EAQs N123 Dysrhythmia
The nurse is reviewing discharge instructions with a patient who received an implantable cardioverter-defibrillator (ICD). Which patient statement indicates the need for further teaching?
"I should avoid flying for three years." Flying is not contraindicated in a patient with 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.
Which electrocardiogram (ECG) findings are consistent with type II second-degree atrioventricular (AV) block? Select all that apply.
1. Atrial rhythm is regular 2. PR intervals are consistent. 3. There are more P waves than QRS complexes.
Which electrocardiogram (ECG) characteristics will be present if a patient is experiencing unifocal premature ventricular contractions (PVCs)? Select all that apply.
1. Normal T wave 2. PR interval that is not measurable 3.Wide and distorted QRS complex 4. PVCs that have the same shape
Which instruction would the nurse include in discharge teaching for a patient with an implantable cardioverter-defibrillator (ICD)? Select all that apply.
1. Obtain and wear a Medic Alert ID device at all times. 2. Avoid large magnets and strong electromagnetic fields. 3. Avoid lifting the arm on ICD side above the shoulder until approved.
In which order do electrical impulses travel through the heart?
1. Sinoatrial node 2.Internodal pathways 3.Atrioventricular node 4.Bundle of His 5.Purkinje fibers
A patient is experiencing third-degree AV block. Which electrocardiogram (ECG) findings are characteristic of this rhythm? Select all that apply.
1. The PR interval is variable. 2. The P wave has a normal shape. 3. The atrial and ventricular rhythms are regular but unrelated.
The nurse presents information about electrocardiogram (ECG) changes associated with myocardial infarction (MI) to a group of nursing students. Which information would the nurse include? Select all that apply.
1. The ST segment will be elevated 2. A physiologic Q wave is normally very short and narrow. 3. A pathologic Q wave that develops during MI is wide and deep.
Which conditions are possible causes of the artifact in a patient's electrocardiogram (ECG) tracing? Select all that apply.
1. The patient is shivering 2. Electrical interference is present. 3. The leads and electrodes are not secure.
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 BP of 120/60 mm Hg. Which treatments would the nurse expect to be added to the patient's plan of care? Select all that apply.
1. Vagal stimulation 2. IV β-blockers 3. IV adenosine 4. Calcium channel blockers
The nurse analyzes a patient's electrocardiogram (ECG) and determines that there are 8 R-R intervals in a span of six seconds. What should the nurse document as the patient's heart rate? Record the answer using a whole number. __ beats/min.
80
A patient has sought care following a syncopal episode of unknown etiology. Which item will be included in the patient's treatment plan?
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-adrenergic 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.
A patient is hospitalized following a three-day history of heart palpitations and dizziness. The patient's electrocardiogram (ECG) shows the following rhythm. For which condition is this patient at risk?
A risk for atrial fibrillation is clot formation in the atria caused by altered blood flow through the heart. If the clot forms on the left side of the heart, the risk is for the clot traveling to the brain, causing a stroke or an embolism to other arteries in the body. If the clot forms on the right side of the heart, then it can travel to the lungs, causing a pulmonary embolism. The risk for an embolus is particularly high when the patient converts back to a normal sinus rhythm. To reduce the risk for clot formation in the heart, most patients with chronic atrial fibrillation are on some type of anticoagulation. Coumadin (warfarin) is often prescribed.
A patient's electrocardiogram (ECG) now shows no P waves, fine and wavy lines between the QRS complexes, QRS complexes that measure 0.08 sec, and QRS complexes that occur irregularly with a rate of 120 beats/minute. Which interpretation of the rhythm would the nurse make?
A. fib. is represented on the cardiac monitor by irregular R-R intervals and small fibrillatory (f) waves. There are no normal P waves because the atria are not contracting truly, just fibrillating.
A patient develops symptomatic sinus tachycardia. Which drug will likely be included in the patient's treatment plan?
Adenosine
A patient with a heart rate of 120 beats/minute is prescribed an antidysrhythmic drug. Which diagnostic test would the nurse anticipate the patient having?
An ESP identifies the causes of heart blocks, tachydysrhythmias, bradydysrhythmias, and syncope. It can also locate accessory pathways and determine the effectiveness of antidysrhythmic drugs.
A patient states, "I feel tired all the time, and I struggle with activities of daily living." The patient's heart rate is 120 beats/minute. Which rhythm does the nurse anticipate observing on the electrocardiogram tracing?
Atrial fibrillation can reduce cardiac output due to the loss of atrial kick and a rapid ventricular rate, causing a reduced exercise tolerance and an elevated heart rate above 100 beats/minute.
The nurse monitoring the electrocardiogram (ECG) of a patient with hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial rate of 250 beats/minute. Which term would the nurse use to document this pattern?
Atrial flutter is an atrial tachydysrhythmia identified by flutter (F) waves, a sawtooth-shaped pattern, with a 200 to 350 beats/minute atrial rate.
Which cardiac activity is absent when a permanent pacemaker fails to capture?
Atrial or Ventricular contraction. Failure to capture occurs when the electrical charge to the myocardium is insufficient to produce atrial or ventricular contraction.
Which term is used for the property of heart cells to initiate an impulse spontaneously and continuously?
Automaticity
Which term is used for the property of the cardiac cell responding mechanically to an impulse?
Contractility
A patient reports a sudden onset of dizziness. The nurse records the following electrocardiogram (ECG) tracing. Which condition is the likely cause of dizziness?
Decreased CO. The patient's rhythm is paroxysmal supraventricular tachycardia (PSVT). Depending on the rate and duration of PSVT, the patient often experiences symptoms related to decreased cardiac output. The cardiac output drops because of decreased ventricular filling time.
A patient is diagnosed with pulseless ventricular tachycardia. In which order would the nurse perform the steps of defibrillation?
Defibrillation is the treatment of choice for pulseless ventricular tachycardia. 1. The nurse would first turn the defibrillator on and select the proper energy level, then 2. check to see that the synchronizer switch is turned off. 3. The nurse then would apply conductive materials to the chest and 4. charge the defibrillator using the button on the defibrillator or the paddles. 5. The nurse would then position the paddles firmly on the chest wall over the conductive material. 6. The nurse would then check to see that everyone is "all clear." 7. Finally, the nurse would deliver the charge by depressing buttons on both paddles simultaneously.
The nurse is reviewing the use of defibrillation and synchronized cardioversion with students. Which information would the nurse provide?
Defibrillation is the treatment of choice for ventricular fibrillation and pulseless ventricular tachycardia. Patients are not sedated for defibrillation because a patient in ventricular tachycardia (VT) or pulseless VT will generally be unconscious.
The nurse is preparing a patient for an electrocardiogram (ECG). When placing the six unipolar chest leads, at which position should the nurse place the V 6 lead?
Fifth intercostal space at the left midaxillary line
The nurse analyzes a patient's telemetry monitor strip and documents a heart rate of 86, regular rhythm, PR interval of 0.24 second, and a QRS interval of 0.10 second. How should the nurse interpret the findings?
First-degree AV block In first-degree AV block, there is prolonged duration of AV conduction that lengthens the PR interval to greater than 0.20 second.
Symptomatic second-degree heart block type 2 can be managed with which procedure?
Implanted pacemaker.
Which is a disadvantage of a centralized monitoring system?
It requires continuous observation of patients' ECGs
Which are the most common electrocardiograph leads selected for continuous monitoring? Select all that apply.
Lead II and lead V1 are commonly used for continuous monitoring of the cardiac impulses.
A patient with a heart rate of 180 beats/minute has a regular heart rhythm, normal P waves, and normal PR intervals. Which QRS complex shape would the nurse expect to see on the patient's electrocardiogram (ECG) tracing?
Normal
A patient with a heart rate of 180 beats/minute has a regular heart rhythm, normal P waves, and normal PR intervals. Which QRS complex shape would the nurse expect to see on the patient's electrocardiogram (ECG) tracing?
Normal. A normal P wave and normal PR interval in ECG and the heart rate of 180 beats/minute indicates sinus tachycardia. The patient with sinus tachycardia generally shows normal QRS complexes.
A patient with paroxysmal supraventricular tachycardia (PSVT) who is receiving IV adenosine becomes hemodynamically unstable. Which intervention would the nurse expect to be included in the patient's immediate treatment plan?
PSVT is a dysrhythmia starting in an ectopic focus anywhere above the bifurcation of the bundle of His. The standard drug of choice to treat PSVT is 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.
Which heart rate would the nurse expect in a patient with paroxysmal supraventricular tachycardia (PSVT)?
Paroxysmal supraventricular tachycardia (PSVT) is characterized by a heart rate of 150 to 220 beats/minute
The electrocardiogram (ECG) monitor of a patient in the cardiac care unit after myocardial infarction (MI) indicates ventricular fibrillation. Which action would the nurse take immediately?
Perform cardiopulmonary resuscitation (CPR) Treatment consists of immediate initiation of CPR and advanced cardiac life support (ACLS) with the use of defibrillation and definitive drug therapy (e.g., epinephrine, vasopressin). There should be no delay in using a defibrillator once available.
The electrocardiogram (ECG) of a patient indicates P waves that are hidden in the preceding T waves and normal QRS complexes. Which condition is the patient experiencing?
Premature atrial contractions
The electrocardiogram (ECG) of a patient indicates P waves that are hidden in the preceding T waves and normal QRS complexes. Which condition is the patient experiencing?
Premature atrial contractions. A premature atrial contraction occurs in either the left atrium or right atrium and travels along the atria. The ECG of a premature atrial contraction usually shows hidden P waves in preceding T waves with prolonged PR interval. The QRS complex remains normal.
A patient is experiencing atrial flutter. Which treatment will be included in the patient's plan of care?
Radiofrequency catheter ablation is the most effective technique for the treatment of atrial flutter. It is performed in the electrophysiology study laboratory and involves the introduction of a catheter in the right atrium. The tissue is targeted and destroyed by the application of low-voltage, high-frequency electrical impulses. The destruction of the tissue results in a normal sinus rhythm.
Which electrocardiogram (ECG) characteristic is consistent with ventricular tachycardia (VT)?
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.
Which statement made by the student nurse indicates the need for additional teaching about electrocardiograms (ECGs)?
Six bipolar leads (V1 through V6) measure the electrical forces in the horizontal plane.
Which statement is accurate regarding the role of the autonomic nervous system in impulse formation?
Stimulation of the vagus nerve causes a decreased rate of firing of the sinoatrial (SA) node
A patient develops atrial flutter with a rapid ventricular response. The nurse anticipates that which treatment will be prescribed?
Synchronized cardioversion is the therapy of choice for patients with ventricular tachydysrhythmias (e.g., ventricular tachycardia [VT] with a pulse) or supraventricular tachydysrhythmias (e.g., atrial flutter with a rapid ventricular response).
Which waveform in the electrocardiogram (ECG) tracing would be distorted when a patient has an electrolyte imbalance?
T wave. The T wave represents ventricular repolarization in an ECG. Disturbances (e.g., tall, peaked, inverted) in T waves can occur due to electrolyte imbalances, ischemia, and infarction.
Which time period does the T wave in an electrocardiogram (ECG) represent?
The T wave of the ECG represents ventricular repolarization as the heart rests and prepares to contract again
Which time period does the T wave in an electrocardiogram (ECG) represent?
The T wave of the ECG represents ventricular repolarization as the heart rests and prepares to contract again.
The nurse obtains a prescription for adenosine to treat a patient who is having paroxysmal supraventricular tachycardia (PSVT). Which information would the nurse use in administering the medication?
The medication decreases conduction through the atrioventricular (AV) node. It may be given through a peripheral IV, but the site should be as close to the heart as possible because of its short half-life of 10 seconds. A brief period of asystole is common. Adenosine is given as an IVP over one to two seconds and then immediately followed by a rapid 20 mL normal saline flush.
The nurse provides teaching to a group of nursing students about radiofrequency catheter ablation therapy. Which information would the nurse include?
The therapy uses electrical energy to remove problematic areas of the heart's conduction system.
Which type of dysrhythmia is treated with a pacemaker?
Third-degree atrioventricular (AV) block
Which type of arrhythmia is associated with the absence of P waves on an electrocardiogram (ECG)?
Ventricular fibrilation
Which cardiac dysrhythmia is life threatening and requires immediate intervention?
Ventricular fibrillation
Which medication is used to manage a complication of atrial fibrillation?
Warfarin