Chapter 35: Dysrhythmias

When preparing to defibrillate a patient, in which order will the nurse perform the following steps? (Put a comma and a space between each answer choice [A, B, C, D, E].) a. Turn the defibrillator on. b. Deliver the electrical charge. c. Select the appropriate energy level. d. Place the hands-free, multifunction defibrillator pads on the patient's chest. e. Check the location of other staff and call out "all clear."

A,C,D,E,B

A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a college soccer team. The patient is found to have sinus bradycardia, rate 52 and blood pressure (BP) 114/54 mm Hg. The student denies any health problems. What action by the nurse is appropriate? A. Allow the student to participate on the soccer team. B. Refer the student to a cardiologist for further testing. C. Tell the student to stop playing immediately if any dyspnea occurs. D. Obtain more detailed information about the student's family health history.

A. Allow the student to participate on the soccer team.

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. What topic should the nurse plan to include in patient teaching? A. Anticoagulant therapy B. Permanent pacemakers C. Emergency cardioversion D. IV adenosine (Adenocard)

A. Anticoagulant therapy

After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the drug has been effective? A. Increase in the patient's heart rate B. Increase in strength of peripheral pulses C. Decrease in premature atrial contractions D. Decrease in premature ventricular contractions

A. Increase in the patient's heart rate

A patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg is being prepared for cardioversion. Which action should the nurse take? A. Turn the synchronizer switch to the "off" position. B. Give a sedative before cardioversion is implemented. C. Set the defibrillator/cardioverter energy to 360 joules. D. Provide assisted ventilations with a bag-valve-mask device.

B. Give a sedative before cardioversion is implemented.

A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval is 0.24 seconds. What action should the nurse take? A. Notify the health care provider immediately. B. Document the finding and monitor the patient. C. Give atropine per agency dysrhythmia protocol. D. Prepare the patient for temporary pacemaker insertion.

B. Document the finding and monitor the patient.

Which action by a new registered nurse (RN) who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias? A. Prepares defibrillator settings at 360 joules for a patient whose monitor shows asystole. B. Injects IV adenosine (Adenocard) over 2 seconds for a patient with supraventricular tachycardia. C. Turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation. D. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second-degree AV block.

B. Injects IV adenosine (Adenocard) over 2 seconds for a patient with supraventricular tachycardia.

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin? A. Explain the association between dysrhythmias and syncope. B. Instruct the patient to call for assistance before getting out of bed. C. Teach the patient about the need to avoid caffeine and other stimulants. D. Tell the patient about the benefits of implantable cardioverter-defibrillators.

B. Instruct the patient to call for assistance before getting out of bed.

A patient is apneic and has no palpable pulses. The heart monitor shows sinus tachycardia, rate 132. What action should the nurse take next? A. Perform synchronized cardioversion. B. Start cardiopulmonary resuscitation (CPR). C. Give atropine per agency dysrhythmia protocol. D. Apply supplemental O2 via non-rebreather mask.

B. Start cardiopulmonary resuscitation (CPR).

A patient's heart monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm? A. Ventricular couplets B. Ventricular bigeminy C. Ventricular R-on-T phenomenon D. Multifocal premature ventricular contractions

B. Ventricular bigeminy

A patient has a junctional escape rhythm on the monitor. What heart rate should the nurse expect the patient to have? A. 15 to 20 B. 20 to 40 C. 40 to 60 D. 60 to 100

C. 40 to 60

A 19-year-old student comes to the student health center at the end of the semester stating, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional unifocal premature ventricular contractions (PVCs). What action should the nurse take next? A. Insert an IV catheter for emergency use. B. Start supplemental O2 at 2 to 3 L/min via nasal cannula. C. Ask the patient about current stress level and caffeine use. D. Have the patient taken to the nearest emergency department (ED).

C. Ask the patient about current stress level and caffeine use.

A patient on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the agency dysrhythmia protocol should the nurse do first? A. Obtain a 12-lead electrocardiogram (ECG). B. Notify the health care provider of the change in rhythm. C. Give supplemental O2 at 2 to 3 L/min via nasal cannula. D. Assess the patient's blood pressure and discomfort level.

C. Give supplemental O2 at 2 to 3 L/min via nasal cannula.

A patient's heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take first? A. Place the transcutaneous pacemaker pads on the patient. B. Give atropine sulfate 1 mg IV per agency dysrhythmia protocol. C. Hold the scheduled metoprolol (Lopressor) and call the health care provider. D. Document the patient's rhythm and PR measurements in the medical record.

C. Hold the scheduled metoprolol (Lopressor) and call the health care provider.

Which action by a nurse caring for a patient after an implantable cardioverter-defibrillator (ICD) insertion indicates a need for more teaching about the care of patients with ICDs? A. The nurse administers amiodarone (Cordarone) to the patient. B. The nurse helps the patient fill out the application for obtaining a Medic Alert device. C. The nurse encourages the patient to do active range-of-motion exercises for all extremities. D. The nurse teaches the patient that sexual activity can be resumed when the incision is healed.

C. The nurse encourages the patient to do active range-of-motion exercises for all extremities.

Which information will the nurse include when teaching a patient with atrial flutter who is scheduled for a radiofrequency catheter ablation? A. The procedure stimulates the growth of new pathways between the atria. B. The procedure uses cold therapy to stop the formation of the flutter waves. C. The procedure uses electrical energy to destroy areas of the conduction system. D. The procedure prevents or minimizes the patient's risk for sudden cardiac death.

C. The procedure uses electrical energy to destroy areas of the conduction system.

he nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be fastest to use? A. Count the number of large squares in the R-R interval and divide by 300. B. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. C. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. D. Calculate the number of small squares between one QRS complex and the next and divide into 1500.

C. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first? A. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin (Coumadin) due B. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating C. A patient who is in a sinus rhythm, rate 98 and regular, recovering from an elective cardioversion 2 hours ago D. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone (Cordarone) due

D. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone (Cordarone) due

A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of 80/42 mm Hg, and reports feeling faint. Which action should the nurse take? a. Reposition the patient on the left side. b. Have the patient perform the Valsalva maneuver. C. Give the scheduled dose of diltiazem (Cardizem). D. Apply the transcutaneous pacemaker (TCP) pads.

D. Apply the transcutaneous pacemaker (TCP) pads.

A patient who was admitted with a myocardial infarction has a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which action should the nurse take next? A. Immediately notify the health care provider. B. Document the rhythm and continue to monitor the patient. C. Prepare for synchronized cardioversion per agency protocol. D. Prepare to give IV amiodarone per agency dysrhythmia protocol.

D. Prepare to give IV amiodarone per agency dysrhythmia protocol.

What should the nurse measure to determine whether there is a delay in impulse conduction through the patient's ventricles? A. P wave B. Q wave C. PR interval D. QRS complex

D. QRS complex

Which finding from a newly admitted adult patient's electrocardiogram (ECG) requires further investigation by the nurse? A. Isoelectric ST segment B. PR interval of 0.18 second C. QT interval of 0.38 second D. QRS interval of 0.14 second

D. QRS interval of 0.14 second

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval regular, QRS complex wide and distorted, and QRS duration of 0.18 second. How should the nurse interpret this cardiac rhythm? A. Atrial flutter B. Sinus tachycardia C. Ventricular fibrillation D. Ventricular tachycardia

D. Ventricular tachycardia

A patient has ST segment changes that suggest an acute inferior wall myocardial infarction. Which lead would be the most useful for monitoring the patient? a. I b. II c. V2 d. V6

b. II

Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as telemetry technicians on the cardiac care unit? a. Decide whether a patient's heart rate of 116 requires urgent treatment. b. Observe heart rhythms for multiple patients who have telemetry monitoring. c. Monitor a patient's level of consciousness during synchronized cardioversion. d. Select the best lead for monitoring a patient admitted with acute coronary syndrome.

b. Observe heart rhythms for multiple patients who have telemetry monitoring.

A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action should the nurse take first? a. Give epinephrine (Adrenalin) IV. b. Perform immediate defibrillation. c. Prepare for endotracheal intubation. d. Ventilate with a bag-valve-mask device.

b. Perform immediate defibrillation.

A patient who reports a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next? a. Prepare to perform electrical cardioversion. b. Have the patient perform the Valsalva maneuver. c. Obtain the patient's vital signs including O2 saturation. d. Prepare to give a -blocker medication to slow the heart rate.

c. Obtain the patient's vital signs including O2 saturation.

A patient reports dizziness and shortness of breath for several days. During heart monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. How does the nurse interpret this heart rhythm? a. Junctional escape rhythm b. Accelerated idioventricular rhythm c. Third-degree atrioventricular (AV) block d. Sinus rhythm with premature atrial contractions

c. Third-degree atrioventricular (AV) block

The nurse evaluates that discharge teaching about the management of a new permanent pacemaker has been effective when the patient states a. "It will be several weeks before I can return to my usual activities." b. "I will avoid cooking with a microwave oven or being near one in use." c. "I will notify the airlines when I make a reservation that I have a pacemaker." d. "I won't lift the arm on the pacemaker side until I see the health care provider."

d. "I won't lift the arm on the pacemaker side until I see the health care provider."

Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose of 243 mg/dL b. Serum chloride of 92 mEq/L c. Serum sodium of 134 mEq/L d. Serum potassium of 2.9 mEq/L

d. Serum potassium of 2.9 mEq/L