Lewis Chapter 35 Dysrhymthias, Unit 8

6. A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a. notify the health care provider immediately. b. document the finding and monitor the patient. c. give atropine per agency dysrhythmia protocol. d. prepare the patient for temporary pacemaker insertion.

B

The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time? A Reinforcing the pressure dressing as needed B Encouraging range-of-motion exercises of the involved arm C Assessing the incision for any redness, swelling, or discharge D Applying wet-to-dry dressings every 4 hours to the insertion site

C

14. A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54 mm Hg, and the student denies any health problems. What action by the nurse is most appropriate? a. Allow the student to participate on the soccer team. b. Refer the student to a cardiologist for further testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the student's family health history.

A

8. After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the drug has been effective? a.Increase in the patient's heart rate b.Increase in strength of peripheral pulses c.Decrease in premature atrial contractions d.Decrease in premature ventricular contractions

A

9. A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. Teaching for this patient would include information about a.anticoagulant therapy. b.permanent pacemakers. c.emergency cardioversion. d.IV adenosine (Adenocard).

A

A patient has sought care following a syncopal episode of unknown etiology. Which nursing action should the nurse prioritize in the patient's subsequent diagnostic workup? A Preparing to assist with a head-up tilt-test B Preparing an IV dose of a β-adrenergic blocker C Assessing the patient's knowledge of pacemakers D Teaching the patient about the role of antiplatelet aggregators

A

A patient in asystole is likely to receive which drug treatment? A Epinephrine and atropine B Lidocaine and amiodarone C Digoxin and procainamide D β-adrenergic blockers and dopamine

A

For which dysrhythmia is defibrillation primarily indicated? A Ventricular fibrillation B Third-degree AV block C Uncontrolled atrial fibrillation D Ventricular tachycardia with a pulse

A

The patient has hypokalemia, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm; the P wave is 0.06 seconds (sec) and normal shape; the PR interval is 0.24 sec; the QRS is 0.09 sec. How should the nurse document this rhythm? A First-degree AV block B Second-degree AV block C Premature atrial contraction (PAC) D Premature ventricular contraction (PVC)

A

13. Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the "off" position. b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device.

B

16. A patient has ST segment changes that suggest an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient? a.I b.II c.V2 d.V6

B

18. A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action should the nurse take first? a. Give epinephrine (Adrenalin) IV. b. Perform immediate defibrillation. c. Prepare for endotracheal intubation. d. Ventilate with a bag-valve-mask device.

B

24. A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic, and has no palpable pulses. What action should the nurse take next? a. Perform synchronized cardioversion. b. Start cardiopulmonary resuscitation (CPR). c. Give atropine per agency dysrhythmia protocol. d. Provide supplemental O2 via non-rebreather mask.

B

25. Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin? a. Explain the association between dysrhythmias and syncope. b. Instruct the patient to call for assistance before getting out of bed. c. Teach the patient about the need to avoid caffeine and other stimulants. d. Tell the patient about the benefits of implantable cardioverter-defibrillators.

B

26. Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as telemetry technicians on the cardiac care unit? a. Decide whether a patient's heart rate of 116 requires urgent treatment. b. Observe heart rhythms for multiple patients who have telemetry monitoring. c. Monitor a patient's level of consciousness during synchronized cardioversion. d. Select the best lead for monitoring a patient admitted with acute coronary syndrome.

B

27. Which action by a new registered nurse (RN) who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias? a. Prepares defibrillator settings at 360 joules for a patient whose monitor shows asystole. b. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia c. Turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation d. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second degree AV block

B

5. The nurse notes that a patient's heart monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Multifocal premature ventricular contractions

B

The nurse is doing discharge teaching with the patient and spouse of the patient who just received an implantable cardioverter-defibrillator (ICD) in the left side. Which statement by the patient indicates to the nurse that the patient needs more teaching? A "I will call the cardiologist if my ICD fires." B "I cannot fly because it will damage the ICD." C "I cannot move my left arm until it is approved." D "I cannot drive until my cardiologist says it is okay."

B

The nurse is watching the cardiac monitor, and a patient's rhythm suddenly changes. There are no P waves. Instead 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. The nurse correctly interprets this rhythm as what? A Sinus tachycardia B Atrial fibrillation C Ventricular fibrillation D Ventricular tachycardia

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 is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? A Myocardia injury B Myocardial ischemia C Myocardial infarction D A pacemaker is present.

B

The patient is admitted with acute coronary syndrome (ACS). The ECG shows ST-segment depression and T-wave inversion. What should the nurse know that this indicates? A Myocardia injury B Myocardial ischemia C Myocardial infarction D A pacemaker is present.

B.

10. Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter? a.The procedure prevents or minimizes the risk for sudden cardiac death. b.The procedure uses cold therapy to stop the formation of the flutter waves. c.The procedure uses electrical energy to destroy areas of the conduction system. d.The procedure stimulates the growth of new conduction pathways between the atria.

C

12. Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more teaching about the care of patients with ICDs? a. The nurse administers amiodarone (Cordarone) to the patient. b. The nurse helps the patient fill out the application for obtaining a Medic Alert device. c. The nurse encourages the patient to do active range of motion exercises for all extremities. d. The nurse teaches the patient that sexual activity can be resumed when the incision is healed.

C

19. A patient's heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next? a. Place the transcutaneous pacemaker pads on the patient. b. Give atropine sulfate 1 mg IV per agency dysrhythmia protocol. c. Call the health care provider before giving scheduled metoprolol (Lopressor). d. Document the patient's rhythm and assess the patient's response to the rhythm.

C

2. The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next and divide into 1500.

C

21. A 19-yr-old student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional unifocal premature ventricular contractions (PVCs). What action should the nurse take next? a. Insert an IV catheter for emergency use. b. Start supplemental O2 at 2 to 3 L/min via nasal cannula. c. Ask the patient about current stress level and caffeine use. d. Have the patient taken to the nearest emergency department (ED).

C

23. A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the patient's vital signs including O2 saturation.

C

28. A patient reports dizziness and shortness of breath for several days. During heart monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as a. junctional escape rhythm. b. accelerated idioventricular rhythm. c. third-degree atrioventricular (AV) block. d. sinus rhythm with premature atrial contractions (PACs).

C

29. A patient who is complaining of a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next? a. Prepare to perform electrical cardioversion. b. Have the patient perform the Valsalva maneuver. c. Obtain the patient's vital signs including O2 saturation. d. Prepare to give a β-blocker medication to slow the heart rate.

C

3. A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/min. a. 15 to 20 b. 20 to 40 c. 40 to 60 d. 60 to 100

C

7. A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which action should the nurse take next? a.Immediately notify the health care provider. b.Document the rhythm and continue to monitor the patient. c.Prepare to give IV amiodarone per agency dysrhythmia protocol. d.Perform synchronized cardioversion per agency dysrhythmia protocol.

C

Cardioversion is attempted for a 64-year-old man with atrial flutter and a rapid ventricular response. After the nurse delivers 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.

C

The nurse is monitoring the ECGs of several patients on a cardiac telemetry unit. The patients are directly visible to the nurse, and all of the patients are observed to be sitting up and talking with visitors. Which patient's rhythm would require the nurse to take immediate action? A A 62-year-old man with a fever and sinus tachycardia with a rate of 110 beats/minute B A 72-year-old woman with atrial fibrillation with 60 to 80 QRS complexes per minute C A 52-year-old man with premature ventricular contractions (PVCs) at a rate of 12 per minute D A 42-year-old woman with first-degree AV block and sinus bradycardia at a rate of 56 beats/minute

C

The nurse is seeing artifact on the telemetry monitor. Which factors could contribute to this artifact? A Disabled automaticity B Electrodes in the wrong lead C Too much hair under the electrodes D Stimulation of the vagus nerve fibers

C

When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From these data, the nurse calculates the patient's heart rate to be A 60 beats/min. B 75 beats/min. C 100 beats/min. D 150 beats/min.

C

Which ECG characteristic is consistent with a diagnosis of ventricular tachycardia (VT)? 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

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

C

1. To determine whether there is a delay in impulse conduction through the ventricles, the nurse will measure the duration of the patient's a. P wave. b. Q wave. c.PR interval. d. QRS complex.

D

11. The nurse knows that discharge teaching about the management of a new permanent pacemaker has been most effective when the patient states a. "It will be several weeks before I can return to my usual activities." b. "I will avoid cooking with a microwave oven or being near one in use." c. "I will notify the airlines when I make a reservation that I have a pacemaker." d. "I won't lift the arm on the pacemaker side until I see the health care provider."

D

15. When analyzing the rhythm of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n) a. isoelectric ST segment. b. PR interval of 0.18 second. c. QT interval of 0.38 second. d. QRS interval of 0.14 second.

D

17. Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose of 243 mg/dL b. Serum chloride of 92 mEq/L c. Serum sodium of 134 mEq/L d. Serum potassium of 2.9 mEq/L

D

20. A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which action should the nurse take next? a. Recheck the heart rhythm and BP in 5 minutes. b. Have the patient perform the Valsalva maneuver. c. Give the scheduled dose of diltiazem (Cardizem). d. Apply the transcutaneous pacemaker (TCP) pads.

D

22. The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first? a. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin (Coumadin) due b. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating c. A patient who is in a sinus rhythm, rate 98 and regular, recovering from an elective cardioversion 2 hours ago d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone (Cordarone) due

D

4. The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval regular, and QRS complex wide and distorted, and QRS duration of 0.18 second. The nurse interprets the patient's cardiac rhythm as a.atrial flutter. b. sinus tachycardia. c. ventricular fibrillation. d. ventricular tachycardia.

D

A 38-year-old teacher who reported dizziness and shortness of breath while supervising recess is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole? A Atropine sulfate B Digoxin (Lanoxin) C Metoprolol (Lopressor) D Adenosine (Adenocard)

D

A 50-year-old man who develops third-degree heart block 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."

D

The nurse performs discharge teaching for a 74-year-old woman with an implantable cardioverter-defibrillator. 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