Dysrhythmia AQ
A patient has sought care following a syncopal episode of unknown etiology. The nurse anticipates that what will be included in the patient's treatment plan? A head-up tilt-test Intravenous (IV) β-adrenergic blocker Pacemaker insertion Antiplatelet therapy
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 produce a response. Addressing pacemakers is premature and inappropriate at this stage of diagnosis. There is no data to support the initiation of antiplatelet therapy.
A patient with a heart rate of 120 beats/minute is prescribed an antidysrhythmia drug. The nurse anticipates that the patient will also receive a prescription for what diagnostic test? Holter monitoring Electrophysiologic study (EPS) Exercise treadmill testing Signal-averaged electrocardiogram (ECG)
Electrophysiologic study (EPS) An electrophysiologic study identifies the causes of heart blocks, tachydysrhythmias, bradydysrhythmias, and syncope. It can also locate accessory pathways and determine the effectiveness of antidysrhythmia drugs
A patient on a cardiac unit is shivering. What does the nurse expect to see on the patient's ECG tracing? Artifact Asystole Atrial flutter Junctional dysrhythmia
Artifact An artifact is a distortion of the baseline and waveforms seen on the electrocardiogram (ECG). If the patient is shivering or shows any muscle activity, accurate interpretation of the heart rhythm is difficult and artifacts can occur on the monitor. Asystole is the absence of all cardiac electrical activity. Atrial flutter occurs in chronic lung disease or hypertension. Junctional dysrhythmias are associated with an electrolyte imbalance or rheumatic heart disease.
What should the nurse include in discharge instruction for a patient with an implantable cardioverter-defibrillator (ICD)? Select all that apply. Avoid or limit air travel. Avoid large magnets and strong electromagnetic fields. Obtain and wear a Medic Alert ID device at all times. Avoid lifting arm on ICD side above the shoulder until approved. Do not walk through antitheft devices in doorways of stores and public buildings.
Avoid large magnets and strong electromagnetic fields. Obtain and wear a Medic Alert ID device at all times. Avoid lifting arm on ICD side above the shoulder until approved. Patients with ICDs need to avoid large magnets and strong electromagnetic fields, because they may interfere with ICD function. These patients need to obtain and wear a Medic Alert ID device at all times, and avoid lifting their arms on the ICD side above their shoulders until approved. These patients do not need to avoid air travel; they can walk through antitheft devices at a normal pace but should not stand next to them.
While the nurse is administering furosemide via intravenous push (IVP), a patient becomes unresponsive. The patient's electrocardiogram (ECG) tracing shows the following. What action should the nurse perform first? Cardiovert Defibrillate Check for a pulse Administer oxygen
Check for a pulse The ECG tracing is ventricular tachycardia (VT). Ventricular tachycardia can either be with a pulse or pulseless. The treatment algorithm depends on whether the patient has a pulse or not. Therefore, checking for a pulse is a priority. If the patient does not have a pulse, defibrillation is the priority. If the patient has a pulse, cardioversion and/or drug therapy is the priority. Oxygen may be administered, but it is not a priority.
A patient that is being tested for syncope has undergone the head-up tilt-test. After 30 minutes of testing, the patient's blood pressure and heart rate did not respond and no clinical symptoms were reproduced. The nurse anticipates that what medication will be given in a low dose intravenously (IV), to provoke a response? Adenosine Midazolam Magnesium Isoproterenol
Isoproterenol A head-up tilt-test is a procedure used to determine the cause of fainting spells in a patient. In the head-up tilt-test, the patient is placed on a table supported by a belt across the torso and feet. The electrocardiogram and heart rate are recorded continuously and blood pressure is measured every three minutes throughout the test. If the patient's BP and HR responses are abnormal and faintness is reproduced, the test is considered positive. If after 30 minutes there is no response, the table is returned to the horizontal position and an IV infusion of low-dose isoproterenol is started to provoke a response. IV adenosine is the drug used in the treatment of paroxysmal supraventricular tachycardia. IV midazolam is used to sedate a patient before performing synchronized cardioversion. IV magnesium is used to treat polymorphic ventricular tachycardia with a prolonged baseline QT interval.
Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)? Unmeasurable rate and rhythm Rate 150 beats/minute; inverted P wave Rate 200 beats/minute; P wave not visible Rate 125 beats/minute; normal QRS complex
Rate 200 beats/minute; P wave not visible VT is associated with a rate of 150 to 250 beats/minute; the P wave normally is not 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 providing care for a patient with type I second-degree atrioventricular (AV) block. Which statements about this type of rhythm are true? Select all that apply. A pacemaker is the only viable treatment. Some P waves are conducted to the ventricles. The P waves are not conducted to the ventricles. If the patient is symptomatic, atropine or a pacemaker may be needed. It may result from drugs such as digoxin. It is generally transient and well tolerated.
Some P waves are conducted to the ventricles. If the patient is symptomatic, atropine or a pacemaker may be needed. It may result from drugs such as digoxin. It is generally transient and well tolerated. Type I second-degree heart block refers to AV conduction that is intermittently blocked. Therefore, some P waves are conducted to the ventricle and some are not. Symptomatic patients may need atropine or a transcutaneous pacemaker. This type of heart block may result from drugs such as digoxin, and the condition is transient and well tolerated. If the patient is asymptomatic, no treatments may be needed. Third-degree block is often called complete heart block because no atrial impulses are conducted through the AV node to the ventricles.
Which statement is true regarding the role of the autonomic nervous system in impulse formation? Stimulation of the parasympathetic nerves increases cardiac contractility. Stimulation of the vagus nerve causes a decreased rate of firing of the sinoatrial (SA) node. Stimulation of the sympathetic nerves decreases atrioventricular (AV) node impulse conduction. Stimulation of the vagus nerve causes increased impulse conduction of the atrioventricular (AV) node.
Stimulation of the vagus nerve causes a decreased rate of firing of the sinoatrial (SA) node The autonomic nervous system plays an important role in the rate of impulse formation, the speed of conduction, and the strength of cardiac contraction. Stimulation of the vagus nerve causes a decreased rate of firing of the sinoatrial node. Stimulation of the parasympathetic system decreases cardiac contractility. Stimulation of the sympathetic nerves increases atrioventricular node impulse conduction. Stimulation of the vagus nerve decreases impulse conduction of the atrioventricular node. Vagus nerve fibers of the parasympathetic nervous system and nerve fibers of the sympathetic nervous system are the components of the autonomous nervous system that affect the heart rate.
A patient with paroxysmal supraventricular tachycardia (PSVT) that is receiving intravenous adenosine becomes hemodynamically unstable. The nurse expects what to be included in the patient's immediate treatment plan? β-adrenergic blocker Calcium channel blocker Catheter ablation therapy Synchronized cardioversion
Synchronized cardioversion Paroxysmal supraventricular tachycardia is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The standard drug of choice to treat paroxysmal supraventricular tachycardia is intravenous (IV) adenosine. Sometimes the drug therapy is ineffective and the patient becomes hemodynamically unstable. For patients who are unresponsive to treatment, synchronized cardioversion is used. Synchronized cardioversion is low energy shock, which uses a sensor to deliver electricity that is synchronized with the peak of the QRS complex. Drug therapy is not effective for such patients. β -adrenergic blockers and calcium channel blockers do not improve paroxysmal supraventricular tachycardia. Catheter ablation therapy is used in patients with Wolff-Parkinson-White syndrome who have recurring paroxysmal supraventricular tachycardia (PSVT).
The nurse reviews the electrocardiogram (ECG) tracing of a patient with an electrolyte imbalance and expects to find a disturbance in which waveform? P wave Q wave S wave T wave
T wave The T wave represents ventricular repolarization in an electrocardiogram. Disturbances (e.g., tall, peaked, inverted) in T waves can occur due to electrolyte imbalances, ischemia, and infarction. Disturbances in the P wave can be due to alterations in atrial conduction. Disturbances in the Q wave can occur due to myocardial infraction. Disturbances in the S wave do not affect the normal functioning of heart.
The nurse provides teaching to a group of nursing students about radiofrequency catheter ablation therapy and should include what information? The procedure has a high complication rate. The procedure is done before electrophysiological study (EPS). The therapy is considered the nonpharmacologic treatment of choice for severe bradycardic heart rhythms. The therapy uses electrical energy to remove problematic areas of the heart's conduction system.
The therapy uses electrical energy to remove problematic areas of the heart's conduction system. Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias. The ablation procedure is successful with a low complication rate. Ablation therapy is done after EPS has identified the source of the dysrhythmia. The therapy is considered the nonpharmacologic treatment of choice for atrial dysrhythmias resulting in rapid ventricular rates and AV nodal recurrent tachycardia refractory to drug therapy.
The nurse provides education to a group of nursing students about cardiac conditions that are common causes of dysrhythmias. What should the nurse include in the teaching? Select all that apply. Valve disease Emotional crisis Conduction defects Accessory pathways Electrolyte imbalances
Valve disease Conduction defects Accessory pathways Dysrhythmia is a condition of abnormal heart rhythm caused by either abnormal conduction or abnormal formation of heart impulses. Several conditions are responsible for the development of dysrhythmia. The cardiac disorders that may lead to dysrhythmia involve valve disease, conduction defects, and accessory pathways. Emotional crisis and electrolyte imbalances are noncardiac conditions that may cause a dysrhythmia.
The nurse is reviewing discharge instructions with a patient that received an implantable cardioverter-defibrillator (ICD). Which patient statement indicates the need for further teaching? "I should avoid flying for three years." "I should avoid direct blows to the ICD site." "I should avoid standing near antitheft devices in doorways." "I should avoid large magnets and strong electromagnetic fields."
"I should avoid flying for three years." Flying is not contraindicated in a patient with an implantable cardioverter-defibrillator (ICD). To ensure safety, the patient should inform airport security about the presence of the ICD at the airport because it may set off the metal detector. The patient should avoid direct blows to the ICD site to reduce pressure at the site. Electric and magnetic signals from antitheft devices and strong electromagnetic fields can affect ICD functioning.
A patient with a newly inserted pacemaker receives discharge instructions from the nurse. Which patient statement indicates that further teaching is required? "I should avoid using microwave ovens." "I should avoid standing near antitheft devices." "I should avoid direct blows to the pacemaker site." "I should avoid close proximity to high-output electric generators."
"I should avoid using microwave ovens." Microwaves do not interfere with a pacemaker's function and can be used safely. Electric signals from antitheft devices can affect pacemaker functioning. The patient should avoid direct blows to the pacemaker site to reduce pressure at the site. Electric signals from high-output electric generators can move the pacemaker from its position and affect its functioning.
A patient develops symptomatic sinus tachycardia. The nurse recognizes that which drug will likely be included in the patient's treatment plan? Atropine Dopamine Adenosine Epinephrine
Adenosine Hypotension, dizziness, and dyspnea are symptoms of sinus tachycardia. Sinus tachycardia manifests as increased heart rate from 101 beats per minute to 200 beats per minute. Adenosine is used in the treatment of sinus tachycardia. Adenosine decreases the heart rate caused by inhibition of the vagus nerve and myocardial oxygen consumption. Anticholinergic drugs like atropine, dopamine, and epinephrine are the choice of drugs in the treatment of sinus bradycardia.
A patient with chest pain experiences a heart rate of 200 beats/minute and blood pressure of 80/50 mm Hg. The electrocardiogram shows absent P waves. The nurse expects that which intravenous medication will be prescribed? Digoxin Atropine Adenosine Vasopressin
Adenosine Paroxysmal supraventricular tachycardia (PSVT) is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The symptoms associated with PSVT include hypotension, palpitations, dyspnea, and angina. In PSVT, the heart rate will be greater than 180 beats/minute and the electrocardiogram will often show a hidden P wave. Intravenous adenosine is the standard drug for paroxysmal supraventricular tachycardia. Digoxin, atropine, and vasopressin are not prescribed for paroxysmal supraventricular tachycardia. Digoxin is used in the treatment of atrial fibrillation. Atropine is used in the treatment of junctional escape rhythm. Vasopressin is used in the treatment of asystole.
The nurse is caring for a patient 24 hours after the patient underwent pacemaker insertion surgery. What will be included on the postoperative plan of care? Changing the surgical dressing as needed Encouraging full range-of-motion exercises of the involved arm Assessing the incision for any redness, swelling, or discharge Applying wet-to-dry dressings every four hours to the insertion site
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 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.
A patient's permanent pacemaker is failing to capture. The nurse recalls that the definition of failure to capture is when the electrical charge to the myocardium is insufficient to produce what cardiac activity? Spontaneous atrial activity Atrial or ventricular contraction Excitability during the cardiac cycle Spontaneous ventricular activity
Atrial or ventricular contraction Failure to capture occurs when the electrical charge to the myocardium is insufficient to produce atrial or ventricular contraction. Failure to sense occurs when the pacemaker fails to recognize spontaneous atrial or ventricular activity, and it fires inappropriately. This can result in the pacemaker firing during the excitable period of the cardiac cycle, resulting in ventricular tachycardia.
The nurse is caring for a patient that is experiencing symptomatic sinus bradycardia. Which drugs are used to treat this rhythm? Select all that apply. Atropine Dopamine Adenosine Metoprolol Epinephrine
Atropine Dopamine Epinephrine Sinus bradycardia is a condition in which the sinoatrial node elicits a heartbeat at a rate of less than 80 beats per minute. Sinus bradycardia is associated with hypotension, weakness, dizziness, and shortness of breath. It can be treated by the administration of atropine, an anticholinergic drug. Sympathomimetic drugs like dopamine and epinephrine are administered if atropine is ineffective. Beta blockers like adenosine and metoprolol are used in the treatment of sinus tachycardia.
The nurse is caring for a patient that has been advised to have a permanent pacemaker implanted. What are indications for a permanent pacemaker? Select all that apply. Cardiomyopathy SA node dysfunction Coronary angioplasty Drug therapy that may cause bradycardia Third-degree atrioventricular (AV) block
Cardiomyopathy SA node dysfunction Third-degree atrioventricular (AV) block A permanent pacemaker helps to maintain the normal cardiac pace and is implanted within the body. The power source of such a device is placed subcutaneously, usually over the pectoral muscle on the patient's nondominant side. The permanent pacemaker is used in cardiomyopathy, SA node dysfunction, and third-degree AV block when the dysfunction of the electrical pathways is assumed to be permanent or irreversible. A temporary pacemaker may be required during coronary angioplasty and during drug therapy that may cause bradycardia. To maintain adequate cardiac rhythms during postoperative recovery and as a prophylactic measure after open heart surgery, temporary pacemakers are used.
A patient's electrocardiogram (ECG) has changed from a normal sinus rhythm to the following rhythm. The nurse assesses the patient who was sleeping. The patient's respirations are 16 and unlabored, and the blood pressure has dropped from 110/70 to 104/68. What action should the nurse take? Continue monitoring the patient Notify the primary health care provider Check the medical record for hyperkalemia Perform an in-depth assessment
Continue monitoring the patient Sinus bradycardia can be a normal finding for athletes or patients when they sleep. Sinus bradycardia becomes clinically significant if the patient is symptomatic (hypotensive, chest pain, shortness of breath, change of level of consciousness). Because the respiratory status of the patient is stable and the blood pressure is only slightly lower because the patient is sleeping, the nurse should continue monitoring the patient. Hyperkalemia is characterized by a peaked T wave, and in advanced stages a widened QRS complex, neither of which are demonstrated on this ECG tracing.
Which action does flecainide have on the heart? Decreases automaticity Accelerates repolarization Decreases impulse conduction Reduces myocardial contractility
Decreases impulse conduction Flecainide is a class IC sodium channel blocker; it decreases impulse conduction in patients. Mexiletine is a class IB sodium channel blocker that accelerates repolarization. β-adrenergic blockers like esmolol decrease the automaticity of the sinoatrial node. Myocardial contractility is reduced with diltiazem, a calcium channel blocker.
The nurse prepares to defibrillate a patient in a life-threatening rhythm. The nurse recalls that defibrillation differs from synchronized cardioversion in which aspect? The patient is sedated before defibrillation is initiated. Defibrillation is the treatment of choice for ventricular fibrillation. Synchronized cardioversion is indicated to treat atrial bradydysrhythmias. Defibrillation is synchronized to deliver a shock during the QRS complex.
Defibrillation is the treatment of choice for ventricular fibrillation Defibrillation is the treatment of choice for ventricular fibrillation and pulseless ventricular tachycardia. Synchronized cardioversion is the therapy of choice for the patient with hemodynamically unstable ventricular or supraventricular tachydysrhythmias. Defibrillation is not synchronized to deliver a shock during the QRS complex, nor is the patient sedated for defibrillation (a patient in ventricular tachycardia [VT] or pulseless VT will generally be unconscious).
A patient in asystole is likely to receive which drug treatment? Epinephrine and vasopressin Lidocaine and amiodarone Digoxin and procainamide β-adrenergic blockers and dopamine
Epinephrine and vasopressin Treatment of asystole consists of CPR with initiation of ACLS measures. These include definitive drug therapy with epinephrine and/or vasopressin, and intubation. Lidocaine and amiodarone are used for premature ventricular contractions (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.
What should a nurse advise a group of caregivers with regards to a patient with an implantable cardioverter-defibrillator (ICD)? Select all that apply. Restrict air travel. If the ICD fires more than once, contact the emergency response system (ERS). Report any signs of infection at incision site. Restrict magnetic resonance imaging (MRI) scan. Restrict the lifting of the arm on the ICD side above the shoulder until approved.
If the ICD fires more than once, contact the emergency response system (ERS). Report any signs of infection at incision site. Restrict magnetic resonance imaging (MRI) scan. Restrict the lifting of the arm on the ICD side above the shoulder until approved. The patient should be instructed to contact ERS if the ICD fires more than once. The patient with an ICD should immediately report any signs of infection such as redness, swelling, drainage, or fever. The patient should not undergo MRI scan unless the ICD is approved as MRI-safe. Also, the arm on the ICD side should not be lifted above the shoulder unless approved by the cardiologist. Air travel is not restricted. However, while traveling, the patient should inform the airport security personnel about the presence of ICD because it may set off the metal detector.
The nurse assesses an unresponsive patient and reviews the patient's ECG tracing. The nurse determines that the patient is experiencing pulseless electrical activity (PEA). In addition to identifying the cause, what is the priority nursing action? Defibrillate Apply warm blankets Assist with intubation Initiate cardiopulmonary resuscitation (CPR)
Initiate cardiopulmonary resuscitation (CPR) PEA is a situation in which organized electrical activity is seen on the ECG, but there is no mechanical heart activity and the patient has no pulse. Treatment begins with CPR followed by drug therapy and intubation. Correcting the underlying cause is critical to prognosis. Applying warm blankets would help with hypothermia but can be completed later. Intubation depends upon the patient's response to cardiopulmonary resuscitation. It is not appropriate to defibrillate; the activity on the ECG is organized.
A patient reports a fluttering feeling in the chest. The nurse assesses a rhythm of supraventricular tachycardia (PSVT), a heart rate of 150 beats per minute, and a blood pressure of 120/60 mm Hg. The nurse anticipates that the patient's plan of care will include what treatments? Select all that apply. Intravenous adenosine Intravenous β-blockers Intravenous calcium channel blockers Vagal stimulation Emergent cardioversion
Intravenous adenosine Intravenous β-blockers Intravenous calcium channel blockers Vagal stimulation Medications that may be used include adenosine, β-blockers, calcium channel blockers, and amiodarone. These drugs have impact on various phases of action potential. Adenosine decreases conduction through the AV nodes. β-blockers decrease automaticity of the SA node. Treatment for PSVT also includes vagal stimulation. Common vagal maneuvers include Valsalva, carotid massage, and coughing. If the patient becomes hemodynamically unstable and symptomatic, emergent cardioversion is considered.
The patient is diagnosed with acute coronary syndrome (ACS). The nurse reviews the patient's electrocardiogram (ECG) and notes ST segment depression and T wave inversion. The ECG findings are indicative of what? Myocardial injury Myocardial ischemia Myocardial infarction The presence of a pacemaker
Myocardial ischemia Typical ECG changes that are seen in myocardial ischemia include ST segment depression and/or T wave inversion. Medications, fluid overload, and dehydration do not often affect the ST segment position on the ECG tracing.
A patient with a heart rate of 180 beats/minute has a regular heart rhythm, normal P waves, and normal PR intervals. The nurse expects to see what QRS complex shape on the patient's ECG tracing? Normal Not measurable Wide and distorted Abnormally shaped
Normal A normal P wave and normal PR interval in electrocardiogram (ECG) and the heart rate of 180 beats/minute indicates sinus tachycardia. The patient with sinus tachycardia generally shows normal QRS complexes. The QRS complex will not be measurable in the patient with ventricular fibrillation. The QRS complex will be wide and distorted or abnormally shaped in the ECG of a patient who has ventricular tachycardia or premature ventricular contractions. The P wave in these patients will not usually be visible and the PR interval will not be measurable.
The nurse is reviewing prescriptions of four patients. What does the nurse infer from this review? Patient A - Amiodarone Patient B - Adenosine Patient C - Atropine Patient D - Synchornized Cardioversion Patient A - Atrial fibrillation Patient B - Sinus Tachycardia Patient C - Junctional Escape Rhythm Patient D - Sinus Bradycardia
Patient C - Junctional Escape Rhythm A patient with junctional escape rhythm shows a heart rate in the range of 40 to 60 beats/minute. Atropine increases the ventricular rate and can effectively improve the junctional escape rhythm in patient C. Atrial fibrillation in patient A is treated with diltiazem. Sinus tachycardia can be effectively treated by synchronized cardioversion in patient B. Sinus bradycardia in patient D can be treated by amiodarone.
The nurse reviews a patient's electrocardiogram (ECG) tracing and notes a heart rate of 82 and an irregular rhythm. How should the nurse interpret the findings? Sinus tachycardia Junctional dysrhythmia Premature atrial contractions Paroxysmal supraventricular tachycardia
Premature atrial contractions When premature atrial contractions are present, the result is an irregular rhythm. In sinus tachycardia, the patient's heart rate is 101 to 200 beats per minute, and the cardiac rhythm is regular. A heart rate of 40 to 180 beats per minute with regular cardiac rhythm is observed in patients with junctional dysrhythmias. A heart rate of 150 to 220 beats per minute with regular cardiac rhythm is observed in patients with paroxysmal supraventricular tachycardia.
The nurse suspects that a patient is experiencing myocardial infarction (MI). Which component of the patient's electrocardiogram (ECG) is most important for the nurse to analyze to make this determination? P wave PR interval ST segment Heart rate
ST segment The typical ECG change seen during myocardial injury is ST segment elevation. The P wave represents time for the passage of the electrical impulse through the atrium; there are no specific changes that occur with MI. A prolonged PR interval is indicative of a heart block and is usually not associated with MI. A specific change is heart rate is not associated with MI.
The nurse presents information about electrocardiogram (ECG) changes associated with myocardial infarction (MI) to a group of nursing students. What should the nurse include in the information? Select all that apply. The ST segment will be elevated. The T wave will be normal. A pathologic Q wave that develops during MI is wide and deep. The pathologic Q wave will eventually disappear from the ECG. A physiologic Q wave is normally very short and narrow.
The ST segment will be elevated. A pathologic Q wave that develops during MI is wide and deep. A physiologic Q wave is normally very short and narrow. The typical ECG changes associated with MI are pathologic Q wave, ST segment elevation, and T wave inversion. ST segment elevation is considered significant if it is 1 mm or more above the isoelectric line in at least two contiguous leads. A pathologic Q wave that develops during MI is wide (greater than 0.03 seconds in duration) and deep (greater than or equal to 25% of the height of the R wave). The pathologic Q wave may remain on the ECG indefinitely. A physiologic Q wave is the first negative deflection following the P wave. It is normally very short and narrow.
A patient arrives in the emergency room with indigestion, shortness of breath, and back pain. The nurse reviews the results of the patient's 12-lead electrocardiogram (ECG) and notes ST elevation in leads II, III, and AVF. How should the nurse interpret the findings? The patient has acute injury to the circumflex artery. The patient has acute injury to the right coronary artery. The patient has acute infarction of the left anterior descending artery. The patient is not having a heart attack and most likely has gastric reflux.
The patient has acute injury to the right coronary artery. An ST elevation in leads II, III, and AVF indicates an acute injury to the inferior wall of the left ventricle involving the right coronary artery. An ST elevation in leads V1-V4 indicates acute infarction of the septal or anterior wall of the left ventricle involving the circumflex and left anterior descending arteries. An ST elevation with T wave inversion and a pathologic Q wave indicate acute infarction with cardiac cell death. A patient with symptoms of indigestion, shortness of breath, and back pains should have an immediate 12-lead ECG to rule out cardiac involvement; these symptoms indicate something more severe than reflux.
A patient is hospitalized with heart failure. The patient has the following electrocardiogram (ECG) tracing, is experiencing chest pain, shortness of breath, and has a blood pressure of 70/40. The nurse anticipates that what will be included on the patient's plan of care? Lidocaine IV infusion Transcutaneous pacing Trendelenburg position A 500 mL bolus of normal saline
Transcutaneous pacing The patient is in a third-degree atrioventricular (AV) block and requires some type of pacemaker. Lidocaine is contraindicated because it further decreases ventricular conduction. Placing the patient in a Trendelenburg position would increase the work of breathing and increase venous return, which could worsen the patient's condition. Administration of fluid boluses in heart failure patients would cause worsening of symptoms.
The nurse is placing leads on a patient in a coronary care unit. What are the correct lead positions? Select all that apply. V 1 is placed on the fourth intercostal space on the right sternal border. V 2 is placed on the fourth intercostal space on the left sternal border. V 3 is situated halfway between V 2 and V 4. V 4 is placed on the fifth intercostal space at the left midclavicular line. V 5 is placed on the fifth intercostal space at the left midaxillary line. V 5 is placed on the fifth intercostal space at the left anterior axillary line.
V 1 is placed on the fourth intercostal space on the right sternal border. V 2 is placed on the fourth intercostal space on the left sternal border. V 3 is situated halfway between V 2 and V 4. V 4 is placed on the fifth intercostal space at the left midclavicular line. V 5 is placed on the fifth intercostal space at the left anterior axillary line The V 1 lead is placed on the fourth intercostal space at the right sternal border. The V 2 lead is placed on the fourth intercostal space at the left sternal border. The V 3 lead is placed halfway between V 2 and V 4. The V 4 lead is placed on the fifth intercostal space at the left midclavicular line. The V 5 lead is placed on the fifth intercostal space at the left anterior axillary line, not the midaxillary line.