Exam 2 Complex Nursing Fall
The nurse is educating the client about a transvenous pacemaker. What is the best statement to explain why the client will have a transvenous pacemaker? "A transvenous pacemaker is used in place of a transarterial pacemaker." "A transvenous pacemaker is a permanent pacemaker that is asynchronous." "A transvenous pacemaker is used for a ventricular tachydysrhythmias." "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."
"A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."
Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers."
"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."
The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response? "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate." "This is okay as long as you are not having any symptoms." "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase."
"Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."
The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? "It is when the heart conduction is primarily from the aterioventricular node." "The rhythm has a normal beat, then a premature beat pattern." "The rhythm is regular but fast." "The heart rate is between 150 to 250 bpm."
"The rhythm has a normal beat, then a premature beat pattern."
A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? "The small box will transmit the heart rhythm to the central monitor all the time." "When your spouse needs help, an alarm will go off at the desk." "The box is recording the heart's electrical activity, and a physician will review the tracing later." "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute."
"The small box will transmit the heart rhythm to the central monitor all the time."
The nurse cares for a 56-year-old client who received an implantable cardioverter defibrillator (ICD) 2 days prior. The client tells the nurse "My wife and I can never have sex again now that I have this ICD." What is the nurse best response by the nurse? "You seem apprehensive about resuming sexual activity." "Sex is permitted following the implantation of an ICD." "You really should speak to your wife about your concerns." "I will be sure to share your concerns with the physician."
"You seem apprehensive about resuming sexual activity."
The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? "The doctor wants to see if your heart will switch back to its normal rhythm by itself." "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." "There is a long list of clients in line to be cardioverted."
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm? 0.05 and 0.1 seconds. 0.12 and 0.2 seconds. 0.15 and 0.3 seconds. 0.25 and 0.4 seconds
0.12-0.2 seconds
The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds? 0.2 0.1 0.3 0.4
0.2
The nurse knows that what PR interval presents a first-degree heart block? 0.24 seconds 0.14 seconds 0.16 seconds 0.18 seconds
0.24 seconds
The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? 20 to 40 Not measurable 100 to 250 220 to 350
20-40
A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25 small, square boxes within an RR interval. The nurse correctly identifies the client heart rate as 60 bpm. 100 bpm. 80 bpm. 70 bpm.
60 bpm
The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first? A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV A client who received elective cardioversion 1 hour ago and whose heart rate (HR) is 115 bpm A client diagnosed with new onset of atrial fibrillation, requiring scheduled IV diltiazem A client returned from an electrophysiology procedure 2 hours ago, reporting constipation
A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? Assessing the client's blood pressure and heart rate frequently Identifying the client's code level status Maintaining the client's intravenous fluids Alerting the healthcare provider of the third-degree heart block
Alerting the healthcare provider of the third-degree heart block
A client's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia
Atrial flutter
A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.) Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation. The patient may have a throbbing pain that is normal The patient will have to schedule monthly chest x-rays to make sure the device is patent.
Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation.
Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent? Disrupting the heart during the critical period of atrial repolarization Disrupting the heart during the critical period of ventricular repolarization Disrupting the heart during the critical period of ventricular depolarization Disrupting the heart during the critical period of atrial depolarization
Disrupting the heart during the critical period of ventricular repolarization
The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching? During the procedure, the dysrhythmia will be reproduced under controlled conditions. The procedure will occur in the operating room under general anesthesia. The procedure takes less time than a cardiac catheterization. After the procedure, the dysrhythmia will not recur.
During the procedure, the dysrhythmia will be reproduced under controlled conditions
The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? Defibrillation Maze procedure Pacemaker implantation Elective cardioversion
Elective cardioversion
A nurse is caring for a client who has premature ventricular contractions. What sign would the nurse assess in this client? Fluttering/heart skipping Nausea Hypotension Fever
Fluttering/heart skipping
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? Instruct the client to restrict food and oral intake Administer digitalis and diuretics 24 hours before cardioversion Facilitate CPR until the client is prepared for cardioversion Monitor blood pressure every 4 hours
Instruct the client to restrict food and oral intake
A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? Calcium and magnesium Potassium and calcium Magnesium and potassium Potassium and sodium
Magnesium and potassium
A confused client exhibits a blood pressure of 112/84, pulse rate of 116 beats per minute, and respirations of 30 breaths per minute. The client's skin is cold and clammy. The nurse next Administers oxygen by nasal cannula at 2 liters per minute Re-assesses the vital signs Contacts the admitting physician Calls the Rapid Response Team
O2 at 2L/min
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? P wave PR interval QRS complex T wave
P wave
the part of an ECG that reflects conduction of an electrical impulse through the atrium; atrial depolarization
P wave
A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply. QRT wave P wave S-Q segment P-R interval T wave
P wave P-R interval T wave
the duration between the beginning of one P wave and the beginning of the next P wave; used to calculate atrial rate and rhythm
PP interval
the part of an ECG that reflects conduction of an electrical impulse from the sinoatrial node through the atrioventricular node
PR interval
When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? Premature ventricular contraction (PVC) Ventricular bigeminy Ventricular tachycardia Ventricular fibrillation
PVC
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response? Premature atrial complex Atrial flutter Sinus tachycardia Ventricular fibrillation
Premature atrial complex
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? P wave QRS complex PR interval QT interval
QRS complex
the part of an ECG that reflects conduction of an electrical impulse through the ventricles; ventricular depolarization
QRS complex
The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up? QT interval that is 0. 46 seconds long PR interval that is 0.18 seconds long QRS complex that is 0.10 seconds long ST segment that is isoelectric in appearance
QT interval that is 0. 46 seconds long
the part of an ECG that reflects the time from ventricular depolarization through repolarization
QT repolarization
The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? PP interval QT interval RR interval TP interval
RR interval
the duration between the beginning of one QRS complex and the beginning of the next QRS ; used to calculate ventricular rate and rhythm
RR interval
The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? Right side of sternum, fourth intercostal space Left side of sternum, fourth intercostal space Midway between V2 and V4 Mid-clavicular line, fifth intercostal space
Right side of sternum, fourth intercostal space
the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave
ST segment
The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe? Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches
Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers
the part of an ECG wave that reflects repolarization of the ventricles
T wave
the part of an ECG that reflects the time between the end of the T wave and the beginning of the next P wave; used to identify the isoelectric line
TP interval
the part of an ECG wave that may reflect Purkinje fiber repolarization; usually, it is not seen unless a patient's serum potassium level is low
U wave
The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? A new myocardial infarction client A client with poor kidney perfusion A client with third-degree heart block A client with atrial dysrhythmias
a client with atrial dysrhythmias
removal of material, by mechanical means, from the surface of an object; in the context of cardiology, it is the purposeful destruction of heart muscle cells, usually in an attempt to correct or eliminate a dysrhythmia
ablation
a client has a medical dx of an advanced atrioventricular block, Mobitz Type II, and is symptomatic. What initial tx will the nurse be prepared to complete? prepare the client for a cardioversion administer an IV bolus of atropine administer an IV bolus of furosemiu
administer an IV bolus for atropine
A client has an irregular heart rate of around 100 beats/minute and a significant pulse deficit. What component of the client's history would produce such symptoms? atrial fibrillation atrial flutter heart block bundle branch block
afib
what type of shock occurs from an antigen-antibody response?
anaphylactic
distorted, irrelevant, and ECG waveforms
artifact
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? Atrial depolarization Early ventricular repolarization Ventricular depolarization Ventricular repolarization
atrial depolarization
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? Atrial flutter Atrial fibrillation Ventricular fibrillation Ventricular tachycardia
atrial flutter
The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? nadolol diltazem atropine sulfate atenolol
atropine sulfate
ability of the cardiac cells to initiate an electrical impulse
automaticity
A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to avoid caffeinated beverages. request sublingual nitroglycerin. apply supplemental oxygen. lie down and elevate the feet.
avoid caffeinated beverages
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? Keep the arm on the side of the pacemaker higher than the head Delay activities such as swimming and bowling for at least 3 weeks Keep moving the arm on the side where the pacemaker is inserted Avoid sources of electrical interference
avoid sources of electrical interference
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? Begin cardiopulmonary resuscitation (CPR) Administer epinephrine Administer atropine 0.5 mg Defibrillate with 360 joules (monophasic defibrillator)
begin cpr
The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record? Bigeminy Couplets Multifocal PVCs R-on-T phenomenon
bigeminy
The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record? Bigeminy Couplets Multifocal PVCs R-on-T phenomenon
bigeminy
Which is not a likely origination point for cardiac dysrhythmias? bundle of His ventricles atria atrioventricular node
bundle of His
When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be triggered. captured. inhibited. nonsynchronous.
captured
biventricular pacing used to correct interventricular, intraventricular, and atrioventricular conducrion disturbances that occur in patients with heart failure
cardiac resynchronization therapy
electrical current given in synchrony with the patient's own QRS complex to stop a dysrhythmia
cardioversion
Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which statement does the nurse note is not correct? Both procedures sedate the clients. Cardioversion uses more electrical energy than defibrillation. Both used to eliminate ventricular dysrhythmias. Machine determines when electrical energy is delivered.
cardioversion uses more electrical energy than defib
rate of impulse formation
chronotropy
A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? Clients with recurrent life-threatening bradycardias Clients with sinus tachycardia Clients with ventricular bradycardia Clients with recurrent life-threatening tachydysrhythmias
clients with recurrent life-threatening tachydysrhythmias
transmission of electrical impulses from one cell to another
conduction
After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? Decreased cardiac output and decreased systolic and diastolic blood pressure Decreased blood pressure with reflex tachycardia Increased cardiac output and increased systolic and diastolic blood pressure Decreased peripheral vascular resistance
decreased cardiac output and decreased systolic and diastolic blood pressure
The nurse recognizes which as being true of cardioversion? Amount of voltage used should exceed 400 watts/second. Electrical impulse can be discharged during the T wave. Defibrillator should be set to deliver a shock during the QRS complex. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.
defib should be set to deliver a shock during the QRS complex
electrical current given to stop a dysrhythmia, not synchronized with the patient's QRS complex
defribrillation
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? A variable heart rate, usually fewer than 60 bpm An irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden with the QRS complex
delayed conduction, producing a prolonged PR interval
process by which cardiac muscle cells change from a more negatively charged to a more positively charged intracellular state
depolarization
A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? Document the findings and continue to monitor the client Reposition the extremity and turn the client to left side Obtain a 12-lead ECG and a portable chest x-ray Check the security of all connections and increase the milliamperage
document the findings and continue to monitor the client
conduction velocity
dromotropy
disorder of the formation or conduction (or both) of the electrical impulse within the heart, altering the heart rate, heart rhythm, or both and potentially causing altered blood flow (also referred to as arrhythmia)
dysrhythmia
A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the patient about for termination of the dysrhythmia? Defibrillation Mace procedure Pacemaker implantation Elective cardioversion
elective cardioversion
A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? Elective electrical cardioversion Chemical cardioversion Mace procedure Elective electrical defibrillation
elective electrical cardioversion
a signal produced by a pacemaker when it is interrogated to indicate a near-depleted battery
elective replacement inficator (ERI)
a record of a test that graphically measures the electrical activity of the heart, including each phase of the cardiac cycle
electrocardiogram (ECG)
A client who experienced shock is now nonresponsive and having cardiac dysrhythmias. The client is being mechanically ventilated, receiving medications to maintain renal perfusion, and is not responding to treatment. In this stage, it is most important for the nurse to Encourage the family to touch and talk to the client. Inform the family that everything is being done to assist with the client's survival. Open up discussion among the family members about nursing home placement. Contact a spiritual advisor to provide comfort to the family. Inform the family that everything is being done to assist with the client's survival. Open up discussion among the family members about nursing home placement.
encourage fam to touch and talk to pt
A client has had an automatic implanted cardioverter defibrillator (AICD) implanted. The nurse explains the purpose and benefits of the AICD to the client's family. The least likely reason for the client's AICD implantation is that the client: experiences recurrent episodes of atrial flutter. has survived at least one episode of cardiac arrest with ventricular origin. experiences recurrent episodes of ventricular tachycardia. is at risk for death due to structural cardiac disease with poor ventricular function.
experiences recurrent episodes of atrial flutter.
A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that don't precede a beat. Which condition should the nurse suspect? Failure to pace Failure to capture Failure to sense Asystole
failure to capture
Which rhythm is also termed a ventricular escape rhythm? Idioventricular rhythm Ventriuclar asystole First degree AV block Ventricular fibrillation
idioventricular block
device implanted into the chest wall to treat dysrhythmias
implantable cardioverter defibrillator
what is the major clinical use of dobutamine?
increase cardiac output
force of myocardial contraction
inotropy
A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? internal cardioverter defibrillator insertion pacemaker insertion radiofrequency ablation electrophysiological study
internal cardioverter defib insertion
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? Fracture of the lead wire Lead wire dislodgement Faulty generator Sensitivity is too low
lead wire dislodgement
A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended? Angiography Maze procedure Open heart surgery Heart transplantation
maze
which positioning strategy should be used in hypovolemic shock?
modified trendelburg
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? Extended PR interval More P waves than QRS complexes Atrial rate of 60 bpm or below Shortened QRS duration.
more p waves than qrs complexes
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? Date and time of insertion Location of the generator Model number Pacer rate
pacer rate
a dysrhythmia that has a sudden onset and terminates spontaneously; usually of short duration, but may recur
paroxysmal
A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next? Question the client about alcohol and illicit drug use. Instruct the client to hold the breath and bear down. Prepare to administer a calcium channel blocker. Place the client on supplemental oxygen.
question the client about alcohol and illicit drug use
process by which cardiac muscle cells return to a more negatively charged intracellular condition, their resting state
repolarization
The staff educator is presenting a class on cardiac dysrhythmias. How would the educator describe the characteristic pattern of the atrial waves in atrial flutter? Sinusoidal Triangular Sawtooth Square
sawtooth
electrical activity of the heart initiated by the sinoatrial node
sinus rhythm
A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? supraventricular tachycardia sinus tachycardia heart block atrial flutter
supraventricular tachycardia
When no atrial impulse is conducted through the AV node into the ventricles, the client is said to be experiencing which type of AV block? First degree Second degree, type I Second degree, type II Third degree
third degree
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? The medication increases the force of the myocardial contraction. The medication causes the kidneys to retain fluid and increase intravascular volume. The medication increases the heart rate. The medication helps the kidneys produce more urine.
this medication increases the force of the myocardial contraction
During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during atrial depolarization. ventricular depolarization. ventricular repolarization. the QT interval.
ventricular depolarization
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? Ventricular tachycardia Atrial fibrillation Third-degree heart block Ventricular fibrillation
ventricular fib
