CH 26 Dysrhythmias
A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching? a. "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." b. "I will document the date and time if my ICD fires." c. "I can play golf with my son in about 2 or 3 weeks." d. "I should tell close friends and family members that I have an ICD."
a. "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." Rationale: The client does not need to take a CPR class. However, it is recommended that the family members and friends of a client who has an ICD learn CPR. The other statements indicate that the nurse's teaching was effective.
The nurse is instructing on home care after placement of an automatic implanted cardioverter defibrillator (AICD). Which statement, made by the client, needs clarification by the nurse? a. "I need to notify my cardiologist if I feel frequent kicks to the chest." b. "I can continue to work with my power tools." c. "I need to stay away from microwaves." d. "I should opt for a hand search at the airport instead of metal detector scan."
c. "I need to stay away from microwaves." Rationale: Similar to hand tools, microwaves have shields or are grounded, making them safe for clients with AICDs. There is no restriction from microwave use. All of the other options are correct.
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? a. Assessing the client's blood pressure and heart rate frequently b. Identifying the client's code level status c. Maintaining the client's intravenous fluids d. Alerting the healthcare provider of the third-degree heart block
d. Alerting the healthcare provider of the third-degree heart block Rationale: 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.
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? a. Elective electrical cardioversion b. Chemical cardioversion c. Mace procedure d. Elective electrical defibrillation
d. Elective electrical cardioversion Rationale: 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 scheduled for a transesophageal echocardiogram with a diagnosis of atrial fibrillation. The client's spouse asks the nurse to explain the purpose of the test. What is the nurse's best response? a. "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." b. "This test will show the specific area causing the atrial fibrillation and what can be done to stop it." c. "This test will show if the client needs a cardiac catheterization." d. "This test will let the doctor know if the client is at risk for hypotension."
a. "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." Rationale: The transesophageal echocardiogram will show if the client has blood clots and help determine if it is safe to use cardioversion. The transesophageal echocardiogram does not indicate which area is causing the atrial fibrillation or the need to evaluate coronary arteries, as with a cardiac catheterization. Hypotension is diagnosed with blood pressure readings.
The nurse cares for a 56-year-old client who received an implantable cardioverter defibrillator (ICD) 2 days prior. The client tells the nurse "My wife and I can never have sex again now that I have this ICD." What is the nurse best response by the nurse? a. "You seem apprehensive about resuming sexual activity." b. "Sex is permitted following the implantation of an ICD." c. "You really should speak to your wife about your concerns." d. "I will be sure to share your concerns with the physician."
a. "You seem apprehensive about resuming sexual activity." Rationale: The client treated with an electronic device experiences not only lifestyle and physical changes but also emotional changes. At different times during the healing process, the client may feel angry, depressed, fearful, anxious, or a combination of these emotions. It is imperative for the nurse to observe the client's response to the device and provide the client and family members with emotional support and teaching as indicated. Identifying that the client appears apprehensive about resuming sexual activity acknowledges the client's concerns while allowing for further discussion. The remaining responses ignore the client's feelings and do not facilitate an ongoing conversation or explore the client's concern.
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? a. Atrial depolarization b. Early ventricular repolarization c. Ventricular depolarization d. Ventricular repolarization
a. Atrial depolarization Rationale: The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave.
The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? a. Atrial rate of 300 to 400 b. Normal PR interval c. Regular rhythm d. P wave resent before each QRS
a. Atrial rate of 300 to 400 Rationale: ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves.
A 43-year-old male came into the emergency department where you practice nursing and was diagnosed with atrial fibrillation. It's now 48 hours since his admittance and the dysrhythmia persists. Which of the following medications will the client's healthcare provider most likely order? a. Heparin b. Warfarin (Coumadin) c. Flecainide (Tambocor) d. Dabigatran (Pradaxa)
a. Heparin Rationale: Heparin is generally prescribed initially if the dysrhythmia persists longer than 48 hours.
When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? a. Premature ventricular contraction (PVC) b. Ventricular bigeminy c. Ventricular tachycardia d. Ventricular fibrillation
a. Premature ventricular contraction (PVC) Rationale: A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.
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? a. Question the client about alcohol and illicit drug use. b. Instruct the client to hold the breath and bear down. c. Prepare to administer a calcium channel blocker. d. Place the client on supplemental oxygen.
a. Question the client about alcohol and illicit drug use. Rationale: The client is experiencing sinus tachycardia. Since the client's findings of tachycardia, dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the client about alcohol and illicit drug use. This information will direct the client's plan of care. Causes of tachycardia include medications that stimulate the sympathetic response, stimulants, and illicit drugs. The treatment goals for sinus tachycardia is usually determined by the severity of symptoms and directed at identifying and abolishing its cause. The other interventions may be implemented, but 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? a. Right side of sternum, fourth intercostal space b. Left side of sternum, fourth intercostal space c. Midway between V2 and V4 d. Mid-clavicular line, fifth intercostal space
a. Right side of sternum, fourth intercostal space Rationale: view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space. V2 is the left side of the sternum, fourth intercostal space. V3 is midway between V2 and V4. V4 is at the mid-clavicular line, fifth intercostal space.
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? a. The medication increases the force of the myocardial contraction. b. The medication causes the kidneys to retain fluid and increase intravascular volume. c. The medication increases the heart rate. d. The medication helps the kidneys produce more urine.
a. The medication increases the force of the myocardial contraction. Rationale: 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 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? a. atrial fibrillation b. atrial flutter c. heart block d. bundle branch block
a. atrial fibrillation Rationale: 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.
Which is not a likely origination point for cardiac dysrhythmias? a. bundle of His b. ventricles c. atria d. atrioventricular node
a. bundle of His Rationale: 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? a. chest pain b. hypertension c. leg pain d. hypocarbia
a. chest pain Rationale: 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.
A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended? a. Angiography b. Maze procedure c. Open heart surgery d. Heart transplantation
b. Maze procedure Rationale: Clients who are not candidates for cardioversion and fail to respond to conventional measures may be candidates for a surgical intervention referred to as the Maze procedure. Angiography, open heart surgery, and heart transplantation are not recommended surgeries for these clients.
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. A suction machine b. A defibrillator c. Cardioversion equipment d. An ECG machine
b. A defibrillator Rationale: The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death. A suction machine is used to remove respiratory secretions. Cardioversion is used in a planned setting for atrial dysrhythmias. An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed.
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. a. QRT wave b. P wave c. S-Q segment d. P-R interval e. T wave
b. P wave d. P-R interval e. T wave Rationale: 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.
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? a. P wave b. QRS complex c. PR interval d. QT interval
b. QRS complex Rationale: The QRS complex represents ventricular depolarization. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.
The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? a. PP interval b. QT interval c. RR interval d. TP interval
c. RR interval Rationale: The rhythm is often identified at the same time the rate is determined. The RR interval is used to determine ventricular rhythm and the PP interval to determine atrial rhythm. If the intervals are the same or if the difference between the intervals is less than 0.8 seconds throughout the strip, the rhythm is called regular. If the intervals are different, the rhythm is called irregular.
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 a. normal sinus rhythm. b. sinus bradycardia. c. sinus dysrhythmia. d. sinus tachycardia.
c. sinus dysrhythmia Rationale: 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.
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? a. Keep the arm on the side of the pacemaker higher than the head b. Delay activities such as swimming and bowling for at least 3 weeks c. Keep moving the arm on the side where the pacemaker is inserted d. Avoid sources of electrical interference
d. Avoid sources of electrical interference Rationale: he 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 caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? a. Defibrillation b. Maze procedure c. Pacemaker implantation d. Elective cardioversion
d. Elective cardioversion Rationale: Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Maze procedure is only a distractor for this question. Pacemakers are implanted for bradycardia.
When no atrial impulse is conducted through the AV node into the ventricles, the client is said to be experiencing which type of AV block? a. First degree b. Second degree, type I c. Second degree, type II d. Third degree
d. Third Degree Rationale: In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria. In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.
The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first? a. Sustained asystole b. Supraventricular tachycardia c. Atrial fibrillation d. Ventricular fibrillation
d. Ventricular fibrillation Rationale: 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 is monitored and reported to the physician but is not addressed first.
