Chapter 8 dysrhythmia interpretation and management SOLE
The normal width of the QRS complex is which of the following?
0.06 to 0.10 seconds & 1.5-2.5 small boxes
ECG paper contains a standardized grid where the horizontal access measures time in the vertical axis measures voltage or amplitude. The nurse must understand that each horizontal box indicates what?
40 milliseconds or 0.04 seconds duration
What's the normal rate for the SA note when the patient is at rest?
60-100 BPM
The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient is on digitalis medication at home. The nurse should expect that action to be taken?.
A digitalis level would be ordered upon admission.
Because of the location of the AV node, the possible P waveforms that are associated with junctional rhythms include which of the following? (Select all that apply.) a. No P wave b. Inverted P wave c. Shortened PR interval d. P wave after the QRS complex e. Normal P wave and PR interval
A, B, C, D Because of the location of the AV node—in the center of the heart—impulses generated may be conducted forward, backward, or both. With the potential of forward, backward, or bidirectional impulse conduction, three different P waveforms may be associated with junctional rhythms: When the AV node impulse moves forward, P waves may be absent because the impulse enters the ventricle first. The atria receives the wave of depolarization at the same time as the ventricles; thus, because of the larger muscle mass of the ventricles, there is no P wave. When the AV node impulse is conducted backward, the impulse enters the atria first. When depolarization occurs backward, an inverted P wave is created. Once the atria have been depolarized, the impulse moves down the bundle of His and depolarizes both ventricles normally. A short PR interval (<0.12 second) is noted. When the impulse is conducted both forward and backward, P waves may be present after the QRS complex.
The nurse working on the night shift Notices sinus bradycardia on the patient's cardiac monitor. What initial action should the nurse take?
Assess for hemodynamic instability
The patient is in chronic junctional escape rhythm with no atrial activity noted. Studies have demonstrated normal AV node function. This patient may be a candidate for which type of pacing?
Atrial pacing
The patient scheduled to have a permanent pacemaker implanted asks the nurse, "How long will the battery in this thing last?" What answer should the nurse provide?
Battery life varies depending on usage, but it can last up to 10 years.
The nurse notices ventricular tachycardia on the heart monitor. When the patient is assessed, the patient is found to be unresponsive with no pulse. The nurse should take what action immediately?
Begin cardiopulmonary resuscitation & advanced life-support
Sinus bradycardia is a symptom of which of the following
Calcium channel blocker medication Beta-blocker medication Athletic conditioning Hypothermia
The patient is admitted with a condition that requires cardiac rhythm monitoring. To apply the monitoring electrodes the nurse must first take what action?
Clip cheat hair if needed
The patient's heart rate is 165 beats per minute and the cardiac monitor shows a rapid rate with narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patient's blood pressure has dropped from 124/62 to 78/30; skin is cold and diaphoretic and the patient is reporting nausea. The nurse prepares the patient for what intervention
Emergent cardioversion
Ventricular pacing
Interpret the following
Atrial pacing
Interpret the following rhythm
Normal sinus rhythm
Interpret the rhythm
Sinus bradycardia
Interpret the rhythm
Sinus rhythm with paired premature ventricular contractions (couplets)
Interpret the rhythm
Sinus tachycardia
Interpret the rhythm
2nd degree AV block mobitz II
Interpret this rhythm
The nurse understands what to be true of a third-degree AV block?
None of the P waves are conducted to the ventricles
The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute. How does the nurse interpret this?
The pacemaker will pace only if pts intrinsic HR is less than 60 bpm
The patient is alert and talking when the nurse notices the following rhythm. The patient's blood pressure is 90/44 mm Hg. The nurse should take what action?
Treat w/intravenous amiodarone or lidocaine
When assessing the 12 lead ECG, or a rhythm strip, it is helpful to understand that the electrical activity is viewed in relation to the positive electrode of that particular lead. What is the effect on the inflection when an electrical signal is aimed directly at the positive electrode?
Upright
Why is the sinus note identified as a pacemaker of the heart?
contains the fastest pacemaker cell in the heart
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P WAVE and 20 small boxes between each R WAVE. What is the ventricular rate?
75 BPM
The patient is in third-degree heart block (complete heart block) and is symptomatic. The treatment for this patient is which of the following? (Select all that apply.) a. transcutaneous pacemaker. b. atropine IV. c. temporary transvenous pacemaker. d. permanent pacemaker. e. amiodarone IV.
ANS: A, C, D Treatments include transcutaneous or transvenous pacing and implanting a permanent pacemaker. Atropine reduces vagal tone, but that is not a cause of complete heart block and will produce more P waves, but the P waves will still not be associated with the QRS complexes. It is important to note that the only treatment is pacing. Amiodarone IV is used to suppress ventricular dysrhythmia and is not used to treat third-degree heart block.
The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS complexes following the spikes. The nurse realizes this as what?
Failure 2 capture
What are common causes of sinus tachycardia?
Hyperthyroidism, hypovolemia, and heart failure
The pt has an irregular HR. To determine an accurate hr, the nurse will take which action?
Identify the markers on the ECG paper that indicate a 6 second strip.
The QT INTERVAL is the total time taken for the ventricular depolarization and repolarization. Prolongation of the QT interval will result in what outcome?
Increase in the risk of lethal dysrhythmias
The nurse notes the following rhythm on the heart monitor. The patient is unresponsive and not breathing. The nurse should be prepared to implement what action?
Provide emergent basic & advanced life support
What is the one of the functions of the atrioventricular node?
Slowing the impulse, arriving from the SA node
The patient is admitted with sinus pauses causing periods of loss of consciousness. The patient is currently asymptomatic, awake and alert, but fatigued and answers questions appropriately. When admitting this patient, what should be the nurse's initial action?
Assess the patient's medication profile
The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex. The nurse should take what action immediately?
Assess the pt & electrical leads
Failure 2 pace
Interpret the following
Failure 2 sense
Interpret the following
3rd degree AV block (complete heart block)
Interpret this rhythm
Idioventricular rhythm
Interpret this rhythm
Sinus rhythm w/ 1st degree AV block
Interpret this rhythm
The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and understands that the rhythm is due to what cause?
Loss of sinus node activity
The nurse notices that a patient is in first-degree AV block but everything else about the rhythm is normal. The nurse should be prepared to take what action?
Monitor rhythm & pts conditions
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P WAVES are upright and look the same except the one that has a different shape and is inverted. The nurse realizes that the P WAVE with the abnormal shape is probably a result of what?
Originating from some area in the atria, other than the SA NODE
The pt is having premature ventricular contractions (PVC). What is the nurses greatest concern?
Proximity of the R wave of the PVC to the wave of a normal beat.
Which statement is true about a patient diagnosed with sinus arrhythmia
The heart rate varies, dependent on vagal tone and respiratory pattern
The patient is admitted with a fever and rapid heart rate and a temperature of 103°F. The nurse places the patient on a cardiac monitor and finds the patients atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen AND appear normal in configuration. QRS complexes are normal in appearance and 00.08 seconds wide. The rhythm is regular, and blood pressure is normal. What should be the nurses initial focus?
Treatment to lower temperature
2nd degree AV block mobitz I (wenckebach phenomenon)
What is this rhythm
R-on-t phenomenon
What is this rhythm
Sinus rhythm with bigeminal premature ventricular contractions
What is this rhythm
Sinus rhythm with multifocal premature ventricular contractions
What is this rhythm
Sinus Rhythm with PAC
What is this rhythm?
Atrial fibrillation
Which rhythm is this?
Ventricular fibrillation
Which rhythm is this?
The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is EXTREMELY IRREGULAR and there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is hemodynamically stable. The,nurse realizes that the patient is demonstrating what rhythm?
Atrial fibrillation
The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min. The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes. How does the nurse interpret this?
Failure to pace
The nurse is caring for a patient diagnosed with atrial fibrillation. Sequelae that place the patient at greater risk for mortality/morbidity include which of the following?
Stroke, pulmonary emboli, & decreased cardiac output
