevation and a widened and deep Q wave. A pacemaker's presence is evident on the ECG by a spike leading to depolarization and contraction.

Evolve online quiz ch 35... When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be A 60 beats/min. B 75 beats/min. C 100 beats/min. D 150 beats/min.

C 100 beats/min. Since each small block on the ECG paper represents 0.04 seconds, 1500 of these blocks represents 1 minute. By dividing the number of small blocks (15, in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100). pic attached ATI p.179. Lewis p 757

The nurse is monitoring the ECGs of several patients on a cardiac telemetry unit. The patients are directly visible to the nurse, and all of the patients are observed to be sitting up and talking with visitors. Which patient's rhythm would require the nurse to take immediate action? A A 62-year-old man with a fever and sinus tachycardia with a rate of 110 beats/minute B A 72-year-old woman with atrial fibrillation with 60 to 80 QRS complexes per minute C A 52-year-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute D A 42-year-old woman with first-degree AV block and sinus bradycardia at a rate of 56 beats/minute

C A 52-year-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute Frequent premature ventricular contractions (PVCs) (greater than 1 every 10 beats) may reduce the cardiac output and precipitate angina and heart failure, depending on their frequency. Because PVCs in CAD or acute MI indicate ventricular irritability, the patient's physiologic response to PVCs must be monitored. Frequent PVCs most likely must be treated with oxygen therapy, electrolyte replacement, or antidysrhythmic agents.

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time? A Reinforcing the pressure dressing as needed B Encouraging range-of-motion exercises of the involved arm C Assessing the incision for any redness, swelling, or discharge D Applying wet-to-dry dressings every 4 hours to the insertion site

C Assessing the incision for any redness, swelling, or discharge After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site. The nonpressure dressing is kept dry until removed, usually 24 hours postoperatively. It is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement.

Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)? A Unmeasurable rate and rhythm B Rate 150 beats/min; inverted P wave C Rate 200 beats/min; P wave not visible D Rate 125 beats/min; normal QRS complex

C Rate 200 beats/min; P wave not visible VT is associated with a rate of 150 to 250 beats/min; the P wave is not normally visible. Rate and rhythm are not measurable in ventricular fibrillation. P wave inversion and a normal QRS complex are not associated with VT.

The nurse is seeing artifact on the telemetry monitor. Which factors could contribute to this artifact? A Disabled automaticity B Electrodes in the wrong lead C Too much hair under the electrodes D Stimulation of the vagus nerve fibers

C Too much hair under the electrodes Artifact is caused by muscle activity, electrical interference, or insecure leads and electrodes that could be caused by excessive chest wall hair. Disabled automaticity would cause an atrial dysrhythmia. Electrodes in the wrong lead will measure electricity in a different plane of the heart and may have a different wave form than expected. Stimulation of the vagus nerve fibers causes a decrease in heart rate, not artifact.

The client with tachycardia is experiencing clinical manifestations. Which one alerts the nurse to the need for immediate intervention? Chest pain Increased urine output Mild orthostatic hypotension P wave touching the T wave

Chest pain

The nurse performs discharge teaching for a 74-year-old woman with an implantable cardioverter-defibrillator. Which statement by the patient indicates to the nurse that further teaching is needed? A "The device may set off the metal detectors in an airport." B "My family needs to keep up to date on how to perform CPR." C "I should not stand next to antitheft devices at the exit of stores." D "I can expect redness and swelling of the incision site for a few days."

D "I can expect redness and swelling of the incision site for a few days." Patients should be taught to report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever to their primary care provider immediately. Teach the patient to inform airport security of presence of ICD because it may set off the metal detector. If hand-held screening wand is used, it should not be placed directly over the ICD. Teach the patient to avoid standing near antitheft devices in doorways of stores and public buildings, and to walk through them at a normal pace. Caregivers should learn cardiopulmonary resuscitation (CPR).

...Evolve online quiz ch 35 A 50-year-old man who develops third-degree heart block reports feeling chest pressure and shortness of breath. Which instructions should the nurse provide to the patient before initiating emergency transcutaneous pacing? A "The device will convert your heart rate and rhythm back to normal." B "The device uses overdrive pacing to slow the heart to a normal rate." C "The device is inserted through a large vein and threaded into your heart." D "The device delivers a current through your skin that can be uncomfortable."

D "The device delivers a current through your skin that can be uncomfortable." Before initiating transcutaneous pacing (TCP) therapy, it is important to tell the patient what to expect. The nurse should explain that the muscle contractions created by the pacemaker when the current passes through the chest wall are uncomfortable. Pacing for complete heart block will not convert the heart rhythm to normal. Overdrive pacing is used for very fast heart rates. Transcutaneous pacing is delivered through pacing pads adhered to the skin.

A client with third-degree AV block presents to the emergency room with a heart rate of 40 beats/min. Which nursing diagnosis would most likely be a priority for this client? Decreased Cardiac Output Impaired Electrical Conduction Impaired Self-Care Management

Decreased Cardiac Output

What does the P wave on an ECG tracing represent? Contraction of the atria Contraction of the ventricles Depolarization of the atria Depolarization of the ventricles

Depolarization of the atria

A nurse is caring for a client with chronic atrial fibrillation who is at risk for systemic emboli. Which drug should the nurse expect to administer to prevent this complication? Heparin (Heparin) Atropine (Atropine) Lidocaine (Xylocaine) Sotalol (Betapace)

Heparin (Heparin)

Which action will the nurse take to improve the quality of the electrocardiographic rhythm transmission to the monitoring system? Remove the hair from the chest area before attaching the chest leads. Instruct the client not to wear any clothing made from synthetic fabrics during the test. Apply skin protectant to area prior to placing electrode. Apply lotion to the client's chest before attaching the chest leads.

Remove the hair from the chest area before attaching the chest leads.

The nurse observes a prominent U wave on the client's ECG tracing. What is the nurse's interpretation of this finding? This is a normal finding. The client may have a potassium imbalance. The client is at risk for R-on-T phenomenon. The client has an evolving myocardial infarction.

The client may have a potassium imbalance.

Which dysrhythmia may develop in a client with frequent premature ventricular contractions? Sinus tachycardia Rapid atrial flutter Ventricular tachycardia Atrioventricular junctional rhythm

Ventricular tachycardia

For which dysrhythmia is defibrillation primarily indicated? A Ventricular fibrillation B Third-degree AV block C Uncontrolled atrial fibrillation D Ventricular tachycardia with a pulse

A Ventricular fibrillation Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). Pacemakers are the treatment of choice for third-degree heart block.

ATI ch 28... A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia? (Select all that apply.) A. A client who has metabolic alkalosis B. A client who has a serum potassium level of 4.3 mEq/L C. A client who has an SaO2 of 96% D. A client who has COPD E. A client who underwent stent placement in a coronary artery

A. CORRECT: A client who has an acid‐base imbalance such as metabolic alkalosis is at risk for a dysrhythmia. B. A serum potassium of 4.3 mEq/L is within the expected reference range and does not increase the risk of a dysrhythmia. C. SaO2 of 96% is within the expected reference range and does not increase the risk of a dysrhythmia. D. CORRECT: A client who has lung disease, such as COPD, is at risk for a dysrhythmia. E. CORRECT: A client who has cardiac disease and underwent a stent placement is at risk for a dysrhythmia.

ATI ch 29 Pacemakers & implantables... A nurse is admitting a client who has complete heart block as demonstrated by ECG. The client's heart rate is 34/min and blood pressure is 83/48 mm Hg. The client is lethargic and unable to complete sentences. Which of the following actions should the nurse perform first? A. Transport the client to the cardiovascular laboratory. B. Prepare the client for insertion of a permanent pacemaker. C. Obtain a signed informed consent form for a pacemaker. D. Apply transcutaneous pacemaker pads.

A. Plan to transport the client to the cardiovascular laboratory for placement of a permanent pacemaker to control the client's heart; however, there is another action the nurse should take first. B. Plan to prepare the client for insertion of a permanent pacemaker by cleansing the skin and clipping excess hair; however, there is another action the nurse should take first. C. Obtain informed consent for placement of a permanent pacemaker if an individual with authority to make decisions for the client is present; however, there is another action the nurse should take first. Emergency procedures can be performed without consent if the client is not coherent. D. CORRECT: The greatest risk to this client is injury or death from inadequate tissue perfusion; therefore, the first action the nurse should take is to apply transcutaneous pacemaker pads and begin external pacing of the heart until a permanent pacemaker can be placed.

Cardioversion is attempted for a 64-year-old man with atrial flutter and a rapid ventricular response. After the nurse delivers 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take immediately? A Administer 250 mL of 0.9% saline solution IV by rapid bolus. B Assess the apical pulse, blood pressure, and bilateral neck vein distention. C Turn the synchronizer switch to the "off" position and recharge the device. D Tell the patient to report any chest pain or discomfort and administer morphine sulfate.

C Turn the synchronizer switch to the "off" position and recharge the device. Ventricular fibrillation produces no effective cardiac contractions or cardiac output. If during synchronized cardioversion the patient becomes pulseless or the rhythm deteriorates to ventricular fibrillation, the nurse should turn the synchronizer switch off and initiate defibrillation. Fluids, additional assessment, or treatment of pain alone will not restore an effective heart rhythm.

A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure? (Select all that apply.) A. Follow‐up ECG B. Energy settings used C. IV fluid intake D. Urinary output E. Skin condition under electrodes

A. CORRECT: The client's ECG rhythm is documented following the procedure. B. CORRECT: Energy settings used during the procedure are documented. C. IV fluid intake is not documented during defibrillation. D. Urinary output is not documented during defibrillation. E. CORRECT: The condition of the client's skin where electrodes were placed is documented.

The ECG monitor of a patient in the cardiac care unit after an MI indicates ventricular bigeminy with a rate of 50 beats/min. The nurse would anticipate a. performing defibrillation b. treating with IV amiodarone c. inserting a temporary transvenous pacemaker d. assessing the patient's response to the dysrhythmia

d. assessing the patient's response to the dysrhythmia Rationale: A premature ventricular contraction (PVC) is a contraction originating in an ectopic focus in the ventricles. When every other beat is a PVC, the rhythm is called ventricular bigeminy. PVCs are usually a benign finding in patients with a normal heart. In patients with heart disease, PVCs may reduce the cardiac output and precipitate angina and heart failure, depending on the frequency. Because PVCs in coronary artery disease (CAD) or acute myocardial infarction indicate ventricular irritability, the patient's physiologic response to PVCs must be monitored. Assessment of the patient's hemodynamic status is important for determining whether treatment with drug therapy is needed.

The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that a. defibrillation requires a lower dose of electrical energy b. cardioversion is indicated to treat atrial bradydysrhythmias c. defibrillation is synchronized to deliver a shock during the QRS complex d. patients should be sedated if cardioversion is done on a non-emergency basis

d. patients should be sedated if cardioversion is done on a non-emergency basis Rationale: Synchronized cardioversion is the therapy of choice for patients with hemodynamically unstable ventricular or supraventricular tachydysrhythmias. A synchronized circuit in the defibrillator delivers a countershock that is programmed to occur on the R wave of the QRS complex of the electrocardiogram. The synchronizer switch must be turned on when cardioversion is planned. The procedure for synchronized cardioversion is the same as for defibrillation with the following exceptions: If synchronized cardioversion is performed on a nonemergency basis, the patient is sedated before the procedure, and the initial energy needed for synchronized cardioversion is less than the energy needed for defibrillation.

A nurse is completing discharge teaching with a client who has a permanent pacemaker. Which of the following statements by the client indicates understanding of the teaching? A. "I will notify the airport screeners about my pacemaker." B. "I will expect to have occasional hiccups." C. "I will have to disconnect my garage door opener." D. "I will take my pulse every 2 to 3 days."

A. CORRECT: The client should notify airport screening personnel about a pacemaker. B. The client should report hiccups to the provider because they can indicate improper lead placement. C. The use of household appliances, such as microwaves and garage door openers, does not affect pacemaker function. D. The client should check their pulse at the same time every day to ensure the pacemaker is maintaining the prescribed heart rate.

A nurse on a cardiac unit is caring for a client who is on telemetry. The nurse recognizes the client's heart rate is 46/min and notifies the provider. The nurse should anticipate that which of the following management strategies will be used for this client? A. Defibrillation B. Pacemaker insertion C. Synchronized cardioversion D. Administration of IV lidocaine

A. Defibrillation is used when a client has ventricular fibrillation or pulseless ventricular tachycardia. B. CORRECT: A client who has bradycardia is a candidate for a pacemaker to increase his heart rate. C. Synchronized cardioversion is used when a client has a dysrhythmia such as atrial fibrillation, supraventricular tachycardia (SVT), or ventricular tachycardia with pulse. D. The administration of IV lidocaine is used in clients who have a pulseless ventricular dysrhythmia to stimulate cardiac electrical function.

...ATI ch 28 A student nurse is observing a cardioversion procedure and hears the team leader call out, "Stand clear." The student should recognize the purpose of this action is to alert personnel that A. the cardioverter is being charged to the appropriate setting. B. they should initiate CPR due to pulseless electrical activity. C. they cannot be in contact with equipment connected to the client. D. a time‐out is being called to verify correct protocols.

A. The cardioverter is charged prior to the delivery of the shock during cardioversion. B. The team leader calls out "Initiate CPR" when members of the team are to begin CPR. C. CORRECT: A safety concern for personnel performing cardioversion is to "stand clear" of the client and equipment connected to the client when a shock is delivered to prevent them from also receiving a shock. D. A "time‐out" is called by personnel during a procedure to verify that proper protocols are being followed.

The client is experiencing occasional premature atrial contractions (PACs) accompanied by palpitations. These episodes resolve spontaneously without treatment. What instructions will be included in a teaching plan for this client? Limit or abstain from caffeine. Lie on your left side until the attack subsides. Use your oxygen whenever you experience PACs. Take your quinidine twice daily on the days that you experience palpitations.

Limit or abstain from caffeine.

Lewis Bridge to NCLEX ch 35... A patient admitted with ACS has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate 74 beats/min and regular; ventricular rate 62 beats/min and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. The priority nursing intervention would be to a. perform synchronized cardioversion b. administer epinephrine 1 mg IV push c. observe for symptoms of hypotension or angina d. apply transcutaneous pacemaker pads on the patient

c. observe for symptoms of hypotension or angina Rationale: The rhythm is a second-degree atrioventricular (AV) block, type I (i.e., Mobitz I or Wenckebach heart block). The rhythm is characterized by a gradual lengthening of the PR interval. Type I AV block is usually a result of myocardial ischemia or infarction and typically is transient and well tolerated. The nurse should assess for bradycardia, hypotension, and angina. If the patient experiences symptoms, atropine or a temporary pacemaker may be needed.

A nurse working on a cardiac unit is admitting a client who is to undergo a cardioversion and is reviewing the health record. Which of the following data requires that the nurse notify the provider to cancel the procedure? (Review the data below for additional client information.) MAR Ferrous Sulfate 200 mg PO 0800 and 2000 Diazepam 2 mg PO 0800 and 2000 Isosorbide 2.5 mg PO 4 times a day AC and HS VITAL SIGNS 0800: T 99° F (37.2° C), Blood pressure 142/86 mm Hg Heart rate 88/min and irregular, Respirations 20/min HISTORY AND PHYSICAL Bariatric surgery 10 years ago Dyspnea with exertion for 3 years Atrial fibrillation began 3 years ago Client reports taking the following medications for the past 6 weeks: iron supplement, multivitamin, antilipemic, and nitroglycerin A.Respiratory history B.Vital signs C.Medication history D.Medications to be administered

A. A client who has a dysrhythmia often has a history of lung disease, which can make him a candidate for cardioversion. B. A client who has a dysrhythmia might have an irregular pulse, which can make him a candidate for cardioversion. C. CORRECT: A client who is to undergo cardioversion needs to be on anticoagulant therapy for 4 to 6 weeks prior to the procedure. D. A client who has a dysrhythmia often has a history of cardiac disease and angina, which can make him a candidate for cardioversion.

A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is set as a VVI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Cool and clammy foot with capillary refill of 5 seconds B. Observed pacing spike followed by a QRS complex C. Persistent hiccups D. Heart rate 84/min E. Blood pressure 104/62 mm Hg

A. CORRECT: A cool, clammy foot can be an indication of a femoral hematoma secondary to insertion of the lead wires and should be reported. B. A pacing spike followed by a QRS complex is an expected finding. C. CORRECT: Persistent hiccups can indicate lead wire perforation and stimulation of the diaphragm and should be reported. D. A heart rate of 84/min is an expected finding. E. A blood pressure of 104/62 mm Hg is an expected finding.

A cardiac nurse educator is reviewing the use of the fixed rate mode pacemaker with a group of newly hired nurses. Which of the following statements by a newly hired nurse indicates understanding of the review? A. "This means the pacemaker fires in an asynchronous pattern." B. "This means the pacemaker fires only when the heart rate is below a certain rate." C. "The pacemaker can automatically adjust to a client's increased activity level." D. "The pacemaker activity is triggered by heart muscle activity."

A. CORRECT: Fixed rate mode is asynchronous, meaning the pacemaker fires without regard for electrical activity in the heart. B. D emand mode detects an electrical impulse, and the pacemaker will then fire only if this impulse remains below a certain level. C. Fixed rate pacemaker mode means the rate does not change in relation to activity level. D. Fixed rate mode means the pacemaker fires without regard for electrical activity in the heart.

...ATI ch 29 Pacemakers & implantables. A nurse is completing discharge teaching with a client following placement of an ICD. Which of the following information should the nurse include? (Select all that apply.) A. Avoid large magnetic fields. B. Caution family members that they can receive harmful unexpected shocks from the ICD. C. Take body temperature at the same time each day. D. Wear tight clothing to hold the device in place. E. Perform arm stretching exercises to strengthen muscles surrounding the ICD.

A. CORRECT: Large magnetic fields can deactivate the device, causing it to be ineffective for dysrhythmias. B. Family members can feel the shock of an ICD if in contact with the client, but the shock is not harmful. C. CORRECT: The client should take their temperature at the same time each day and report any increase to the provider. This is done to monitor for infection. D. The client should avoid wearing tight clothing, as this can cause friction over the insertion site. E. The client should restrict arm movement until healing of the incision occurs. The client should not raise arms above the head for 2 weeks.

The patient has atrial fibrillation with a rapid ventricular response. The nurse knows to prepare for which treatment if an electrical treatment is planned for this patient? A Defibrillation B Synchronized cardioversion C Automatic external defibrillator (AED) D Implantable cardioverter-defibrillator (ICD)

B Synchronized cardioversion Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response). Defibrillation or AEDs are the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia (VT). An ICD is used with patients who have survived sudden cardiac death (SCD), have spontaneous sustained VT, and are at high risk for future life-threatening dysrhythmias.

Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? A The length of time it takes to depolarize the atrium B The length of time it takes for the atria to depolarize and repolarize C The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers D The length of time it takes for the electrical impulse to travel from the SA node to the AV node

C The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers in order for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and is not usually measured.

A 38-year-old teacher who reported dizziness and shortness of breath while supervising recess is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole? A Atropine sulfate B Digoxin (Lanoxin) C Metoprolol (Lopressor) D Adenosine (Adenocard)

D Adenosine (Adenocard) IV adenosine (Adenocard) is the first drug of choice to convert supraventricular tachycardia to a normal sinus rhythm. Adenosine is administered IV rapidly (over 1 or 2 seconds) followed by a rapid, normal saline flush. The nurse should monitor the patient's ECG continuously because a brief period of asystole after adenosine administration is common and expected. Atropine sulfate increases heart rate, whereas lanoxin and metoprolol slow the heart rate.

Which patient teaching points should the nurse include when providing discharge instructions to a patient with a new permanent pacemaker and the caregiver (select all that apply)? a. Avoid or limit air travel b. Take and record a daily pulse rate c. Obtain and wear a Medic Alert ID device at all times d. Avoid lifting arm on the side of the pacemaker above shoulder e. Avoid microwave ovens because they interfere with pacemaker function

b. Take and record a daily pulse rate c. Obtain and wear a Medic Alert ID device at all times d. Avoid lifting arm on the side of the pacemaker above shoulder Rationale: Pacemaker discharge teaching should include the following instructions: First, air travel is not restricted. The patient should inform airport security of the presence of a pacemaker because it may set off the metal detector. If a hand-held screening wand is used, it should not be placed directly over the pacemaker. Manufacturer information may vary with regard to the effect of metal detectors on the function of the pacemaker. Second, the patient should monitor the pulse and inform the cardiologist if it drops below a predetermined rate. Third, the patient should obtain and wear a Medic Alert ID device at all times. Fourth, the patient must avoid lifting the arm on the pacemaker side above the shoulder until this is approved by the cardiologist. Fifth, microwave ovens are safe to use, and they do not interfere with pacemaker function. Table 35-13 provides additional discharge teaching guidelines for a patient with a pacemaker.

The nurse is monitoring the ECG of a patient admitted with ACS. Which ECG characteristics would be most suggestive of myocardial ischemia? a. Sinus rhythm with a pathologic Q wave b. Sinus rhythm with an elevated ST segment c. Sinus rhythm with a depressed ST segment d. Sinus rhythm with premature atrial contractions

c. Sinus rhythm with a depressed ST segment Rationale: Typical electrocardiographic (ECG) changes that are seen in myocardial ischemia include ST-segment depression and T-wave inversion.

...Lewis Bridge to NCLEX ch 35 Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that a. ventricular bradycardia may be induced and treated during the procedure b. a catheter will be placed in both femoral arteries to allow double-catheter use c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms d. a general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences

c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms Rationale: Radiofrequency catheter ablation therapy involves the use of electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias.