Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems
Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: a) have the same shape b) occur at a rate of more than six per minute c) are paired with a normal beat d) occur during the QRS complex
B
A 73-year-old client has returned to the postanesthesia care unit where you practice nursing. The client had a pacemaker implanted and it is your responsibility to begin client education upon his becoming alert. Which of the following postimplantation instructions must you provide to the client now that he has a permanent pacemaker? a) Keep moving the arm on the side where the pacemaker is inserted. b) Keep the arm on the side of the pacemaker higher than the head. c) Avoid sources of electrical interference. d) Delay for at least 3 weeks activities such as swimming and bowling.
C
A patient with hypertension has a newly diagnosed A FIB What medication does the nurse anticipate administering to prevent the complication of ATRIAL THROMBI? a) Adenosine (Adenocard) b) Atropine c) Warfarin (Coumadin) d) Amiodarone (Pacerone)
C
After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have? a) Decreased blood pressure with reflex tachycardia b) Decreased peripheral vascular resistance c) Decreased cardiac output and decreased systolic and diastolic blood pressure d) Increased cardiac output and increased systolic and diastolic blood pressure
C
Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following? a) P wave resent before each QRS b) Normal PR interval c) Atrial rate of 300 to 400 d) Regular rhythm
C
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) A client with poor kidney perfusion b) A new myocardial infarction client c) A client with atrial dysrhythmias d) A client with third-degree heart block
C
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) Ventricular fibrillation d) Atrial fibrillation
C
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.) a) The patient will have to schedule monthly chest x-rays to make sure the device is patent. b) The patient may have a throbbing pain that is normal c) Record events that trigger a shock sensation. d) Call for emergency assistance if feeling dizzy. e) Avoid magnetic fields such as metal detection booths.
CDE
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with A FIB? a) Potassium supplement b) Diuretic c) Antihypertensive d) Anticoagulant
D
The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? a) Altered patterns frequently cause a variety of home safety issues. b) Altered patterns frequently turn into life-threatening arrhythmias. c) Altered patterns frequently affect the heart's ability to pump blood effectively. d) Altered patterns frequently produce neurological deficits.
C
When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block? a) First degree b) Second degree, type II c) Third degree d) Second degree, type I
C
Which of the following is a potential cause of premature ventricular complexes (PVCs)? a) Bradycardia b) Alkalosis c) Hypokalemia d) Hypovolemia
C
Which of the following is the treatment of choice for ventricular fibrillation? a) Implanted defibrillator b) Pacemaker c) Immediate bystander CPR d) Atropine
C
Your client has just been diagnosed with a dysrhythmia. The client asks you to explain normal sinus rhythm. What would you explain are the characteristics of normal sinus rhythm? a) Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 seconds. b) Heart rate between 60 and 150 beats per minute. c) The sinoatrial (SA) node initiates the impulse. d) The ventricles depolarize in 0.5 seconds or less.
C
A 26-year-old Air Force staff sergeant is returning for diagnostic follow-up to the cardiologist's office where you practice nursing. Her 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? a) All options are correct b) Elevated temperature c) Shock d) Strenuous exercise
A
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? a) "Spike" on the rhythm strip b) Quality of the pulse c) Scar on the chest d) Vibration under the skin
A
A patient's ECG tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as which of the following? a) Atrial flutter b) Atrial fibrillation c) Ventricular tachycardia d) Ventricular fibrillation
A
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? a) "I should ask for a handheld device search when I go through airport security." b) "I should avoid contact sports." c) "I'll watch the incision for swelling or redness and will report if either occurs." d) "I should avoid large magnetic fields, such as an MRI machine or large motors."
A
Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block? a) PR interval b) T wave c) P wave d) QRS
A
You are an operating room nurse caring for a client who is having a pacemaker implanted. The physician has requested a demand mode pacemaker for this client. What is this type of pacemaker? a) Self-activated b) A fixed-rate pacemaker c) A temporary pacemaker d) Asynchronous
A
You enter your client's room and find him pulseless and unresponsive. What would be the treatment of choice for this client? a) Immediate defibrillation b) Electric cardioversion c) Chemical cardioversion d) IV lidocaine
A
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.) a) Call for emergency assistance if feeling dizzy. b) The patient may have a throbbing pain that is normal c) The patient will have to schedule monthly chest x-rays to make sure the device is patent. d) Avoid magnetic fields such as metal detection booths. e) Record events that trigger a shock sensation.
ADE
A nurse is providing morning care for a patient in the ICU. Suddenly, the bedside monitor shows ventricular fibrillation and the patient becomes unresponsive. After calling for assistance, what action should the nurse take next? a) Prepare for endotracheal intubation. b) Begin cardiopulmonary resuscitation. c) Provide electrical cardioversion. d) Administer intravenous epinephrine.
B
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? a) Date and time of insertion b) Pacer rate c) Location of the generator d) Model number
B
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? a) It uses less electrical energy than cardioversion. b) It is used to eliminate ventricular dysrhythmias. c) The client is sedated before the procedure. d) It is a scheduled procedure 1 to 10 days in advance.
B
Undersensing occurs as a pacemaker malfunctions as a result of which of the following events? a) Total absence of the pacing spike b) Pacing spike occurs at the preset level despite the patient's intrinsic rhythm c) Loss of pacing artifact d) The complex does not follow the pacing spike
B
A 63-year-old client is in the cardiac step-down unit where you practice nursing. In your discussions about his condition, the client is puzzled as to what causes the heart to be an effective pump. Which of the following statements would you include in your response? a) Sufficient blood pressure b) Inherent rhythmicity of all muscle tissue c) Inherent electrons in muscle tissue d) Inherent rhythmicity of cardiac muscle tissue
D
In looking at the ECG of a new patient, 43-year-old Mrs. Smith, you see what appears to be a P wave slightly different than normal. You're considering the possibility of premature atrial contractions (PAC). Which of the following questions will you ask her when taking her history? a) Caffeine b) Nicotine c) Hyperthyroidism or other metabolic disorders d) All options are correct
D
The nurse is working on a telemetry unit, caring for a client who has been in a sinus rhythm for the past 2 days with a heart rate of 88 to 96 beats per minute. The client puts on the call light in the bathroom and reports severe dizziness. The telemetry shows a heart rate of 46 beats per minute. What should the nurse be prepared to do? a) Assist with a temporary pacemaker. b) Prepare the client for maze surgery. c) Send the client to the cardiac catheterization laboratory. d) Give an IV bolus of atropine.
D
The treatment for symptomatic junctional rhythm is the same as for which of the following other heart rhythms? a) Atrial flutter b) Tachycardia c) Atrial fibrillation d) Bradycardia
D
When the nurse observes that the patient's heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating a) sinus bradycardia. b) normal sinus rhythm. c) sinus tachycardia. d) sinus dysrhythmia.
D
Which PR interval presents a first-degree heart block? a) 0.14 seconds b) 0.18 seconds c) 0.16 seconds d) 0.24 seconds
D
Which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other? a) Second-degree heart block b) Asystole c) First-degree AV block d) Third-degree atrioventricular (AV) heart block
D
Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke? a) Plavix b) Lovenox c) Aspirin d) Coumadin
D
Which medication is the drug of choice for SINUS BRADYCARDIA? a) Pronestyl b) Cardizem c) Lidocaine d) Atropine
D
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? a) "I can still drink coffee and tea." b) "I should increase my fluid intake." c) "I should eat foods rich in protein." d) "I'll enroll in an aerobic exercise program."
A
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? a) Lead wire dislodgement b) Faulty generator c) Sensitivity is too low d) Fracture of the lead wire
A
Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? a) Valium b) Vasotec c) Atropine d) Lanoxin
A
A 26-year-old male patient, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is being treated in the emergency department. The patient is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the patient becomes lightheaded but does not lose consciousness. Which of the following maneuvers may be used to interrupt the patient's atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. a) Stimulating the patient's gag reflex b) Performing carotid massage c) Instructing the patient to breathe deeply d) Placing the patient's face in cold water e) Instructing the patient to vigorously exercise
ABC
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) T wave b) P-R interval c) QRT wave d) P wave e) S-Q segment
ABD
A client has had a pacemaker inserted and is ready for discharge. The nurse is providing education about pacemaker safety. Which of the following are items that the nurse will be sure to address? Choose all that apply. a) Avoid large magnetic fields. b) Sit at least 12 feet from television sets. c) Carry a card identifying yourself as a pacemaker recipient. d) Monitor your pulse once a month. e) Do not spend time near a microwave oven.
AC
A 78-year-old client was just admitted to the cardiac step-down unit where you practice nursing. Upon stabilizing his condition, you begin a conversation about his symptoms and you answer his questions to the best of your ability. In your discussion of cardiac dysrhythmias, which of the following would you rule out as a likely origination point for cardiac dysrhythmias? a) Ventricles b) Bundle of His c) Atria d) Atrioventricular node
B
A patient tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? a) Apply supplemental oxygen. b) Avoid caffeinated beverages. c) Lie down and elevate the feet. d) Request sublingual nitroglycerin.
B
The nurse is analyzing a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as which of the following? a) Junctional tachycardia b) Normal sinus rhythm c) Sinus tachycardia d) First-degree atrioventricular (AV) block
B
The nurse is caring for a client with a diagnosis of atrial fibrillation. The onset was approximately 2 to 3 days ago. The client is scheduled for a transesophageal echocardiogram this morning. The client's spouse asks what this test is for. The best response by the nurse is which of the following? a) "This test will show the specific area causing the atrial fibrillation and what can be done to stop it." b) "This test will show any blood clots in the heart and if it is safe to do a cardioversion." c) "This test will let the doctor know if the client is at risk for hypotension." d) "This test will show if the client needs a cardiac catheterzation."
B
The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include? a) The procedure takes less time than a cardiac catheterization. b) During the procedure, the arrhythmia will be reproduced under controlled conditions. c) After the procedure, the arrhythmia will not recur. d) The procedure will occur in the operating room under general anesthesia.
B
You are overseeing a 62-year-old who has started to exhibit dangerous PVCs in the cardiac postoperative unit. He's been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should you be ready to do? a) Prepare for defibrillation. b) Adjust the IV infusion. c) Administer additional lidocaine. d) Call for the doctor and just wait.
B
A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of VENTRICULAR TACHYCARDIA? a) Potassium and calcium b) Potassium and sodium c) Magnesium and potassium d) Calcium and magnesium
C
A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. What does the nurse determine this rhythm to be? a) Sinus tachycardia b) Ventricular flutter c) Atrial flutter d) Nonparoxysmal junctional tachycardia
C
The nurse is caring for a 32-year-old client admitted with a medical diagnosis of atrial fibrillation, related to "holiday heart" syndrome. A nursing student working with the nurse asks for information about "holiday heart" syndrome. The best response by the nurse is which of the following? a) "This is the association of heart dysrhythmias, especially atrial fibrillation, with extramarital sex." b) "This is the association of heart dysrhythmias, especially atrial fibrillation, with very heavy meals." c) "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." d) "This is the association of heart dysrhythmias, especially atrial fibrillation, with physical activity. the client is not used to"
C
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) Ventricular tachycardia b) Ventricular bigeminy c) Premature ventricular contraction (PVC) d) Ventricular fibrillation
C
Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? a) Elective electrical defibrillation b) Chemical cardioversion c) Elective electrical cardioversion d) Mace procedure
C
A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for? a) Insertion of an ICD b) Maze procedure c) Insertion of a permanent pacemaker d) Catheter ablation therapy
D
An 83-year-old resident in the long-term care facility where you practice nursing has an irregular heart rate of around 100 beats/minute. He also has a significant pulse deficit. What component of his history would produce such symptoms? a) Bundle branch block b) Heart block c) Atrial flutter d) Atrial fibrillation
D
Idioventricular rhythm occurs when the impulse starts in the conduction system below the AV node. The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? a) Not measurable b) 100 to 250 c) 220 to 350 d) 20 to 40
D
The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate the need for follow-up? a) ST segment that is isoelectric in appearance b) PR interval that is 0.18 seconds long c) QRS complex that is 0.10 seconds long d) QT interval that is 0. 46 seconds long
D
You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a) Nausea b) Hypotension c) Fever d) Fluttering
D
A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding? a) Peaked T waves b) Flattened P waves c) Prolonged QT interval d) Occasional U waves
A
The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button? a) Shouts, "All clear" b) States, "Charging" c) Placing gel on the chest d) Checking the ECG rhythm
A
The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include? a) Your family and friends may want to take a CPR class. b) Do not be concerned if you experience symptoms of lightheadedness and dizziness. c) If you miss a dose of your antiarrhythmia medication, double up on the next dose. d) It is not necessary to learn how to take your own pulse.
A
Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes: a) Treating the underlying cause b) Immediate defibrillation c) Administration of amiodarone d) Electrical cardioversion
A
A 26-year-old client is returning for diagnostic follow-up. Her Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minutes. What type of dysrhythmia would you expect the cardiologist to diagnose? a) Supraventricular bradycardia b) Sinus tachycardia c) Supraventricular tachycardia d) Sinus bradycardia
B
Which test is used to identify cardiac rhythms? a) Electroencephalogram b) Electrocardiogram c) Electrocautery d) Echocardiogram
B
You are caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? a) Pacemaker implantation b) Elective cardioversion c) Mace procedure d) Defibrillation
B
The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment? a) A cell phone to call 911 b) A stethoscope c) An automatic external defibrillator d) A blood pressure cuff
C
A patient comes to the emergency department with complaints 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? a) Sinus tachycardia b) Ventricular tachycardia c) Normal sinus rhythm d) Sinus bradycardia
A
A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes? a) Implantable cardioverter defibrillator b) Epinephrine c) Pacemaker d) Atropine
A
A physician orders esmolol (Brevibloc) for a client with supraventricular tachycardia. During esmolol therapy, the nurse should monitor the client's: a) heart rate and blood pressure. b) ocular pressure. c) cerebral perfusion pressure. d) body temperature.
A
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? a) More P waves than QRS complexes b) Atrial rate of 60 bpm or below c) Extended PR interval d) Shortened QRS duration.
A
The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation? a) In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output. b) Sinus bradycardia means your heart is not beating fast enough to keep you alive. c) Sinus bradycardia is nothing to worry about. d) In many clients a heart rate slower than 70 beats per minute is considered to slow to maintain an adequate cardiac output.
A
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis for this client would be which of the following? a) Decreased cardiac output b) Ineffective health maintenance c) Ineffective breathing pattern d) Risk for vascular trauma
A
Which of the following nursing interventions must a nurse perform when administering prescribed vasopressors to a patient with a cardiac dysrhythmia? a) Monitor vital signs and cardiac rhythm b) Keep the patient flat for one hour after administration c) Document heart rate before and after administration d) Administer every five minutes during cardiac resuscitation
A
Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker? a) Avoid sources of electrical interference b) Keep moving the arm on the side where the pacemaker is inserted c) Keep the arm on the side of the pacemaker higher than the head d) Delay for at least 3 weeks activities such as swimming and bowling
A
Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? a) Elective electrical cardioversion b) Elective electrical defibrillation c) Chemical cardioversion d) Mace procedure
A
The nurse is caring for a patient following the insertion of a permanent pacemaker. Which of the following discharge instructions are appropriate for the nurse to review with the patient? Select all that apply. a) Wear a medical alert noting the presence of a pacemaker. b) Avoid the usage of microwave ovens and electronic tools. c) Avoid handheld screening devices in airports. d) Refrain from walking through antitheft devices. e) Check pulse daily, reporting sudden slowing or increase.
ACE
The nurse is participating in the care of a client requiring emergent defibrillation. The nurse will complete the following steps in which order? a) Turn on the defibrillator and place it in "not sync" mode. b) Call "clear" three times ensuring patient and environmental safety. c) Deliver the prescribed electrical charge. d) Charge the defibrillator to the prescribed voltage. e) Apply the multifunction conductor pads to the patient's chest.
ADEBC
Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which difference will the nurse confirm? a) Both procedures sedate the clients. b) Cardioversion uses less electrical energy. c) Both used to eliminate ventricular dysrhythmias. d) Machine determines when electrical energy is delivered.
B
A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient? a) Administration of epinephrine b) Insertion of a pacemaker c) Insertion of an implantable cardioverter defibrillator (ICD) d) Administration of atropine
B
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? a) Ventricular tachycardia b) Ventricular fibrillation c) Atrial fibrillation d) Third-degree heart block
B
Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent? a) Disrupting the heart during the critical period of atrial repolarization. b) Disrupting the heart during the critical period of ventricular repolarization. c) Disrupting the heart during the critical period of ventricular depolarization. d) Disrupting the heart during the critical period of atrial depolarization.
B
Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds? a) 0.3 b) 0.2 c) 0.1 d) 0.4
B
Jack Johnson is a 58-year-old who's been living with an internal, fixed-rate pacemaker. You're checking his readings on a cardiac monitor and notice an absence of spikes. What should you do? a) Take Jack's blood pressure. b) Double-check the monitoring equipment. c) Nothing, there's no cause for alarm. d) Suggest the need for a new beta-blocker to the doctor.
B
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? a) The registered nurse stating to administer all medications accept those which are cardiotonics b) The registered nurse administering atropine sulfate intravenously c) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute d) The registered nurse stating to administer Lanoxin (digoxin)
B
The nurse is analyzing the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The patient's ECG strip demonstrates PR intervals that measure 0.24 seconds. Which of the following is the nurse's most appropriate action? a) Instruct the patient to bear down as if having a bowel movement. b) Document the findings and continue to monitor the patient. c) Notify the patient's primary care provider of the findings. d) Apply oxygen via nasal cannula and obtain a 12-lead ECG.
B
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? a) "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." b) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." c) "You should avoid tennis; basketball or football would be a good substitute." d) "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity."
B
The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following? a) SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers b) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers c) SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches d) AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers
B
The nursing instructor is discussing pacemakers with her clinical group. One of the students is caring for a client with a transvenous pacemaker. One of the students asks why this client has a transvenous pacemaker. What would be the instructor's best response? a) "A transvenous pacemaker is used in place of a transarterial pacemaker." b) "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs." c) "A transvenous pacemaker is used for a ventricular tachyarrhythmia." d) "A transvenous pacemaker is a permanent pacemaker that is asynchronous."
B
A 28-year-old female patient presents to the emergency department (ED) stating severe restlessness and anxiety. Upon assessment, the patient's heart rate is 118 bpm and regular, the patient's pupils are dilated, and the patient appears excitable. Which action should the nurse take next? a) Place the patient on supplemental oxygen. b) Prepare to administer a calcium channel blocker. c) Question the patient about alcohol and illicit drug use. d) Instruct the patient to hold her breath and bear down.
C
A 66-year-old female client is having cardiac diagnostic tests to determine the cause of her symptoms. In her follow-up visit to the cardiologist, she is told that she has a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia did the tests reveal? a) Heart block b) Atrial bradycardia c) Sinus bradycardia d) None
C
A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist? a) A maze procedure or IV bolus of furosemide b) Cardiac catheterization c) IV bolus of atropine or temporary pacing d) Cardioversion or IV bolus of dopamine
C
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? a) Asystole b) Ventricular fibrillation c) Atrial flutter d) Premature ventricular contraction
C
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? a) "I need to stay at least 10? away from the microwave." b) "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." c) "I'll keep a log of each time my ICD discharges." d) "I can't wait to get back to my football league."
C
A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between sinus rhythm and sinus bradycardia when I look at the EKG strip" The best reply by the nurse is which of the following? a) "The QRS complex will be smaller in sinus bradycardia." b) "The P waves will be shaped differently." c) "The only difference is the rate, which will be below 60 bpm in sinus bradycardia." d) "The P-R interval will be prolonged in sinus bradycardia, and you will have to measure carefully to note the width."
C
A patient is admitted to the emergency department (ED) with complaints of chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph (ECG) monitor. The nurse counts 9 RR intervals on the patient's 6-second rhythm tracing. The nurse correctly identifies the patient's heart rate as which of the following? a) 70 bpm b) 100 bpm c) 90 bpm d) 80 bpm
C
After evaluating a client for hypertension, a physician orders ATENOLOL (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have? a) Increased cardiac output and increased systolic and diastolic blood pressure b) Decreased blood pressure with reflex tachycardia c) Decreased cardiac output and decreased systolic and diastolic blood pressure d) Decreased peripheral vascular resistance
C
After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker? a) Stay at least 2' away from microwave ovens. b) Never engage in activities that require vigorous arm and shoulder movement. c) Avoid undergoing magnetic resonance imaging (MRI). d) Avoid going through airport metal detectors.
C
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? a) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute b) The registered nurse stating to administer Lanoxin (digoxin) c) The registered nurse administering atropine sulfate intravenously d) The registered nurse stating to administer all medications accept those which are cardiotonics
C
The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle? a) Ventricular repolarization b) Ventricular depolarization c) Atrial depolarization d) Early ventricular repolarization
C
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? a) Defibrillate with 360 joules (monophasic defibrillator) b) Administer atropine 0.5 mg c) Begin cardiopulmonary resuscitation (CPR) d) Administer epinephrine
C
The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education. a) "I will call the doctor if my incision becomes swollen and red." b) "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." c) "We will be getting rid of our microwave oven so it will not affect my pacemaker." d) "I will avoid any large magnets that may affect my pacemaker."
C
Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for an elective electrical cardioversion? a) Administer digitalis and diuretics 24 hours before cardioversion b) Facilitate CPR until the patient is prepared for cardioversion c) Instruct the patient to restrict food and oral intake d) Monitor blood pressure every 4 hours
C
While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of SINUS TACHYCARDIA include which of the following? a) Hypothyroidism and athletic training b) Vagal stimulation and sleep c) Hypovolemia and fever d) Digoxin and vagal stimulation
C
You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a) Nausea b) Hypotension c) Fluttering d) Fever
C
A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond? a) "You'll need to take an extra dose of your antiarrhythmic before you shoot." b) "Being that close to a rifle might make your ICD fire." c) "Enjoy your time with your grandson." d) "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."
D
A nurse is evaluating a client with a temporary pacemaker. The patient's ECG tracing shows each P wave followed by the pacing spike. The nurse's best response is which of the following? a) Reposition the extremity and turn the patient to left side. b) Obtain a 12-lead ECG and a portable chest x-ray. c) Check the security of all connections and increase the milliamperage. d) Document the findings and continue to monitor the patient.
D
After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following? a) IV bolus of dobutamine b) Cardiac catheterization c) IV bolus of lidocaine d) Defibrillation
D
John, an 82-year-old retired librarian is brought into the ED where you practice nursing. The client's heart rate is greater than 155 beats/minute. As you connect him to the ECG, you notice that his rhythm is regular, rate is 162 beats/minute, and diastole is shortened. He is intermittently alert and reports chest pain. P waves cannot be identified. What condition would you expect the physician to diagnose? a) Atrial flutter b) Sinus tachycardia c) Heart block d) Supraventricular tachycardia
D
Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a: a) PR interval of 0.18 seconds. b) P-to-QRS ratio of 1:1. c) QT interval of 0.37 seconds. d) Heart rate of 42 beats per minute (bpm).
D
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) Cardioversion equipment c) An ECG machine d) A defibrillator
D
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? a) "You should avoid tennis; basketball or football would be a good substitute." b) "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." c) "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." d) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
D
The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following? a) "There is a long list of clients in line to be cardioverted." b) "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." c) "The doctor wants to see if your heart will switch back to its normal rhythm by itself." d) "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."
D
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? a) Ventricular fibrillation b) Atrial fibrillation c) Ventricular tachycardia d) Atrial flutter
D
The nurse is observing the monitor of a patient with a FIRST DEGREE AV BLOCK. What is the nurse aware characterizes this block? a) P waves hidden with the QRS complex b) An irregular rhythm c) A variable heart rate, usually fewer than 60 bpm d) Delayed conduction, producing a prolonged PR interval
D
The nurse receives a telephone call from a client with an implanted pacemaker who reports that his pulse is 68 beats per minute, but his pacemaker rate is set at 72 beats per minute. The best response by the nurse is which of the following? a) "This is okay as long as you are not having any symptoms." b) "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase." c) "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate." d) "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."
D
Treatment of symptomatic bradycardia includes which of the following? a) Cardioversion b) Adenocard c) Lidocaine d) Atropine
D
Two days after discharge following a permanent pacemaker insertion, the client returns to the clinic for a follow-up appointment. He reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the site and suspects which of the following: a) Postoperative site hematoma b) Normal postoperative healing c) Internal bleeding at pacemaker site d) Pacemaker site infection
D
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? a) "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." b) "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." c) "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." d) "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."
D
What nursing interventions could you institute with a client who has a suspected dysrhythmia that would help detect life-threatening dysrhythmias and would manage and minimize any that occur? a) Palpate the client's pulse and observe the client's response. b) Provide supplemental oxygen. c) Monitor blood pressure continuously. d) Monitor cardiac rhythm continuously.
D
You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients? a) Clients with recurrent life-threatening bradycardias b) Clients with sinus tachycardia c) Clients with ventricular bradycardia d) Clients with recurrent life-threatening tachydysrhythmias
D
