MS II Prep U Ch. 26: Management of Patients With Dysrhythmias and Conduction Problems
A client reports light-headedness, chest pain, and shortness of breath. The physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? electrocardiogram electroencephalogram echocardiogram electrocautery
electrocardiogram An electrocardiogram is used to identify normal and abnormal cardiac rhythms
A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: inherent rhythmicity of cardiac muscle tissue. inherent rhythmicity of all muscle tissue. sufficient blood pressure. inherent electrons in muscle tissue.
inherent rhythmicity of cardiac muscle tissue. Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively.
Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: occur at a rate of more than six per minute occur during the QRS complex have the same shape are paired with a normal beat
occur at a rate of more than six per minute When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy.
Which PR interval presents a first-degree heart block? 0.24 seconds 0.14 seconds 0.16 seconds 0.18 seconds
0.24 seconds In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.
A nurse is completing a shift assessment on a patient admitted to the telemetry unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The patient is also experiencing dizziness and shortness of breath. Which of the following medications will the nurse anticipate administering to the patient based on these clinical findings? Atropine Lidocaine Pronestyl Cardizem
Atropine The patient is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias.
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. Corgard Procardia Atropine sulfate Tenormin
Atropine sulfate Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation.
A patient tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the patient is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the patient to complete which of the following? Avoid caffeinated beverages. Request sublingual nitroglycerin. Apply supplemental oxygen. Lie down and elevate the feet.
Avoid caffeinated beverages. If PACs are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the patient to avoid caffeinated beverages.
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis for this client would be which of the following? Decreased cardiac output Ineffective health maintenance Ineffective breathing pattern Risk for vascular trauma
Decreased cardiac output Based on assessment data for this client, the most logical nursing diagnosis will be decreased cardiac output. Third-degree AV block that is causing symptoms will be a slow rhythm that will produce a decreased cardiac output.
You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Fluttering Nausea Hypotension Fever
Fluttering Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.
The nurse is analyzing the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which of the following findings indicate 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 QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the patient may be at risk for a lethal ventricular dysrhythmia called torsades de pointes. The other findings are normal.
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 systerm (positive chronotropy)" "Anything that stimulates the parasympathetic nervous system (negative chronotropy)" "Hypothyroidism" "Beta-adrenergic blocking agents"
"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic stimulation reduces heart rate. Administration of beta-adrenergic blocking agents decreases stimulation of the sympathetic nervous system and subsequently heart rate.
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? "I should ask for a handheld device search when I go through airport security." "I should avoid large magnetic fields, such as an MRI machine or large motors." "I should avoid contact sports." "I'll watch the incision for swelling or redness and will report if either occurs."
"I should ask for a handheld device search when I go through airport security." At security gates at airports, government buildings, or other secured areas, the client with a permanent pacemaker should show a pacemaker ID card and request a hand (not handheld device) search. The client should obtain and carry a physician's letter about this requirement.
The nurse is caring for a client with a diagnosis of atrial fibrillation. The onset was approximately 2 to 3 days ago. The client is scheduled for a transesophageal echocardiogram this morning. The client's spouse asks what this test is for. The best response by the nurse is which of the following? "This test will show any blood clots in the heart and if it is safe to do a cardioversion." "This test will show the specific area causing the atrial fibrillation and what can be done to stop it." "This test will show if the client needs a cardiac catheterzation." "This test will let the doctor know if the client is at risk for hypotension."
"This test will show any blood clots in the heart and if it is safe to do a cardioversion." When contemplating cardioversion for the client with atrial fibrillation, the absence of a thrombus in the atria can be confirmed by transesophageal echocardiogram.
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: 0.05 and 0.1 seconds. 0.12 and 0.2 seconds. 0.15 and 0.3 seconds. 0.25 and 0.4 seconds.
0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.
A client has started to exhibit dangerous PVCs in the cardiac postoperative unit. The client has been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should the nurse be ready to do? Adjust the IV infusion. Administer additional lidocaine. Prepare for defibrillation. Call for the doctor and just wait.
Adjust the IV infusion. Call for the physician while adjusting the IV infusion to the slowest possible rate until the physician can examine the patient.
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart? All options are correct. elevated temperature shock strenuous exercise
All options are correct. There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart, including fever, shock, and strenuous exercise.
The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? Altered patterns frequently turn into life-threatening arrhythmias. Altered patterns frequently produce neurological deficits. Altered patterns frequently cause a variety of home safety issues. Altered patterns frequently affect the heart's ability to pump blood effectively.
Altered patterns frequently affect the heart's ability to pump blood effectively. The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer.
The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle? Atrial depolarization Early ventricular repolarization Ventricular depolarization Ventricular repolarization
Atrial depolarization The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave.
Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker? Keep the arm on the side of the pacemaker higher than the head Delay for at least 3 weeks activities such as swimming and bowling Keep moving the arm on the side where the pacemaker is inserted Avoid sources of electrical interference
Avoid sources of electrical interference The nurse must instruct the patient with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the patient to avoid strenuous movement (especially of the arm on the side where the pacemaker is inserted), to keep the arm on the side of the pacemaker lower than the head except for brief moments when dressing or performing hygiene, and to delay for at least 8 weeks activities such as swimming, bowling, tennis, vacuum cleaning, carrying heavy objects, chopping wood, mowing, raking, and shoveling snow.
Which diagnostic study best evaluates different medications ability to restore normal heart rhythm? Elective electrical cardioversion Electrocardiogram (ECG) Electrophysiology study Echocardiogram
Electrophysiology study An electrophysiology study is a procedure that enables the physician to examine the electrical activity of the heart, produce actual dysrhythmias, and determine the best method for care. Cardioversion uses synchronized electricity to change the rhythm pattern. Electrocardiogram and echocardiograms provide diagnostic information.
Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for an elective electrical cardioversion? Instruct the patient to restrict food and oral intake Administer digitalis and diuretics 24 hours before cardioversion Facilitate CPR until the patient is prepared for cardioversion Monitor blood pressure every 4 hours
Instruct the patient to restrict food and oral intake The nurse should instruct the patient to restrict food and oral intake before the cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion. When the patient is in cardiopulmonary arrest, the nurse should facilitate CPR until the patient is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a patient with cardiac dysrhythmia.
The nurse is caring for a client with a dysrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the dysrhythmia to be which of the following? Peripheral vascular disease Ischemic heart disease Aortic stenosis Atherosclerotic heart disease
Ischemic heart disease The nurse realizes that the most common cause of dysrhythmias is ischemic heart disease. When the heart does not obtain sufficient blood to meet demands, the heart works harder to circulate body fluids and becomes inefficient in the process. Problems with the peripheral vessels, narrowing of the aorta and plaque buildup in the vessels may be a component of the disease process but not the best answer
Your client has just been prescribed Pronestyl for their dysrhythmia. What would you teach this client about the side effects? Hypertension Decreased appetite Change in mental status Lupus-like syndrome
Lupus-like syndrome Procainamide hydrochloride (Pronestyl) can have side effects of hypotension, GI upset, and a lupus-like syndrome; With long-term use, it may cause immune system problems.
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 There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.
Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block? PR interval QRS T wave P wave
PR interval First-degree AV block occurs when atrial conduction is delayed through AV node resulting in a prolonged PR interval. The QRS complex, T wave, and P wave are not prolonged in first-degree AV block.
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 Electrical cardioversion Administration of amiodarone Immediate defibrillation
Treating the underlying cause Sinus tachycardia occurs in response to an underlying condition and will usually resolve once that condition is corrected.
Which of the following ECG characteristics is usually seen when a patient's serum potassium level is low? U wave T wave P wave QT interval
U wave The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient's serum potassium level is low. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a patient's serum potassium level is high. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.
Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? Atropine Lanoxin Vasotec Valium
Valium Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as Valium.
A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents: atrial repolarization. ventricular repolarization. atrial depolarization. ventricular depolarization.
ventricular depolarization. The QRS complex on the ECG strip represents ventricular depolarization. Atrial repolarization usually occurs at the same time as ventricular depolarization and is impossible to distinguish on the ECG. The T wave represents ventricular repolarization. The P wave represents atrial depolarization.
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? "I should increase my fluid intake." "I'll enroll in an aerobic exercise program." "I can still drink coffee and tea." "I should eat foods rich in protein."
"I can still drink coffee and tea." The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are
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: 0.05 and 0.1 seconds. 0.12 and 0.2 seconds. 0.15 and 0.3 seconds. 0.25 and 0.4 seconds.
0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.
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. It is not necessary to learn how to take your own pulse. If you miss a dose of your antiarrhythmia medication, double up on the next dose. Do not be concerned if you experience symptoms of lightheadedness and dizziness.
Your family and friends may want to take a CPR class. Having friends and family learn to take a pulse and perform CPR will help patients to manage their condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness are symptoms which should be reported to the provider.
Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds? 0.2 0.1 0.3 0.4
0.2 Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second.
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." "I can't wait to get back to my football league." "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." "I need to stay at least 10? away from the microwave."
"I'll keep a log of each time my ICD discharges." The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD.
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." "I can't wait to get back to my football league." "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." "I need to stay at least 10? away from the microwave."
"I'll keep a log of each time my ICD discharges." The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD.
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 PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers.
The nurse receives a telephone call from a client with an implanted pacemaker who reports that his pulse is 68 beats per minute, but his pacemaker rate is set at 72 beats per minute. The best response by the nurse is which of the following? "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." A client experiencing pacemaker malfunctioning may develop bradycardia as well as signs and symptoms of decreased cardiac output. The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate. This may indicate pacemaker malfunction.
A patient is being examined for medical management of atrial flutter. The nurse reviews the ECG strip. He expects to see which of the following? P-to-QRS duration of less than 0.1 seconds "Sawtooth" pattern to the waveform Ventricular rate below 70 bpm PR interval between 0.12 and 0.2 seconds.
"Sawtooth" pattern to the waveform The "sawtooth pattern" is the classic waveform appearance with atrial flutter. The atrial rate is faster than the AV node can conduct. Not all atrial impulses stimulate the ventricle.
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? Scar on the chest "Spike" on the rhythm strip Quality of the pulse Vibration under the skin
"Spike" on the rhythm strip Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin.
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? "Enjoy your time with your grandson." "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." "Being that close to a rifle might make your ICD fire." "You'll need to take an extra dose of your antiarrhythmic before you shoot."
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with his left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of his antiarrhythmic.
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? "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." Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion.
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: 0.05 and 0.1 seconds. 0.12 and 0.2 seconds. 0.15 and 0.3 seconds. 0.25 and 0.4 seconds.
0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.
A patient is admitted to the emergency department (ED) with complaints of chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph (ECG) monitor. The nurse counts 9 RR intervals on the patient's 6-second rhythm tracing. The nurse correctly identifies the patient's heart rate as which of the following? 90 bpm 80 bpm 70 bpm 100 bpm
90 bpm An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90.
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? Diuretic Anticoagulant Antihypertensive Potassium supplement
Anticoagulant Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation. The other options may be prescribed but not expected in most situations.
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? Stay at least 2? away from microwave ovens. Never engage in activities that require vigorous arm and shoulder movement. Avoid going through airport metal detectors. Avoid undergoing magnetic resonance imaging (MRI).
Avoid undergoing magnetic resonance imaging (MRI). A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens; nonetheless, the client should stay at least 5? away from microwaves, not 2?. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector.
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 cardiopulmonary resuscitation (CPR) Commonly called flatline, ventricular asystole (Fig. 26-19) is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Ventricular asystole is treated the same as PEA, focusing on high-quality CPR with minimal interruptions and identifying underlying and contributing factors.
You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what 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 The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect.
Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke? Coumadin Aspirin Lovenox Plavix
Coumadin Warfarin (Coumadin) is indicated if the patient with atrial fibrillation is at high risk for stroke. Aspirin, Lovenox, and Plavix are not indicated. If immediate anticoagulation is necessary, the patient may be placed on heparin until the warfarin level is therapeutic.
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 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 As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia.
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? Variable heart rate, usually fewer than 90 bpm Irregular rhythm Delayed conduction, producing a prolonged PR interval P waves hidden within the QRS complex
Delayed conduction, producing a prolonged PR interval First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in 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? 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 First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds).
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. Do nothing; there is no cause for alarm. Suggest the need for a new beta-blocker to the doctor. Measure the client's blood pressure.
Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.
Which of the following ECG waveforms characterizes conduction of an electrical impulse through the left ventricle? P wave QRS complex PR interval QT interval
QRS complex The QRS complex represents ventricular depolarization. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.
The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include? During the procedure, the arrhythmia 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 arrhythmia will not recur.
During the procedure, the arrhythmia will be reproduced under controlled conditions. During EP studies, the patient is awake and may experience symptoms related to the arrhythmia. EP studies do not always include ablation of the arrhythmia.
Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? Elective electrical cardioversion Chemical cardioversion Mace procedure Elective electrical defibrillation
Elective electrical cardioversion Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure.
The nurse is asked to explain ventricular bigeminy to a patient. The nurse explains that it is a conduction defect in which: Conduction is primarily from the AV node. Every other complex is a PVC. The rhythm is regular but fast. The rate is between 150 to 250 bpm.
Every other complex is a PVC. The effect of a PVC depends on its timing in the cardiac cycle and how much blood was in the ventricles when they contracted. Bigeminy is a rhythm in which every other complex is a PVC. In trigeminy, every third complex is a PVC.
Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a: PR interval of 0.18 seconds. Heart rate of 42 beats per minute (bpm). QT interval of 0.37 seconds. P-to-QRS ratio of 1:1.
Heart rate of 42 beats per minute (bpm). All answers refer to a normal sinus rhythm (NSR) except for the heart rate. A rate of 42 bpm is slow but normal when it occurs in athletes without symptoms.
The nurse understands that asystole can be caused by several of the following. Select all that apply. Hypoxia Alkalosis Hypovolemia Hypothermia Acidosis
Hypoxia Hypovolemia Hypothermia Acidosis Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality cardiopulmonary resuscitation (CPR) with minimal interruptions and identifying underlying and contributing factors. The key to successful treatment is a rapid assessment to identify a possible cause, which is known as the "Hs and Ts": hypoxia, hypovolemia, hydrogen ion (acid/base imbalance), hypo- or hyperglycemia, hypo- or hyperkalemia, hyperthermia, trauma, toxins, tamponade (cardiac), tension pneumothorax, or thrombus (coronary or pulmonary).
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 Cardioversion or IV bolus of dopamine A maze procedure or IV bolus of furosemide Cardiac catheterization
IV bolus of atropine or temporary pacing The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists.
You enter your client's room and find them pulseless and unresponsive. What would be the treatment of choice for this client? IV lidocaine Chemical cardioversion Immediate defibrillation Electric cardioversion
Immediate defibrillation Defibrillation is used during pulseless ventricular tachycardia and ventricular fibrillation.
A patient with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What choice would be best to sense and terminate these episodes? Implantable cardioverter defibrillator Pacemaker Atropine Epinephrine
Implantable cardioverter defibrillator The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation and who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention).
A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient? Insertion of a pacemaker Administration of atropine Administration of epinephrine Insertion of an implantable cardioverter defibrillator (ICD)
Insertion of a pacemaker Third-degree AV block, also known as a complete block, occurs when no atrial impulse is conducted through the AV node into the ventricles. A permanent pacemaker may be necessary if the block persists.
A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following? It increases the force of the myocardial contraction. It increases the heart rate. It increases the respiratory rate. It causes the kidneys to retain fluid and increase intravascular volume.
It increases the force of the myocardial contraction. A positive inotropic effect increases the force of myocardial contraction. A positive chronotropic effect increases the heart rate. A positive inotropic effect will usually help slow respiratory rate and will increase blood flow through the kidneys, so fluid output will increase.
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 Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances.
What nursing interventions could you institute with a client who has a suspected dysrhythmia that would help detect life-threatening dysrhythmias and would manage and minimize any that occur? Monitor blood pressure continuously. Monitor cardiac rhythm continuously. Provide supplemental oxygen. Palpate the client's pulse and observe the client's response.
Monitor cardiac rhythm continuously. The nurse should monitor cardiac rhythm continuously. Cardiac monitors display real-time heart rate and rhythm and alert the nurse to potentially life-threatening dysrhythmias. Monitoring blood pressure continuously and palpating the client's pulse do not help detect life-threatening dysrhythmias. Providing supplemental oxygen helps maintain adequate cardiac output and does not help detect life-threatening dysrhythmias.
Which of the following nursing interventions must a nurse perform when administering prescribed vasopressors to a patient with a cardiac dysrhythmia? Keep the patient flat for one hour after administration Administer every five minutes during cardiac resuscitation Document heart rate before and after administration Monitor vital signs and cardiac rhythm
Monitor vital signs and cardiac rhythm The nurse should monitor the patient's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill patient. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a patient flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.
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 There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.
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 P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The T wave depicts the relative refractory period, representing ventricular repolarization.
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
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 After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.
A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding? Occasional U waves Peaked T waves Flattened P waves Prolonged QT interval
Peaked T waves The patient's serum potassium level is high. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a patient's serum potassium level is high. The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a patient's serum potassium level is low. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria and is not affected by a patient's serum potassium level. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization, and is not affected by a patient's serum potassium level.
A healthy 46-year-old woman is seeing her health care provider for her annual physical examination. While the nurse is taking the patient's vital signs, the patient states, "Occasionally, my heart skips a beat. Is this normal?" The nurse explains that this feeling is caused by which of the following? Premature atrial complex Atrial flutter Sinus tachycardia Ventricular fibrillation
Premature atrial complex A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.
The nurse is caring for a client who has developed junctional tachycardia with a heart rate (HR) of 80 bpm. Which of the following actions should the nurse complete? Request a digoxin level be ordered. Withhold the patient's oral potassium supplement. Prepare for emergent electrical cardioversion. Prepare to administer IV lidocaine.
Request a digoxin level be ordered. The nurse should request a digoxin level be obtained. Junctional tachycardia generally does not have any detrimental hemodynamic effect; it may indicate a serious underlying condition, such as digitalis toxicity, myocardial ischemia, hypokalemia, or chronic obstructive pulmonary disease (COPD). Potassium supplements do not cause junctional tachycardia. Lidocaine is indicated for the treatment of premature ventricular contractions (PVCs). Because junctional tachycardia is caused by increased automaticity, cardioversion is not an effective treatment; in fact, it causes an increase in ventricular rate.
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 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
A patient comes to the emergency department with complaints of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? Sinus bradycardia Ventricular tachycardia Normal sinus rhythm Sinus tachycardia
Sinus tachycardia Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy).
The registered nurse reviewed the patient's q4h vital signs recorded by the LPN. He noticed a consistent pattern of heart rate recordings between 48 and 58 bpm over a 24-hour period of time. The nurse, aware that bradycardia can be a side-effect of medications, checked the patient's electronic health record. Select the medication that might cause bradycardia. Aminophylline Atropine Tenormin Epinephrine
Tenormin Beta-blockers can lower the heart rate. The other choices stimulate the sympathetic response.
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? The registered nurse stating to administer Lanoxin (digoxin) The registered nurse administering atropine sulfate intravenously The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute The registered nurse stating to administer all medications except those which are cardiotonics
The registered nurse administering atropine sulfate intravenously The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.
When no atrial impulse is conducted through the AV node into the ventricles, the patient is said to be experiencing which type of AV block? First degree Second degree, type I Second degree, type II Third degree
Third degree In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria. In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.
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 Electrical cardioversion Administration of amiodarone Immediate defibrillation
Treating the underlying cause Sinus tachycardia occurs in response to an underlying condition and will usually resolve once that condition is corrected.
The nurse is participating in the care of a client requiring emergent defibrillation. The nurse will complete the following steps in which order? Turn on the defibrillator and place it in "not sync" mode. Charge the defibrillator to the prescribed voltage. Apply the multifunction conductor pads to the patient's chest. Call "clear" three times ensuring patient and environmental safety. Deliver the prescribed electrical charge.
Turn on the defibrillator and place it in "not sync" mode. Charge the defibrillator to the prescribed voltage. Apply the multifunction conductor pads to the patient's chest. Call "clear" three times ensuring patient and environmental safety. Deliver the prescribed electrical charge. This is the sequence of events the nurse should implement when delivering emergent defibrillation. If not followed correctly, the patient and health care team may be placed in danger.
You are discussing complications of a pacemaker with a group of nursing students. One of the students asks about complications associated with use of a cardiac pacemaker. Which of the following items are considered complications of a pacemaker? Choose all that apply. a. Twiddler syndrome b. Hiccuping c. Positive Kernig's d. Local infection e. Negative Babinski Correct answers: a, b, and d Twiddler syndrome Hiccuping Positive Kernig's sign Localized infection Negative Babinski reflex
Twiddler syndrome Hiccuping Localized infection Complications associated with pacemakers include infection at entry site, pneumothorax, bleeding and hematoma, hemothorax, ventricular ectopy and tachycardia, phrenic nerve/diaphragmatic(hiccupping)/skeletal stimulation, cardiac perforation, Twiddler syndrome, and hemodynamic instability. A positive Kernig's sign is an indication of meningitis. A positive Babinski reflex is normal in neonates, but indicates a central nervous system disorder in adults.
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 fibrillation The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations.
A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents: atrial repolarization. ventricular repolarization. atrial depolarization. ventricular depolarization.
ventricular depolarization The QRS complex on the ECG strip represents ventricular depolarization. Atrial repolarization usually occurs at the same time as ventricular depolarization and is impossible to distinguish on the ECG. The T wave represents ventricular repolarization. The P wave represents atrial depolarization.
A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have? sinus bradycardia atrial bradycardia heart block none
sinus bradycardia Sinus bradycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual (less than60 beats/minute) rate.
