Management of Patients with Dysrhythmias and Conduction Problems (Chapter 26)
The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?
a defibrillator
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?
anticoagulant
A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response?
assess the client and monitor leads
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
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?
atrial flutter
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?
atrial flutter
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?
atrial flutter
A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings?
atropine
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication does the nurse anticipate administering to treat his bradycardia?
atropine
The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed.
atropine sulfate
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
The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply.
avoid handheld screening devices in airports; check pulse daily, reporting sudden slowing or increase; wear a medical alert, noting the presence of a pacemaker
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
After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker?
avoid undergoing magnetic resonance imaging (MRI)
A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?
begin cardiopulmonary resuscitation
The nurse is instructing on home care after placement of an automatic implanted cardioverter defibrillator (AICD). Which statement, made by the client, needs clarification by the nurse?
"I need to stay away from microwaves"
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?
"I'll keep a log of each time my ICD discharges"
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"
A nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following?
"anything that stimulates the sympathetic nervous system (positive chronotropy)"
A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between ventricular tachycardia and ventricular fibrillation when I look at the EKG strip?" The best reply by the nurse is which of the following?
"ventricular fibrillation is irregular with undulating waves and no QRS complex. ventricular tachycardia is usually regular and fast with wide QRS complexes"
A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond?
"you can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site"
The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following?
"your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before cardio version"
After taking an ECG on a 38-year-old woman, the nurse reports that the PR interval reflects normal sinus rhythm. The nurse has made this interpretation based on the PR interval of:
0.12 and 0.2 seconds
A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist?
IV bolus of atropine or temporary pacing
Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block?
PR interval
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?
QRS complex
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client?
the need to hav regular blood levels drawn
Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes:
treating the underlying cause
During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during
ventricular depolarization
The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include?
your family and friends may want to take a CPR class
After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have?
decreased cardiac output and decreased systolic and diastolic blood pressure
Cardioversion is used to terminate dysrhythmias. With cardioversion, the:
defibrillator should be set to deliver a shock during the QRS complex
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. He is aware that this dysrhythmia is evident on an ECG strip by which of the following?
delayed conduction, producing a prolonged PR interval
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?
delayed conduction, producing a prolonged PR interval
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
A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?
double-check the monitoring equipment
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
A patient experiences a faster-than-normal heart rate when she drinks more than two cups of coffee in the morning. The nurse knows that an indicator of sinus tachycardia on an ECG would be which of the following?
heart rate of 118 bpm
The nurse enters the client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?
immediate defibrillation
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?
it is used to eliminate ventricular dysrhythmias
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
monitor vital signs and cardiac rhythm
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as
normal sinus rhythm
Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:
occur at a rate of more than six per minute
Two days after discharge following a permanent pacemaker insertion, the client returns to the clinic for a follow-up appointment. He reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the site and suspects which of the following:
pacemaker site infection
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
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. The correct response would be which of the following?
sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branch and the Purkinje fibers
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What type of dysrhythmia would the cardiologist likely diagnose?
sinus tachycardia
