Dysrhythmia EAQ
While waiting for the Rapid Response Team to arrive, the nurse performs the steps of resuscitation in which order when responding to patient in ventricular fibrillation?
1. Initiate cardiac compressions. 2. Maintain an open airway. 3. Ventilate with a mouth-to-mask device. 4. Contact the primary health care provider (HCP). 5. Notify the patient's family members of the change in status. The American Heart Association Guidelines for Basic Cardiac Life Support are to first provide cardiac compressions, then maintain the airway, and then begin rescue breathing (CAB). Compressions are the first priority because the desired outcome of resuscitation is the rapid return of a pulse, blood pressure, and consciousness. The nurse should not delay treatment while attempting to notify the HCP. The family of the patient can be notified after the resuscitative efforts have begun and when the status of the patient has been determined.
Place the steps the nurse takes when using an automated external defibrillator (AED) on a person who is receiving cardiopulmonary resuscitation (CPR) from bystanders in the correct order.
1. Place the AED pads on the victim's chest. 2. Announce to cease contact with victim. 3. Press the analyze button on the machine. 4. Press the button to shock if indicated. 5. Resume CPR. Place adhesive electrodes on the victim's upper-right and lower-left chest. Next, connect the pads to the AED and turn on the machine. The rescuer stops CPR and commands anyone present to cease contact with the victim to eliminate motion artifact during analysis of the rhythm. Next, press the "analyze" button on the machine, which may take up to 30 seconds. If the AED advises that a shock is necessary, press the shock button after announcing "all clear" again. Once the shock is delivered, CPR is resumed.
After providing discharge education for a patient with a new permanent pacemaker, the nurse identifies that which statement indicates the need for further teaching? A. "I no longer need my heart pills." B. "I need to take my pulse every day." C. "I will be able to shower again soon." D. "I might trigger airport security metal detectors."
A. "I no longer need my heart pills." All prescribed medications are still needed after the pacemaker is implanted. Once the wound from the surgery heals, the patient will be able to shower. The patient's pulse will have to be taken and recorded for 1 full minute at the same time each day. The metal in the pacemaker will trigger the alarm in metal detector devices; a card can be shown to authorities to indicate that the patient has a pacemaker.
The nurse provides discharge education for a patient who underwent permanent pacemaker surgery. Which statement by the patient indicates the need for further teaching? A. "I should wear snug clothing over the generator to protect it." B. "I shouldn't lean over electrical or gasoline engines or motors." C. "I should stay away from antitheft devices in stores as much as possible." D. "I should tell airport personnel about the pacemaker before going through a metal detector."
A. "I should wear snug clothing over the generator to protect it." The patient should avoid pressure over the generator, which means loose clothing is preferable to tight clothing. The other statements are correct. The patient should also stay away from antitheft devices and electrical or gasoline engines or motors that can cause pacemaker malfunction. The pacemaker can set off an airport metal detector, so airport personnel should be informed.
Which instruction about taking a pulse does the nurse give to a family member who is caring for a patient with a permanent pacemaker? A. "Take it for 1 full minute at the same time each day." B. "Take it for 2 full minutes at the same time each day." C. "Take it for 1 full minute at different times each day." D. "Take it for 2 full minutes at different times each day."
A. "Take it for 1 full minute at the same time each day." While educating a patient's family member about management of a permanent pacemaker, the nurse should instruct the caregiver to take the patient's pulse for 1 full minute at the same time each day and to record it in a pacemaker diary. The family member may take the patient's pulse any time he or she believes there are symptoms of pacemaker failure and report the patient's heart rate and symptoms to the physician. Taking the pulse for 2 full minutes at the same each day, or at different times of the day, is unnecessary for detecting pacemaker failure. Measuring the pulse for 1 full minute at a different time each day or recording 2 full minutes of the pulse reading at different times on the same day does not provide an accurate assessment of the pacemaker's functioning
Which information does the nurse include when teaching patients who are at risk for bradydysrhythmias? A. "Use a stool softener." B. "Stop smoking, and avoid caffeine." C. "Avoid potassium-containing foods." D. "Take nitroglycerin for a slow heartbeat."
A. "Use a stool softener." Patients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps prevent this. Patients with renal failure and hyperkalemia are instructed to avoid potassium-containing foods; if risk for hypokalemia exists, such as with diuretic therapy, the patient is instructed to eat foods high in potassium. Smoking and caffeine increase the heart rate; although all people should stop smoking, patients at risk for tachycardia, premature beats, and ectopic rhythms are instructed to stop smoking and avoid caffeine. Nitroglycerin is used to reduce oxygen demand in cardiac ischemia, not for bradycardia.
Which patient is appropriate for the cardiac care unit nursing team leader to assign to a float registered nurse (RN) from a medical-surgical unit? A. A 64-year-old patient admitted for weakness who has sinus bradycardia with a heart rate of 58 beats/min B. A 71-year-old patient admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min C. An 88-year-old patient admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min D. A 92-year-old patient admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min
A. A 64-year-old patient admitted for weakness who has sinus bradycardia with a heart rate of 58 beats/min The 64-year-old has a stable, asymptomatic bradycardia, which usually requires monitoring but no treatment unless the patient develops symptoms and/or the slow heart rate causes a decrease in cardiac output. This patient can be managed by a nurse with less cardiac dysrhythmia training. The 71-year-old is unstable and requires immediate intervention for dyspnea and tachycardia. The 88-year-old is displaying symptoms of myocardial injury (elevated troponin) and unstable blood pressure and needs immediate attention and medications. The 92-year-old is experiencing a dysrhythmia that could deteriorate into ventricular tachycardia and requires immediate intervention by a telemetry nurse.
The nurse anticipates which prescription for a patient with asymptomatic atrial fibrillation and a pulse of 88 beats/min? A. Anticoagulation B. Synchronized cardioversion C. Electrophysiology studies (EPS) D. Radiofrequency ablation therapy
A. Anticoagulation Because of the risk for thromboembolism caused by atrial fibrillation, anticoagulation is necessary. The patient is stable; cardioversion is not needed at this time. EPS are indicated for recurring, symptomatic dysrhythmia. Ablation therapy is prescribed for recurring and symptomatic atrial fibrillation.
Which dysrhythmia most likely contributed to a patient's acute pulmonary embolism? A. Atrial fibrillation B. Sinus bradycardia C. Ventricular tachycardia D. Premature atrial contractions
A. Atrial fibrillation Because the atria are not fully contracting in atrial fibrillation, there is stagnation of blood flow resulting in formation of thrombi in the atria. A thrombus can be dislodged from the right atrium and travel to the lung, causing a pulmonary embolus. There is not a risk for thrombus formation with sinus bradycardia, premature atrial contractions, or ventricular tachycardia.
Which information does the nurse include in the discharge teaching for a patient with a newly placed implantable cardioverter-defibrillator (ICD)? Select all that apply. A. Avoid activity more vigorous than bowling or golf. B. Go to the emergency department if the device discharges. C. Use a cell phone on the opposite side from the ICD. D. Do not wear tight clothing over the ICD generator. E. Remove electrodes before showering or bathing, and replace them immediately afterwards. F. Avoid leaning directly over the alternator of a running motor of a car or boat.
A. Avoid activity more vigorous than bowling or golf. C. Use a cell phone on the opposite side from the ICD. D. Do not wear tight clothing over the ICD generator. F. Avoid leaning directly over the alternator of a running motor of a car or boat. The patient should avoid activities that involve rough contact with the ICD site. Activity more vigorous than bowling or golf should be avoided. Most modern wireless communication devices do not interfere with ICD function; however, cell phones should be used on the opposite side from the ICD. The patient should not wear tight clothing or belts that could cause irritation over the ICD generator. Caution should be used when in close proximity to a running alternator because it emits electromagnetic energy. The health care provider may want to be notified each time the device discharges; it does not necessarily mean that the patient should report to the emergency department. There are no external electrodes with an ICD.
The nurse monitors for which significant effect when a patient is prescribed adenosine drug therapy to convert supraventricular tachycardia to normal sinus rhythm? A. Bradycardia B. Rebound tachycardia C. Ventricular fibrillation D. Premature atrial complexes
A. Bradycardia Adenosine is mainly used to covert supraventricular tachycardia to a normal sinus rhythm. Adenosine terminates the acute episode and is followed by a normal saline bolus. The major side effect of this drug therapy is significant bradycardia. Rebound tachycardia, ventricular fibrillation, and premature atrial complexes are conditions that are not associated with adenosine drug therapy.
Which action does the nurse implement first when caring for a patient with unstable angina whose cardiac monitor shows ventricular tachycardia? A. Check the patient for a pulse. B. Cardiovert the patient at 50 joules. C. Give the patient IV lidocaine. D. Defibrillate the patient at 200 joules.
A. Check the patient for a pulse. The nurse needs to assess the patient to determine stability before proceeding with further interventions. If the patient has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. The drug of choice for stable ventricular tachycardia with a pulse is amiodarone. If the patient is pulseless or nonresponsive, the patient is unstable and defibrillation is used.
The nurse suspects which cause of a patient's new onset of sinus bradycardia? Select all that apply. A. Diltiazem was administered 1 hour previously. B. The patient reported bearing down for a bowel movement. C. The patient reported the recent consumption of a cup of coffee. D. Inferior wall myocardial infarction (MI) occurred. E. The patient became emotionally excited when visitors arrived.
A. Diltiazem was administered 1 hour previously. B. The patient reported bearing down for a bowel movement. D. Inferior wall myocardial infarction (MI) occurred. Calcium channel blockers, such as diltiazem, may cause bradycardia. Excessive vagal (parasympathetic) stimulation to the heart causes a decreased rate of sinus node discharge. It may result from carotid sinus massage, vomiting, suctioning, Valsalva maneuvers (e.g., bearing down for a bowel movement, gagging), ocular pressure, or pain. Inferior wall MI is a cause of bradycardia and heart block. Caffeine intake results in an increased heart rate. Stress, such as an emotional encounter, can result in tachycardia.
Which action does the nurse take when the telemetry monitor of a patient with a history of coronary artery disease shows sinus tachycardia with a rate of 144 beats/min? Select all that apply. A. Evaluate whether jugular venous distention is present. B. Assess blood pressure and skin temperature. C. Ask the patient to report any muscle cramps. D. Instruct the patient to ambulate as tolerated, and continue to monitor. E. Assess for the presence of chest pain or pressure.
A. Evaluate whether jugular venous distention is present. B. Assess blood pressure and skin temperature. E. Assess for the presence of chest pain or pressure. A heart rate of 144 beats/min is a major concern in patients with coronary artery disease because it increases the workload of the heart, increasing myocardial oxygen demand. A heart rate of 144 beats/min may decrease ventricular filling time, stroke volume, and cardiac output, which decrease blood pressure and coronary perfusion pressure. These factors combined are likely to exacerbate ischemia, causing chest pain or pressure. Associated symptoms are pallor and cool skin temperature. Tachycardia may also lead to heart failure, manifested by distention of the jugular veins. The patient should be advised to limit activities to reduce cardiac workload. Muscle cramps are not associated with tachycardia or coronary artery disease.
Which assessment finding does the nurse expect when caring for a patient who is hospitalized with sustained tachydysrhythmia? A. Fainting B. Flushing C. Agitation D. Bounding pulse
A. Fainting Patients with tachydysrhythmia may experience syncope (blackout or fainting), palpitations, chest pressure/pain, pallor (not flushing), and restlessness/anxiety. Agitation is a sign of hypoxemia, and a bounding pulse is associated with increased cardiac output or increased intracranial pressure.
The nurse identifies which cause of sinus tachycardia? Select all that apply. A. Fever B. Anxiety C. Hyperthyroidism D. Straining when attempting to have a bowel movement E. Use of a beta-adrenergic blocking drug
A. Fever B. Anxiety C. Hyperthyroidism Sinus tachycardia results from sympathetic nervous system stimulation or parasympathetic inhibition, which increases the heart rate to over 100 beats/min. Causes may include fever, anxiety, pain, stress, hyperthyroidism, hypoxemia, and pulmonary embolism. Beta-adrenergic blocking drugs inhibit or block the sympathetic nervous system resulting in lower heart rates or bradycardia. Straining during defecation (Valsalva maneuver) may cause vagal stimulation of the heart with resulting bradycardia.
When caring for a patient with premature ventricular contractions (PVCs), the nurse monitors for which electrolyte imbalance that may contribute to the dysrhythmia? Select all that apply. A. Hypokalemia B. Hyponatremia C. Hypocalcemia D. Hypomagnesemia E. Hypophosphatemia
A. Hypokalemia D. Hypomagnesemia Low serum levels of potassium and magnesium predispose the patient to PVCs. Low levels of sodium, calcium, and phosphate may cause ECG changes but do not increase the risk for PVCs.
Which is the priority intervention when the nurse notes ventricular fibrillation on a patient's cardiac monitor? A. Initiate high-quality cardiopulmonary resuscitation (CPR). B. Determine the respiratory rate. C. Notify the health care provider. D. Administer 100% oxygen by nonrebreather mask
A. Initiate high-quality cardiopulmonary resuscitation (CPR). In ventricular fibrillation, cardiac output, pulse, and respirations cease, resulting in the absence of systemic tissue perfusion; immediate defibrillation or high-quality CPR with defibrillation as soon as possible is indicated. The health care provider should be notified immediately after CPR is started. Determining the respiratory rate is not necessary because there is no rate to determine. Administration of oxygen is part of the resuscitation effort, but providing oxygen by mask will be ineffective because there is no respiration.
When caring for a patient with heart disease, the nurse identifies that which action may lead to serious bradydysrhythmias? A. Oropharyngeal suctioning B. Insertion of an indwelling urinary catheter C. Hip flexion greater than 90 degrees D. Walking on a treadmill at a moderate pace
A. Oropharyngeal suctioning Anything that causes the patient to perform the Valsalva maneuver (e.g., bear down, gag, vomit) leads to vagal stimulation. Unintended vagal stimulation can result in serious bradydysrhythmias and should be avoided. Oropharyngeal suctioning causes the patient to gag and possibly vomit. None of the other activities (insertion of an indwelling urinary catheter, hip flexion, or moderate walking on a treadmill) induce the Valsalva maneuver.
The nurse expects which assessment finding in a patient with a heart rate of 143 beats/min? Select all that apply. A. Palpitations B. Hypoventilation C. Orthopnea D. Chest discomfort E. Dryness of the skin
A. Palpitations C. Orthopnea D. Chest discomfort Sinus tachycardia is a heart rate greater than 100 beats/min. For patients with sinus tachycardia, the nurse should assess for fatigue, weakness, shortness of breath, orthopnea, decreased oxygen saturation, increased pulse rate, and decreased blood pressure. Also assess for restlessness and anxiety from decreased cerebral perfusion and for decreased urine output from impaired renal perfusion. The patient may also have anginal pain and palpitations. The patient with sinus tachycardia experiences an increased respiratory rate and often shortness of breath, not hypoventilation. The patient may also experience diaphoresis (sweating), not dryness of the skin.
Which is the priority after a crash cart has been brought to a patient's room when the nurse is responding to a patient in ventricular fibrillation? A. Perform defibrillation. B. Administer epinephrine. C. Provide rescue breathing. D. Perform cardiac compressions.
A. Perform defibrillation. In cases of ventricular fibrillation, the earlier that defibrillation (asynchronous countershock) is performed, the greater the chance of survival. Defibrillation depolarizes a critical mass of myocardium simultaneously with the goal of restoring spontaneous circulation. Cardiac compressions, rescue breathing, and the administration of epinephrine follow defibrillation.
Which action does the nurse take when, during a wellness physical examination, a patient's cardiac rhythm strip has all the characteristics of normal sinus rhythm, except that there is a pattern of irregularity that is associated with the patient' s breathing? A. Proceed with the examination as planned. B. Immediately notify the health care provider. C. Move the electrodes, and re-evaluate the rhythm strip. D. Suggest for the patient to follow up with a cardiologist.
A. Proceed with the examination as planned. Sinus arrhythmia is a variant of normal sinus rhythm. It results from changes in intrathoracic pressure during breathing. Instead, the heart rate increases slightly during inspiration and decreases slightly during exhalation. This irregular rhythm is frequently observed in healthy adults. In this context, the term arrhythmia does not mean an absence of rhythm, as the term suggests. Therefore no further action is needed. The health care provider does not need immediate notification. There is no need to re-evaluate the rhythm strip. There is no indication that follow-up with a cardiologist is needed.
In addition to an antidysrhythmic, which medication does the nurse plan to administer to a patient with atrial fibrillation? A. Rivaroxaban B. Atropine C. Dobutamine D. Magnesium sulfate
A. Rivaroxaban The loss of coordinated atrial contractions in atrial fibrillation can lead to pooling of blood resulting in thrombus formation. The patient is at high risk for pulmonary embolism! Thrombi may form within the right atrium and then move through the right ventricle to the lungs . In addition, the patient is at risk for systemic emboli, particularly an embolic stroke, which may cause severe neurologic impairment or death. Rivaroxaban or other anticoagulants are used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke). Atropine is used to treat bradycardia and heart blocks; atrial fibrillation, unless controlled with medication, is typically rapid. Dobutamine is an inotropic agent used to improve cardiac output; it may cause tachycardia, thereby worsening atrial fibrillation. Although electrolyte levels are monitored in patients with dysrhythmia, magnesium sulfate is not used unless depletion is noted.
Which complication is associated with carotid sinus massage therapy? Select all that apply. A. Sinus bradycardia B. Cerebral damage C. Ventricular fibrillation D. Premature atrial complexes E. Premature ventricular complexes
A. Sinus bradycardia B. Cerebral damage C. Ventricular fibrillation Supraventricular tachydysrhythmias are treated temporarily by carotid sinus massage therapy. Complications of this therapy include bradycardia, cerebral damage, and ventricular fibrillation. Premature atrial complexes are caused by irritated atrial tissue, which is not associated with carotid sinus massage therapy. Premature ventricular complexes are caused by irritated ventricular tissue, which is also not associated with carotid sinus massage therapy.
Which information does the nurse include when teaching a patient who experiences palpitations and frequent premature atrial complexes? Select all that apply. A. Smoking cessation B. Limited physical exertion C. Decreased consumption of caffeinated beverages D. Improvement of hydration with increased water intake E. Techniques to reduce stress
A. Smoking cessation C. Decreased consumption of caffeinated beverages E. Techniques to reduce stress Stress is a cause of atrial irritability leading to premature atrial contractions. More effective ways of stress management should be explored. Nicotine and caffeine also increase the incidence of premature atrial contractions and should be avoided or reduced. Limiting physical exertion is not indicated. Increasing water intake will not alleviate the problem.
Which action does the nurse take when responding to a pulseless patient whose telemetry monitor shows ventricular asystole? A. Start compressions. B. Call for the Rapid Response Team. C. Prepare for immediate defibrillation. D. Place electrodes on the chest, and initiate transcutaneous pacing.
A. Start compressions. The American Heart Association Guidelines for Basic Cardiac Life Support are to first provide cardiac compressions, then maintain the airway, and then begin rescue breathing (CAB). Compressions are the first priority because the desired outcome of resuscitation is the rapid return of a pulse, blood pressure, and consciousness. In most hospitals, the Rapid Response Team is different from the Code Blue Team that responds to a patient experiencing a cardiac arrest. Ventricular asystole should never be defibrillated. Transcutaneous pacing is ineffective in asystole.
Which is a cause of atrial irritability? Select all that apply. A. Stress B. Fatigue C. Anemia D. Infection E. Muscle atrophy
A. Stress B. Fatigue D. Infection Stress, fatigue, and infection may cause atrial irritability. Anemia and muscle atrophy may lead to increased fatigue.
Which statement made by a patient who is taking propranolol for a dysrhythmia warrants further investigation by the nurse? A. "I feel constipated since I've been in the hospital." B. "I got dizzy when walking to the bathroom earlier." C. "I have been more tired since I started taking this medicine." D. "My pulse seems to be slower and more regular than before.
B. "I got dizzy when walking to the bathroom earlier." Propranolol is a beta blocker that has been approved for the treatment of dysrhythmias. The nurse should monitor heart rate and blood pressure (BP); bradycardia and decreased BP are expected effects. The nurse should assess for insomnia, fatigue, and dizziness; side effects may require a decrease in dosage or discontinuation of the drug. Constipation and fatigue are possible side effects of metoprolol. An expected outcome with propranolol is a decreased heart rate.
Which teaching does the nurse include for a patient with atrial fibrillation who receives a new prescription for warfarin? A. "Avoid caffeinated beverages." B. "Report nosebleeds to your health care provider immediately." C. "You should take aspirin or ibuprofen for headaches." D. "It is important to consume a diet high in green leafy vegetables."
B. "Report nosebleeds to your health care provider immediately." Warfarin causes decreased ability to clot; a nosebleed could be indicative of excessive dosing. It is not necessary to avoid caffeine because this does not affect clotting; however, green tea may interfere with the effects of warfarin. Aspirin and NSAIDs (such as ibuprofen) may prolong the prothrombin time (PT) and the international normalized ratio (INR), causing predisposition to bleeding; these should be avoided. Green leafy vegetables are high in vitamin K, which may antagonize the effects of warfarin.
The nurse provides education for a patient after the insertion of a synchronous demand pacemaker to treat an episode of complete heart block. Which statement indicates the patient understands the teaching? A. "When my heart beats fast, the pacemaker will correct it." B. "When my pulse is less than the set rate, the pacemaker stimulates my heart to beat." C. "If I develop a life-threatening heart rhythm, the pacemaker will give me a shock to stop it." D. "My heart doesn't beat right, so the pacemaker will stimulate my heart to beat 60 times per minute."
B. "When my pulse is less than the set rate, the pacemaker stimulates my heart to beat." Synchronous or demand pacemakers sense the patient's intrinsic, or own, rhythm. When the patient's heart rate is above the set rate, the pacemaker does not fire. When the heart rate is below the set rate, the pacemaker delivers an electrical impulse that stimulates the heart to beat. Although there are antitachycardic pacemakers, they are not considered demand pacemakers. Pacemakers do not deliver shocks to terminate dysrhythmias; cardioverter-defibrillators do that.
While educating a group of staff nurses, the nurse includes which intervention when discussing treatment of a patient who develops ventricular asystole? Select all that apply. A. Defibrillation B. Administration of oxygen C. Administration of epinephrine D. Cardiopulmonary resuscitation (CPR) E. Synchronized cardioversion
B. Administration of oxygen C. Administration of epinephrine D. Cardiopulmonary resuscitation (CPR) Hypoxia may be a cause of cardiac arrest; the administration of oxygen would be appropriate. Epinephrine is used to increase heart rate in asystole. The patient in ventricular asystole has no pulse, respirations, or blood pressure. The patient is in full cardiac arrest. CPR is needed. Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take over. In asystole, there is no rhythm to interrupt; therefore this intervention is not used. Synchronized cardioversion is not used for ventricular asystole, because the entire conduction system is electrically silent, with no P waves seen on the ECG.
Which risk factor is known to contribute to atrial fibrillation (AF)? Select all that apply. A. Palpitations B. Advancing age C. High blood pressure D. Excessive alcohol use E. Use of beta-adrenergic blockers
B. Advancing age C. High blood pressure D. Excessive alcohol use The incidence of AF increases with age. Risk factors include hypertension, previous ischemic stroke, transient ischemic attack or other thromboembolic event, coronary heart disease, diabetes mellitus, heart failure and mitral valve disease, obesity, Caucasian race, and excessive alcohol. Beta-adrenergic blocking agents, which reduce heart rate, are used to treat AF. Palpitations are a symptom of atrial fibrillation rather than a risk or a cause.
The nurse identifies that which medication will be given to a patient who presents to the emergency department with chest pain, shortness of breath, diaphoresis, hypotension, and a heart rate of 56 beats/min? A. Digoxin B. Atropine C. Verapamil D. Propranolol
B. Atropine The administration of atropine along with IV fluids will increase intravascular volume and help to manage bradycardia. Beta blockers such as propranolol are not administered to patients with bradycardia. Cardiac glycoside (digoxin) and calcium channel blockers (verapamil) will further decrease the heart rate and worsen the symptoms.
When caring for a patient with heart disease, the nurse recognizes that which activity should be avoided to prevent excessive vagal stimulation to the heart? Select all that apply. A. Hiccups B. Constipation C. Oropharyngeal suctioning D. Ocular pressure E. Hip flexion greater than 90 degrees
B. Constipation C. Oropharyngeal suctioning D. Ocular pressure Excessive vagal stimulation may result from carotid sinus massage, vomiting, suctioning, Valsalva maneuvers (e.g., bearing down for a bowel movement, gagging), ocular pressure, or pain. If constipated, the patient may strain or bear down to have a bowel movement. Oropharyngeal suctioning often causes the patient to gag and possibly vomit. Hiccups and hip flexion do not cause vagal stimulation.
The nurse identifies that which monitoring is essential when administering metoprolol to a patient with acute coronary syndrome (ACS) and atrial fibrillation? A. Troponin B. Heart rate C. Myoglobin D. ST segment
B. Heart rate The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand. ST segment elevation is consistent with myocardial infarction (MI); it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS but does not address needed monitoring related to metoprolol.
Which dysrhythmia is caused by atrial irritability? A. Atrial fibrillation B. Premature atrial complexes C. Supraventricular tachycardia D. Premature ventricular complexes
B. Premature atrial complexes Premature atrial complexes will develop when the atrial tissue becomes irritated. The ectopic focus generates impulses before the next normal sinus impulse, which causes palpitations and a sense of the heart skipping a beat. Atrial fibrillation, supraventricular tachycardia, and premature ventricular complexes are not caused by atrial irritability.
Which action does the nurse take first when a patient who was hospitalized after using cocaine develops ventricular fibrillation? A. Establish IV access. B. Prepare for defibrillation. C. Place an oral airway and ventilate. D. Start cardiopulmonary resuscitation (CPR).
B. Prepare for defibrillation. Defibrillating is the priority before any other resuscitative measures, according to Advanced Cardiac Life Support protocols. After immediate defibrillation, establish IV access, place an oral airway, and ventilate. CPR will be started after unsuccessful defibrillation.
Which precaution does the nurse follow when providing cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) to a patient? A. Protective isolation B. Standard Precautions C. Surgical asepsis with the defibrillator D. Airborne precautions during intubation
B. Standard Precautions Standard Precautions and personal protective equipment must be used when there is risk for contact with blood and body fluids. Protective isolation aims to protect an immunocompromised patient who is at high risk for acquiring microorganisms from either the environment or from other patients, staff, or visitors. Surgical asepsis involves ridding an item of all pathogens, such as in the operating room, with sterilization procedures. A defibrillator is a "clean," not sterile, item. Airborne precautions are used when germs, such as the kind that cause tuberculosis (TB) and chickenpox, can be spread through the air from one person to another. Instead, the nurse may choose to use protective eyewear or a face shield during intubation or suctioning of the airway to protect from spraying blood and body fluids.
Which action does the nurse take first when a patient suddenly becomes limp and unresponsive with no carotid pulse? A. Maintain a patent airway. B. Start cardiac compressions. C. Contact the health care provider (HCP) immediately. D. Place a firm board under the patient.
B. Start cardiac compressions. With the new Basic Cardiac Life Support guidelines, cardiac compressions are initiated, followed by maintaining an airway and ventilating the patient. The HCP should be contacted after resuscitative efforts have begun. When help arrives, a firm board is placed under the patient to maximize efficiency of cardiac compressions.
Which condition is a result of a hypereffective heart in a well-conditioned athlete? A. Tachypnea B. Dysrhythmia C. Bradycardia D. Cardiac arrest
C. Bradycardia A hypereffective heart has a strong heart muscle that provides an adequate stroke volume and a low heart rate to achieve a normal cardiac output. Bradycardia occurs because of a hypereffective heart in a well-conditioned athlete. A dysrhythmia is an irregular heart rate. Tachypnea is a key feature of sustained tachydysrhythmias. A cardiac arrest is a temporary cessation of the heart.
How does the nurse recognize that atropine has produced a positive outcome for a patient with bradycardia? A. The nurse notes dyspnea. B. The patient reports dizziness and weakness. C. The patient's heart rate is 42 beats/min. D. The monitor shows an increase in heart rate.
D. The monitor shows an increase in heart rate. An expected outcome after the administration of atropine is increased heart rate. By definition, the bradydysrhythmia has resolved when the heart rate is 60 beats/min. Dizziness and weakness indicate symptoms of decreased cerebral perfusion and intolerance to the bradydysrhythmia. Dyspnea indicates intolerance to the bradydysrhythmia. Atropine is used to treat bradycardia; a heart rate of 42 beats/min indicates that bradycardia is unresolved.
How does the nurse prepare for an immediate carotid sinus massage that is prescribed for a patient's new onset of supraventricular tachycardia? A. Obtain a stat chemistry profile prior to the procedure. B. Remove the pillow and place a rolled towel behind the neck. C. Bring a defibrillator and resuscitative equipment to the bedside. D. Raise the side rails and place the bed in the reverse Trendelenburg position.
C. Bring a defibrillator and resuscitative equipment to the bedside. Serious dysrhythmias may occur as a result of carotid sinus massage. These include bradydysrhythmias, asystole, and ventricular fibrillation, which may result in brain injury. Because of this, a defibrillator and resuscitative equipment must be available during the procedure. Given the urgency of the situation, obtaining a blood specimen before the procedure is not reasonable. The nurse prepares the patient with instruction to turn the head slightly away from the side to be massaged. Preparation does not include hyperextending the neck or placing the patient in the reverse Trendelenburg position.
Which action does the nurse take after noting a patient's assessment findings, which include a regular heart rhythm with a rate of 60 beats/min, a P wave preceding each QRS complex, the PR interval of 0.20 seconds, blood pressure of 118/68 mm Hg, respiratory rate of 16 breaths/min, and temperature of 98.8°F (37.1°C)? A. Anticipate a prescription for digoxin. B. Obtain atropine from the emergency medication cabinet. C. Continue to monitor the patient. D. Notify the health care provider (HCP) of the findings.
C. Continue to monitor the patient. The patient is displaying normal sinus rhythm. Digoxin is used in the treatment of atrial fibrillation, which is, by definition, an irregular rhythm. Atropine is used in the emergency treatment of symptomatic bradycardia; this has normal vital signs. The findings are normal; there is no need to contact the HCP.
How does the nurse respond when an older-adult patient who takes a daily dose of diltiazem for atrial fibrillation reports a recent onset of weakness and confusion? A. Instruct the patient to cut the dose in half. B. Instruct the patient to take the dose every other day. C. Determine if the patient is also experiencing dizziness. D. Recognize that confusion is common for older adults.
C. Determine if the patient is also experiencing dizziness. The nurse should assess for episodes of syncope because diltiazem is a calcium channel blocker that can cause bradycardia and hypotension. With hypotension, perfusion is impaired, and weakness, confusion, and dizziness may result. This is of particular concern in the older patient because it causes an increased risk for falls. It is not within the nurse's scope of practice to advise a patient to change the dose or frequency of a medication. Confusion should not be dismissed as simply age related.
The nurse expects which assessment finding when a patient with a pacemaker experiences loss of capture? A. The patient demonstrates hiccups. B. The pacemaker spike falls on the T wave. C. Pacemaker spikes are noted, but no P wave or QRS complex follows. D. The heart rate is 42 beats/min, and no pacemaker spikes are seen on the rhythm strip.
C. Pacemaker spikes are noted, but no P wave or QRS complex follows. Loss of capture occurs when the pacing stimulus (spike) is not followed by the appropriate response, either P wave or QRS complex, depending on placement of the pacing electrode. Pacemaker spikes falling on the T wave indicate improper sensing. A heart rate of 42 beats/min with no pacemaker spikes seen on the rhythm strip indicates failure to pace or sense properly; demand pacing should cause the pacemaker to intervene with electrical output when the heart rate falls below the set rate. Although the set rate is not given, this heart rate indicates profound bradycardia. Hiccups may indicate stimulation of the chest wall or diaphragm from wire perforation.
Which cardiac rhythm typically deteriorates into ventricular fibrillation (VF)? A. Atrial flutter B. Atrial fibrillation C. Ventricular tachycardia (VT) D. Third-degree heart block
C. Ventricular tachycardia (VT) VT may occur in patients with ischemic heart disease, myocardial infarction (MI), cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, heart failure, drug toxicity, hypotension, or ventricular aneurysm. In patients who go into cardiac arrest, VT is commonly the initial rhythm before deteriorating into VF as the terminal rhythm. Atrial fibrillation and flutter are not life-threatening rhythms. Third-degree heart block is related to ischemia or scarring in the atrioventricular node, which slows the rate, rather than making the heart irritable as in VT and fibrillation.
The nurse provides education for a patient about preventing dysrhythmias caused by premature beats and ectopic rhythms. Which statement made by the patient indicates the need for further teaching? A. "I have to quit smoking." B. "I have to limit alcohol intake." C. "I have to manage stress and avoid getting tired." D. "I have to drink coffee twice daily and other energy drinks to stay active."
D. "I have to drink coffee twice daily and other energy drinks to stay active." A patient with premature beats and ectopic rhythms should not have caffeinated beverages and energy drinks because they can worsen dysrhythmias. Quitting smoking helps prevent dysrhythmias. Managing stress can prevent the risk for dysrhythmias. The patient should limit alcohol intake because alcohol may worsen the symptoms.
How does the nurse respond when a patient's family member requests to be in the room where resuscitation efforts are being performed? A. "It is hospital policy that family cannot be in the room during resuscitation attempts. It does not allow the staff to do their job." B. "You will need to wait in the family waiting area. We will provide you with updates." C. "It will be very difficult to see your loved one at this time. I'll put a chair near the room so you can be close by." D. "We will make accommodations for you to be in the room. I will provide you with explanations."
D. "We will make accommodations for you to be in the room. I will provide you with explanations." An emerging clinical practice is allowing or encouraging family presence at resuscitation attempts. This can be a positive experience for family members and significant others because it promotes closure after the death of a loved one. Although there may be staff resistance and some limits to family presence, overall it is a beneficial practice that should be considered in all resuscitation attempts. If family is present, the nurse should provide emotional support and explanation of events in the room. With proper accommodations, the family can usually be placed near the patient without interfering with the resuscitation efforts. Asking the family to remain separate from their loved one at a critical time by staying in the waiting area or outside the room may promote distress and the feeling that not everything possible was done.
The nurse anticipates a prescription for which medication for a patient who is experiencing episodes of ventricular tachycardia? A. Digoxin B. Diltiazem C. Metoprolol D. Amiodarone
D. Amiodarone Amiodarone, a class III antidysrhythmic, is suggested for use in life-threatening ventricular dysrhythmias. Digoxin, a cardiac glycoside, is used for heart failure and atrial fibrillation. Metoprolol, a beta-adrenergic blocker, and diltiazem, a calcium channel blocker, are useful for atrial fibrillation.
Which action does the nurse take when a patient with asymptomatic sinus bradycardia experiences a decrease in heart rate from 56 beats/min to 46 beats/min? A. Increase the IV fluid flow rate. B. Notify the Rapid Response Team. C. Administer atropine 0.5 mg IV push. D. Assess blood pressure, skin color, and moisture.
D. Assess blood pressure, skin color, and moisture. Intervention for sinus bradycardia should be based on assessment of the patient's condition. The patient may remain asymptomatic. If the patient is symptomatic, the nurse may choose to increase the IV flow rate, administer atropine, or notify the Rapid Response Team, depending on the severity of symptoms.
Which teaching is essential for a patient who has had a permanent pacemaker inserted? A. Avoid sexual activity. B. Do not take tub baths. C. Avoid talking on a cell phone. D. Avoid operating electrical appliances over the pacemaker.
D. Avoid operating electrical appliances over the pacemaker. The patient should avoid operating electrical appliances directly over the pacemaker site because this may cause the pacemaker to malfunction. No hazard exists with sexual activity. Bathing and showering are permitted. It is not necessary to avoid a telephone or a cell phone; radio transmitter towers, arc welding, and strong electromagnetic fields may pose a hazard.
The nurse monitors for which adverse effect when administering acebutolol to a patient? A. Tremors B. Insomnia C. Blurred vision D. Bronchospasm
D. Bronchospasm Acebutolol hydrochloride is a beta-blocking agent. It causes sudden constriction of the muscles in the walls of the bronchioles, which in turn causes bronchospasm. Flecainide acetate causes tremors. Propafenone hydrochloride affects the sleep cycle and causes insomnia. Mexiletine hydrochloride affects vision acuity and may cause blurred vision as a side effect.
Which statement correctly differentiates cardioversion from defibrillation? A. Defibrillation is a synchronized shock delivered to depolarize the myocardium simultaneously in atrial fibrillation. B. Cardioversion is an asynchronous shock to the patient to convert ventricular tachycardia or ventricular fibrillation. C. Defibrillation delivers an electric shock to the heart; cardioversion involves use of a temporary pacemaker to delivery the shock. D. Cardioversion delivers a synchronized shock for ventricular tachycardia or supraventricular tachycardia.
D. Cardioversion delivers a synchronized shock for ventricular tachycardia or supraventricular tachycardia. Cardioversion involves the delivery of a synchronized electric shock to terminate unstable ventricular or supraventricular rhythms. It is not useful in ventricular fibrillation because all electrical activity is disorganized with no ability to synchronize. Defibrillation delivers an asynchronous countershock, depolarizing a critical mass of the myocardium to stop the re-entry circuit in ventricular fibrillation or pulseless ventricular tachycardia, allowing the sinus node to regain control of the heart.
The nurse questions which item that is listed on discharge instructions for a patient with tachycardia? A. Avoid alcohol intake. B. Develop strategies for stress management. C. Consult a mental health professional for increased anxiety. D. Include foods rich in caffeine to stimulate the central nervous system (CNS).
D. Include foods rich in caffeine to stimulate the central nervous system (CNS). The patient should be instructed to avoid taking substances that will increase the heart rate (such as caffeine). Alcohol should be avoided because it increases the heart rate. Patients are advised to develop strategies for stress management because stress can increase the heart rate. Consulting a mental health professional can help to alleviate anxiety, which will increase the heart rate.
When caring for a patient after an acute myocardial infarction, which is the nursing priority? A. Providing a low-fat, low-sodium diet B. Padding the oxygen tubing behind the ears C. Instructing the patient to wear sequential compression devices while in bed D. Monitoring for increased frequency of premature ventricular contractions
D. Monitoring for increased frequency of premature ventricular contractions Increasing frequency of premature ventricular contractions after an acute myocardial infarction can lead to life-threatening ventricular dysrhythmias. Prophylaxis of venous thromboembolism, cardiac diet, and prevention of skin breakdown are important, but the greatest priority is the risk for life-threatening dysrhythmias.
To decrease dysrhythmias, which food does the nurse suggest for a patient who is at risk for potassium imbalance? A. Grapes B. Apples C. Turnips D. Strawberries
D. Strawberries Potassium-containing foods include citrus, tomatoes, beans, prunes, avocados, bananas, strawberries, and lettuce. Turnips, grapes, and apples are not foods high in potassium.