Dysrhythmias

c

A patient with an acute MI is having multifocal PVC's and couplets. He is alert and has a BP reading of 118/78 with an irregular pulse of 86. What is the priority nursing action at this time? a. continue to assess the patient b. ask the patient to perform the Valsalva maneuver c. prepare to administer antidysrhythmic drugs per protocol d. be prepared to administer CPR

d

After defibrillation, the advanced cardiac life support nurse says that the patient has pulseless electrical activity (PEA). What is most important for the nurse to understand about this rhythm? a. the heart rate is 40-60 b. hypoxemia and hypervolemia are common with PEA c. there is dissociated activity of the ventricle and atrium d. there is electrical activity with no mechanical response

d

A patient develops third-degree heart block and reports feeling chest pressure and shortness of breath. Which instructions should the nurse provide to the patient before initiating emergency transcutaneous pacing? a. "The device will convert your heart rate and rhythm back to normal." b. "The device uses overdrive pacing to slow the heart to a normal rate." c. "The device is inserted through a large vein and threaded into your heart." d. "The device delivers a current through your skin that can be uncomfortable."

b

In the patient with a dysrhythmia, which assessment indicates decreased CO? a. hypertension and bradycardia b. chest pain and decreased mentation c. abdominal distention and hepatomegaly d. bounding pulses and a ventricular heave

a

A patient on the cardiac telemetry unit goes into ventricular fibrillation and is unresponsive. Following initation of the emergency call system, what is the next priority for the nurse in caring for this patient? a. begin CPR b. get the crash cart c. administer amiodarone d. defibrillate with 360 joules

b

A patient reports dizziness and shortness of breath and is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole? a. Digoxin b. Adenosine c. Metoprolol d. Atropine sulfate

b

A P wave on an ECG represents an impulse arising at the a. SA node and repolarizing the atria b. SA node and depolarizing the atria c. AV node and depolarizing the atria d. AV node and spreading to the bundle of His

a

A client has been admitted to the coronary care unit. The nurse observes third-degree heart block at a rate of 35 bpm on the client's cardiac monitor. The client has a blood pressure of 90/60. The nurse should first a. prepare for transcutaneous pacing b. prepare to defibrillate the client at 200 j c. administer an IV lidocaine infusion d. schedule the OR for insertion of a permanent pacemaker

d

A client is admitted to the hospital for evaluation of recurrent episodes of ventricular tachycardia as observed on Holter monitoring. The client is scheduled for electrophysiology studies the following morning. Which statement should the nurse include in the teaching plan? a. "you will continue to take your medications until the morning of the test" b. "you might be sedated during the procedure and will not remember what has happened" c. "this test is a noninvasive method of determining the effectiveness of your medication regimen" d. "during the procedure, the healthcare provider will insert a special wire to increase the HR and produce the irregular beats that caused your signs and symptoms"

c

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? a. sensation of palpations b. causative factors, such as caffeine c. blood pressure and oxygen saturation d. precipitating factors, such as infection

c

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? a. call a code b. call the HCP c. check the client's status and lead placement d. press the recorder button on the electrocardiogram console

c

A patient admitted with ACS has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate 74 and regular; ventricular rate 62 and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. The priority nursing intervention would be to a. perform synchronized cardioversion b. administer epinephrine 1 mg IV push c. observe for symptoms of hypotension or angina d. apply transcutaneous pacemaker pads on the patient

b

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take? a. Continue to monitor the rhythm and BP. b. Apply the transcutaneous pacemaker (TCP). c. Have the patient perform the Valsalva maneuver. d. Give the scheduled dose of diltiazem (Cardizem).

b

A patient with an acute myocardial infarction develops the following ECG pattern: atrial rate of 82 and regular; ventricular rate of 46 and regular; P wave and QRS complex normal but no relationship between the P wave and QRS complex. What dysrhythmia does the nurse identify and what treatment is expected? a. Sinus bradycardia and treated with atropine b. Third-degree heart block treated with a pacemaker c. Atrial fibrillation treated with electrical cardioversion d. Type 1 second-degree AV block treated with observation

c

A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about a. electrical cardioversion. b. IV adenosine (Adenocard). c. anticoagulant therapy with warfarin (Coumadin). d. insertion of an implantable cardioverter-defibrillator (ICD).

a

A patient with no history of heart disease has a rhythm strip that shows an occasional distorted P wave followed by normal AV and ventricular conduction. About what should the nurse question the patient? a. the use of caffeine b. the use of sedatives c. any aerobic training d. holding of breath during exertion

a

After the nurse administers IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patients heart rate b. Decrease in premature contractions c. Increase in peripheral pulse volume d. Decrease in ventricular ectopic beats

1st-Degree AV Block

AV Block This is a type of AV block in which every impulse is conducted to the ventricles but the time of AV conduction is prolonged. The HR is normal and rhythm is regular. The P wave is normal, but the PR interval is prolonged

Third-Degree AV Block

AV Block This type of AV block constitutes one form of AV dissociation in which no impulses from the atria are conducted to the ventricles. The atria are stimulated and contract independently to the ventricles. The atrial rate is usually 60-100 and the ventricular rate depends on the block

2nd-Degree AV Block

AV Block This type of AV block includes a gradual lengthening of the PR interval, occurring because of a prolonged AV conduction time until an atrial impulse is nonconducted and a QRS complex is blocked. Atrial rate is regular, but ventricular rate may be slower because of nonconducted or blocked QRS complexes, resulting in bradycardia

Patient

Assessment of Heart Rhythm It is important to interpret the rhythm AND assess the clinical status of the ________

Femoral

Assessment of Heart Rhythm To assess for hemodynamic stability, which pulse location is the best to assess?

Disorganization

Atrial Fibrillation Atrial fibrillation is characterized by a total _______________ of electrical activity as many sites within the atria attempt to initiate impulses at the same time

P

Atrial Fibrillation In atrial fibrillation, there are no discernible _____ waves

Bigeminy

What type of PVC?

Couplet

What type of PVC?

Multifocal PVC

What type of PVC?

c

Cardioversion is attempted for a patient with atrial flutter and a rapid ventricular response. After the delivering 50 joules by synchronized cardioversion, the patient develops ventricular fibrillation. Which action should the nurse take immediately? a. Administer 250 mL of 0.9% saline solution IV by rapid bolus. b. Assess the apical pulse, blood pressure, and bilateral neck vein distention. c. Turn the synchronizer switch to the "off" position and recharge the device. d. Tell the patient to report any chest pain or discomfort and administer morphine sulfate.

Pacemaker

Defibrillation Defibrillation is the treatment of choice to end VF and pulseless VT. it is most effective when the myocardial cells are not anoxic or acidotic. It allows for the SA node to resume ___________ role

Trigeminy

What type of PVC?

b

During physical assessment, the nurse should further assess the client for signs of atrial fibrillation when palpation of the radial pulse reveals a. two regular beats followed by one irregular beat b. an irregular rhythm with a pulse rate >100 c. pulse rate below 60 bpm d. a weak, thready pulse

QT Interval

ECG This interval measures the time of depolarization and repolarization of the ventricles

Atrifact

ECG This is a recording of excessive movement. It can be caused when the leads are not secure, or the patient is moving

QRS Interval

ECG This is measured from the beginning to the end of ventricular contraction

PR Interval

ECG This is the time it takes for the impulse to spread through the atrium and just before it continues with ventricular contraction

c

Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that a. ventricular bradycardia may be induced and treated during the procedure b. a catheter will be placed in both femoral arteries to allow double-catheter use c. the procedure will destroy areas of the conduction system that are causing rapid heart rhythms d. a general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences

c

In the patient experiencing ventricular fibrillation, what is the rationale for using cardiac defibrillation? a. enhance repolarization and relaxation of the ventricular myocardial cells b. provide an electrical impulse that stimulates normal myocardial contractions c. depolarize the cells of the myocardium to allow the SA node to resume pacemaker function d. deliver an electrical impulse to the heart at this time of ventricular contraction to convert the heart to a sinus rhythm

Infection

Pacemaker Discharge/Home Care Teach the patient how to monitor their incision site for signs of what?

5

Pacemaker Discharge/Home Care Teach the patient how to take and record their pulse rate. Also, instruct them to assess their pulse daily before arising and to notify the physician if their HR is ____ bpm slower than the preset pacemaker rate

ROM

Pacemaker Post-Operative Care After insertion of a pacemaker, assist the patient with gentle _________ exercises at least 3 times daily, beginning 24 hours after implantation

Hiccups

Pacemaker Problems A lead positioned near the diaphragm can stimulate these, causing 60 of them in a minute

Perforation

Pacemaker Problems Hiccups may occur in extremely thin clients or may indicate a medical emergency with _____________ of the right ventricle by the pacing electrode tip (This is why we do a chest X-ray during post insertion ALWAYS)

Failure to Capture

Pacemaker Problems This problem occurs when the output (energy) from the pacemaker is too low, resulting in a failure to depolarize the ventricle, causing an absence of a mechanical contraction of the ventricle, or no QRS. A spike will be seen, but no QRS complex will result

Failure to Sense

Pacemaker Problems This problem occurs when the pacemaker fails to read the patient's own intrinsic heart rhythm and generates a pacer spike anyway. This can cause potentially lethal arrhythmias

Sensitivity

Pacemaker Problems When a pacemaker fails to sense, it could be due to the pacemaker's ____________ setting being too low. Nursing interventions include vital signs, checking O2 saturation, notifying the provider, and adjusting the setting

Non-Dominant

Permanent Pacemakers When a permanent pacemaker is placed, it is implanted within the subcutaneous tissue over the pectoralis muscle on the patient's ______-________ side

a

When assessing a patient, you note a pulse deficit of 23 beats. This finding may be caused by a. dysrhythmias b. heart murmurs c. gallop rhythms d. pericardial friction rubs

Cardioversion

Synchronized ________________ is the therapy of choice for the patient with ventricular tachydysrhythmias or SV tachydysrhythmias. A synchronized circuit delivers a shock that is programmed to occur on the R wave of the QRS complex of the ECG

d

The ECG monitor of a patient in the cardiac care unit after an MI indicates ventricular bigeminy with a rate of 50 bpm. The nurse would anticipate a. performing defibrillation b. treating with IV amiodarone c. inserting a temporary transvenous pacemaker d. assessing the patient's response to the dysrhythmia

c

The client has developed atrial fibrillation, with a ventricular rate of 150 beats. The nurse should assess the client for which associated signs and symptoms? a. flat neck veins b. nausea and vomiting c. hypotension and dizziness d. hypertension and headache

Cardioverter-Defibrillator

The implantable __________-________________ consists of a lead system placed via a subclavian vein to the endocardium. It monitors the HR and rhythm and after sensing a lethal dysrhythmia, delivers a 25 joules or less shock to the patient's heart

c

The nurse determines there is artifact on the patient's telemetry monitor. Which factor should the nurse assess for that could correct this issue? a. Disabled automaticity b. Electrodes in the wrong lead c. Too much hair under the electrodes d. Stimulation of the vagus nerve fibers

b

The nurse is evaluating a client's response to cardioversion. Which assessment would be a priority? a. blood pressure b. status of airway c. oxygen flow rate d. level of consciousness

b

The nurse notes that a patients cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Ventricular multifocal contractions

c

The nurse observes a flat line on the patient's monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer? a. Lidocaine and amiodarone b. Digoxin and procainamide c. Epinephrine and/or vasopressin d. β-adrenergic blockers and dopamine

b

The nurse observes no P waves on the patients monitor strip. There are fine, wavy lines between the QRS complexes. The QRS complexes measure 0.08 sec (narrow), but they occur irregularly with a rate of 120 beats/min. What does the nurse determine the rhythm to be? a. Sinus tachycardia b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia

c

The nurse observes ventricular tachycardia (VT) on the patient's monitor. What evaluation made by the nurse led to this interpretation? a. Unmeasurable rate and rhythm b. Rate 150 beats/min; inverted P wave c. Rate 200 beats/min; P wave not visible d. Rate 125 beats/min; normal QRS complex

d

The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patients cardiac rhythm as a. atrial fibrillation. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

d

The nurse performs discharge teaching for a patient with an implantable cardioverter-defibrillator (ICD). Which statement by the patient indicates to the nurse that further teaching is needed? a. "The device may set off the metal detectors in an airport." b. "My family needs to keep up to date on how to perform CPR." c. "I should not stand next to antitheft devices at the exit of stores." d. "I can expect redness and swelling of the incision site for a few days."

d

The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that a. defibrillation requires a lower dose of electrical energy b. cardioversion is indicted to treat atrial bradydysrhythmias c. defibrillation is synchronized to deliver a shock during the QRS complex d. patients should be sedated if cardioversion is done on a non-emergency basis

a

The nurse prepares to defibrillate a patient. For which dysrhythmia has the nurse observed in this patient? a. Ventricular fibrillation b. Third-degree AV block c. Uncontrolled atrial fibrillation d. Ventricular tachycardia with a pulse

b

The patient has atrial fibrillation with a rapid ventricular response. The nurse knows to prepare for which treatment if an electrical treatment is planned for this patient? a. Defibrillation b. Synchronized cardioversion c. Automatic external defibrillator (AED) d. Implantable cardioverter-defibrillator (ICD)

b

The patient has atrial fibrillation with a rapid ventricular response. What electrical treatment option does the nurse prepare the patient for? a. Defibrillation b. Synchronized cardioversion c. Automatic external defibrillator (AED) d. Implantable cardioverter-defibrillator (ICD)

Normal Sinus Rhythm

This refers to a rhythm that starts in the SA node at a rate of 60-100 times per minute and follows the normal conduction pathway

a

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the length of the patients a. P wave. b. PR interval. c. QT interval. d. QRS complex.

6

Types of Dysrhythmias If a patient is having more than ___ PVCs a minute, this is a cause for concern and the patient should be monitored more closely

Premature Ventricular Contractions

Types of Dysrhythmias If a patient is having this type of dysrhythmia, expect a potential cause to be stimulants, electrolyte imbalances, hypoxia, heart disease, or hypokalemia

Bigeminy Trigeminy Couplet

Types of Dysrhythmias In premature ventricular contractions, when every other beat is a PVC, the rhythm is called _________. When every 3rd beat is a PVC, it is called _________. Two consecutive PVCs are called a _________

Pulseless Electrical Activity

Types of Dysrhythmias In this dysrhythmia, electrical activity can be seen on the ECG, but no mechanical activity of the heart is evident, and the patient has no pulse. It is treated with full resuscitation

Sinus Tachycardia

Types of Dysrhythmias In this dysrhythmia, the sinus node increases because of vagal inhibition or sympathetic stimulation. The sinus rate is 101-200 bpm. S&S: Dizziness, dyspnea, and hypotension because of decreased CO

Multifocal

Types of Dysrhythmias PVCs on an EKG strip that do not look identical are called ________. In other words, they originate in different parts of the ventricles

Unifocal

Types of Dysrhythmias PVCs that comes from the same place is called ________. On an EKG strip, an example would be two PVCs that look identical

Cardiac Output

Types of Dysrhythmias Sustained ventricular tachycardia is life-threatening because it leads to a decrease in what?

Sinus Bradycardia

Types of Dysrhythmias The conduction pathway is the same as sinus rhythm, but the SA node fires at a rate less than 60 bpm.

Paroxysmal Superventricular Tachycardia (PSVT)

Types of Dysrhythmias This is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The HR is 150-220 and rhythm is regular or slightly irregular. A prolonged episode will cause decreased CO because of reduced stroke volume S&S: hypotension, palpitations, dyspnea, angina

Ventricular Fibrillation

Types of Dysrhythmias This is a severe derangement of the heart rhythm characterized on ECG by irregular waveforms of varying shapes and amplitude. Mechanically, the ventricle is simply quivering, with no effective contraction, and no CO occurs

Atrial Flutter

Types of Dysrhythmias This is an atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in the right atrium. In 2:1 conduction, the ventricular rate is typically found to be about 150 bpm when the atrial rate is 200-350 bpm

Ventricular Tachycardia

Types of Dysrhythmias This occurs with a run of 3 or more PVCs. It occurs when an ectopic focus fires repeatedly and the ventricle takes control as the pacemaker

Sinus Bradycardia

Types of Dysrhythmias This refers to a HR that is less than 60 and is inadequate for a patients condition. This causes symptoms such as pale, cool skin; hypotension; weakness; angina; dizziness or syncope; confusion; and shortness of breath

Asystole

Types of Dysrhythmias This represents the total absence of ventricular electrical activity. Occasionally, P waves are seen. Patients are unresponsive, pulseless, and apneic. It is treated with immediate CPR and epinephrine or vasopressin

Premature Ventricular Contractions

Types of Dysrhythmias This type of dysrhythmia is the premature occurrence of a QRS complex.

Amiodarone Lidocaine

Types of Dysrhythmias Treatment for PVCs includes giving the patient potassium, or which two antidysrhythmics?

Radial Femoral

Types of Dysrhythmias When a patient is having PVCs, it is important to assess the apical-________ and apical-_______ pulse deficits

Atrial Flutter

Types of Dysrhythmias Which dysrhythmia can also precipitate stroke due to potential thrombus formation?

Chest X-Ray

Types of Pacemakers After placement of a transvenous pacemaker, what is extremely important to perform to ensure proper placement and ensure that damage to the heart did not occur?

Sling

Types of Pacemakers After the placement of a transvenous pacemaker, ensure that the patient lies still or limits movement. Extreme movement of the arm can cause movement of the catheter and cause perforation. Often, the patient will have their arm placed in a _________ to reduce movement

Transcutaneous Pacemaker

Types of Pacemakers External device. The pads placed on the chest are the avenue that the energy goes through. It is known as a single chamber pacemaker, meaning that it functions to affect the ventricle. Requires a lot more energy because it has to go through skin, muscle, and bone

Perforation

Types of Pacemakers Placement of a transvenous pacemaker needs extreme consideration. If proper care is not taken while placing, _____________ of the heart tissue can occur

Transvenous Pacemaker

Types of Pacemakers These types of pacemakers are inserted into the venous system through a central line catheter site using specialty pacing wires and delivering the stimulus via electrodes that are in direct contact with the heart tissue itself

Pads

Types of Pacemakers Transcutaneous pacemakers deliver the pacing stimulus to the heart through the chest wall via two large adhesive _________

Breast

Types of Pacemakers With transcutaneous pacemakers, special considerations should be made for women. It is important to lift the ________ and place the pad underneath, or else the pacemaker will not work properly

c

When looking at the electrocardiogram (ECG) of the patient, the nurse knows that the QRS complex recorded on the ECG represents which part of the heart's beat? a. Depolarization of the atria b. Repolarization of the ventricles c. Depolarization from atrioventricular (AV) node throughout ventricles d. The length of time it takes for the impulse to travel from the atria to the ventricles

Monomorphic Ventricular Tachycardia

Which Rhythm?

Premature Ventricular Contraction

Which Rhythm?

Ventricular Fibrillation

Which Rhythm?

d

Which action should the nurse take when preparing for cardioversion of a patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the off position. b. Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position. c. Set the defibrillator/cardioverter energy to 300 joules. d. Administer a sedative before cardioversion is implemented.

b

Which rhythm abnormality has an increased risk of ventricular tachycardia and ventricular fibrillation? a. PAC b. PVC on the T wave c. Accelerated idioventricular rhythm d. Premature ventricular contraction (PVC) couplet

c

Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the ECG? a. The length of time it takes to depolarize the atrium b. The length of time it takes for the atria to depolarize and repolarize c. The length of time for the electrical impulse to travel from the SA node to the Purkinje fibers d. The length of time it takes for the electrical impulse to travel from the SA node to the AV node

b

While providing discharge instructions to the patient who has had an implantable cardioverter-defibrillator inserted, the nurse teaches the patient that if the ICD fires, it is important that they do what? a. lie down b. call the cardiologist c. push the reset button on the pulse generator d. immediately take their antidysrhythmic medication