Quiz 2 Dysrhythmias

Report pulse rates lower than your pacemaker setting. R= The client should be instructed to report changes in heart rate or rhythm, such as rates lower than the pacemaker setting or greater than 100 beats/min.

A client was admitted for a permanent pacemaker insertion. What priority instruction does the nurse include in the clients discharge teaching?

Tall T wave R= An abnormally high serum potassium level will cause the T wave to become very tall, sometimes the height of the QRS complex.

A client with a serum potassium level of 6.6 mEq/L would have a characteristic ECG configuration of

Document the finding in the chart. R= This prolonged PR interval indicates a first-degree heart block. First-degree heart block in a stable client requires no intervention.

A client with ischemic heart disease has an electrocardiograph (ECG) tracing that shows a PR interval of 0.24 second. What is the nurses best action?

Amiodarone (Cordarone) R= Early, wide ventricular complexes are premature ventricular contractions (PVCs). Amiodarone, an antidysrhythmic, is the treatment of choice for frequent PVCs. The other medications are not appropriate for this condition.

A client with myocardial ischemia is having frequent early, wide ventricular complexes seen on the cardiac monitor. Which medication does the nurse administer?

stress. R=Causes of sinus tachycardia include fever; emotional and physical stress; heart failure; hyperthyroidism; hypercalcemia; medications, including caffeine, atropine, nitrates, epinephrine, isoproterenol, and nicotine; and exercise.

A client with no history of heart disease is seen in the clinic for periodic episodes of tachycardia with a regular rate. When taking the nursing history, the nurse would question the client about the existence of

Mid-sternal chest pain R=Chest pain, possibly angina, indicates that tachycardia may be increasing the clients myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This results in myocardial hypoxia and pain.

A client with tachycardia is experiencing clinical manifestations. Which manifestation requires immediate intervention by the nurse?

Level of consciousness R= A heart rate of 40 beats/min or less, with widened QRS complexes, could have hemodynamic consequences, and the client is at risk for inadequate cerebral perfusion. The nurse should assess for level of consciousness, lightheadedness, confusion, syncope, and seizure activity.

A client with third-degree heart block is admitted to the telemetry unit. The nurse observes wide QRS complexes on the monitor with a heart rate of 35 beats/min. What priority assessment does the nurse perform?

Slow the amiodarone infusion rate. R= IV administration of amiodarone may cause bradycardia and atrioventricular (AV) block. The correct action for the nurse to take at this time is to slow the infusion, because the client is asymptomatic and no evidence reveals AV block that might require pacing. Abruptly ceasing the medication could allow fatal dysrhythmias to occur. A precordial thump is not required at this time because the client still has a heart rate. A side-lying position will not increase the clients heart rate

A client with unstable ventricular tachycardia is receiving amiodarone by intravenous infusion. The nurse notes that the clients heart rate has decreased from 68 to 50 beats/min. The client is asymptomatic. What is the nurses priority intervention?

Initiate cardiopulmonary resuscitation. R= A client with pulseless VT should be defibrillated immediately. If the defibrillator is not available, the nurse should initiate cardiopulmonary resuscitation (CPR) and then should defibrillate as soon as possible. Basic life support (BLS) is the basis of emergency cardiac care; if the client does not have an IV already, this can wait until others have arrived to help. Providing good quality CPR is vital. The client should have already been assessed for code status.

A client with ventricular tachycardia (VT) is unresponsive and has no pulse. The nurse calls for assistance and a defibrillator. What is the nurses priority intervention while waiting for the defibrillator to arrive?

a.) It originates from an ectopic focus. R = If the P wave is firing consistently from the SA node, the P wave will have a consistent shape in a given lead. If the impulse is from an ectopic focus, then the P wave will vary in shape in that lead.

A clients cardiac status is being observed by telemetry monitoring. The nurse observes a P wave that changes shape in lead II. What conclusion does the nurse make about the P wave?

Assess the clients vital signs. R=Assessing the clients vital signs allows the nurse to determine if he or she is stable or unstable and symptomatic with the bradycardia. The clients stability with the bradycardia will determine the need for specific interventions.

A nurse assesses the following ECG strip from a clients telemetry monitor. What does the nurse do next?

80 beats/min R= Precisely 6 seconds is represented by 150 small blocks on ECG paper. The number of R-R intervals, representing ventricular depolarization episodes present in 6 seconds, can be multiplied by 10 to calculate the ventricular heart rate.

A nurse assesses the following electrocardiography (ECG) strip from a clients telemetry monitor. What does the nurse chart as the clients ventricular heart rate?

Document the finding in the clients chart. R= The PR interval normally ranges from 0.12 to 0.20 second. This is a normal finding, so the nurse simply documents this. No further action is required.

A nurse notes that the PR interval on a clients electrocardiograph (ECG) tracing is 0.14 second. What action does the nurse take?

Apply the transcutaneous pacemaker (TCP) pads. R=The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva maneuver will further decrease the rate.

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which actions should the nurse take next?

II R=Leads II, III, and AVF reflect the inferior area of the heart and the ST segment changes. Lead II will best capture any electrocardiographic (ECG) changes that indicate further damage to the myocardium. The other leads do not reflect the inferior part of the myocardial wall and will not provide data about further ischemic changes in that area.

A patient has ST segment changes that support an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient?

40 to 6o R= If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60 beats/minute. The slower rates are typical of the bundle of His and the Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60 to 100 beats/minute.

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/minute.

document the finding and continue to monitor the patient. R=First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to

third-degree atrioventricular (AV) block. R= The inconsistency between the atrial and ventricular rates and the variable P-R interval indicate that the rhythm is third-degree AV block. Sinus rhythm with PACs will have a normal rate and consistent P-R intervals with occasional PACs. An accelerated idioventricular rhythm will not have visible P waves.

A patient reports dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as

Obtain the patients vital signs including oxygen saturation. R=The patient has sinus tachycardia, which may have multiple etiologies such as pain, dehydration, anxiety, and myocardial ischemia. Further assessment is needed before determining the treatment. Vagal stimulation or b-blockade may be used after further assessment of the patient. Electrical cardioversion is used for some tachydysrhythmias, but would not be used for sinus tachycardia.

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.

anticoagulant therapy. R=Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria. Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information does not indicate that the patient has a slow heart rate.

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about

Perform immediate defibrillation. R=The patients rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, the other actions may be appropriate.

A patients cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first?

Call the health care provider before giving the next dose of metoprolol (Lopressor). R=The patient has progressive first-degree atrioventricular (AV) block, and the b-blocker should be held until discussing the medication with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic, and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic.

A patients cardiac monitor shows sinus rhythm, rate 64. The P-R 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?

Ventricular tachycardia R=With an acute myocardial infarction (MI), the onset of PVCs may be considered as a warning that could herald the onset of ventricular tachycardia or ventricular fibrillation.

The nurse is caring for a client admitted for myocardial infarction. The clients monitor shows frequent premature ventricular contractions (PVCs). What dysrhythmia does the nurse remain alert for?

Warfarin (Coumadin) R=Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. The other drugs are not appropriate for this complication.

The nurse is caring for a client with chronic atrial fibrillation. Which drug does the nurse expect to administer to prevent a common complication of this condition?

I will avoid sources of strong electromagnetic fields. R= The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields. Clients should avoid tight clothing, which could cause irritation over the ICD generator. The client should not engage in strenuous activities that cause the heart rate to meet or exceed the ICD cutoff point because the ICD can discharge inappropriately. The client should continue all prescribed medications.

The nurse is providing discharge instructions for a client with an implantable cardioverter-defibrillator (ICD). What statement by the client indicates a good understanding of the instructions?

Muffled heart sounds R=In the postimplantation period, the nurse should be alert for complications of cardiac tamponade, bleeding, and dysrhythmias. Muffled heart sounds are a manifestation of cardiac tamponade. Edema and a lower temperature would not be indicative of a complication of this procedure. Bradycardia might need intervention, but this clients heart rate is not critically low.

The nurse is recovering a client after insertion of an implantable cardioverter-defibrillator (ICD). What complication must the nurse intervene for immediately?

Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. R= This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer.

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use?

Ventricular bigeminy R=Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the premature ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.

The nurse notes that a patients cardiac 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?

Ventricular tachycardia R=Ventricular tachycardia occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min or more.

The nurse notes the following rhythm on a clients telemetry monitor. How does the nurse interpret these findings?

Review the clients daily electrolyte results. R=Prominent U waves may be the result of hypokalemia. The nurse should review the clients daily electrolyte results. Although documentation is important, this is not a normal variant. Moving the crash cart closer to the room may or may not be warranted. The client does not need an immediate ECG.

The nurse observes a prominent U wave on the clients electrocardiograph (ECG) tracing. What is the most appropriate action for the nurse to take?

R waves in a 6-inch strip and multiply by 10. R= The simplest method for obtaining the heart rate is to count the number of R waves in a 6-inch strip of the ECG tracing (which equals 6 seconds) and then multiply this sum by 10 to obtain the rate per minute

The nurse quickly calculating a clients heart rate by examining the electrocardiogram (ECG) would count the number of

Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia R=Adenosine must be given over 1 to 2 seconds to be effective. The other actions indicate a need for more education about treatment of cardiac dysrhythmias. The RN should hold the diltiazem until talking to the health care provider. The treatment for asystole is immediate CPR. The synchronizer switch should be off when defibrillating.

Which action by a new registered nurse (RN) who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias?

Give a sedative before cardioversion is implemented. R=When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this patient.

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?

Instruct the patient to call for assistance before getting out of bed. R=A patient with fainting episodes is at risk for falls. The nurse will plan to minimize the risk by having assistance whenever the patient up. The other actions may be needed if dysrhythmias are found to be the cause of the patients syncope, but are not appropriate for syncope of unknown origin.

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin?

Observe cardiac rhythms for multiple patients who have telemetry monitoring. R=UAP serving as telemetry technicians can monitor cardiac rhythms for individuals or groups of patients. Nursing actions such as assessment and choice of the most appropriate lead based on ST segment elevation location require RN-level education and scope of practice.

Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as a telemetry technician on the cardiac care unit?

Atropine (Atropine) R=Atropine is a cholinergic antagonist that inhibits parasympathetically-induced hyperpolarization of the sinoatrial node. This inhibition results in an increased heart rate. The other medications are not appropriate.

A client is experiencing sinus bradycardia with hypotension and dizziness. What medication does the nurse administer?

Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol. R= The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The nurse should notify the health care provider after the medication is started. Defibrillation is not indicated given that the patient is currently in a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.

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/minute. Which of the following actions should the nurse take next?

I wont lift the arm on the pacemaker side up very high until I see the doctor. R=The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period.

After providing a patient with discharge instructions on the management of a new permanent pacemaker, the nurse knows that teaching has been effective when the patient states

Increase in the patients heart rate R=Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The patient does not have premature atrial or ventricular contractions.

After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective?

50 R=There are 1500 small blocks in a minute, and the nurse will divide 1500 by 30.

When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patients heart rate as ____.

Depolarization of the atria R=The ECG tracing of a P wave represents electrical changes caused by atrial depolarization.

The nurse is assessing the clients electrocardiography (ECG). What does the P wave on the ECG tracing represent?

Shortness of breath and anxiety R=The rhythm described is atrial flutter with a rapid ventricular response. Rapid atrial flutter may manifest with palpitations, shortness of breath, and anxiety. Syncope, angina, and evidence of heart failure also may be present.

The nurse is caring for a client on a cardiac monitor. The monitor shows a rapid rhythm with a saw tooth configuration. What physical assessment findings does the nurse expect?

Begin external pacing. R=The nurse would expect the client with complete heart block or third-degree AV block to be paced externally until the client can be scheduled for a permanent pacemaker.

The nurse is caring for a client with a complete heart block (third-degree atrioventricular [AV] block). What is the nurses priority intervention

Ensure that all personnel are clear of contact with the client and the bed. R=To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and ensures their compliance before delivery of the shock. A precordial thumb can be delivered when no defibrillator is available. Equipment should not be tested before a client is defibrillated because this is an emergency procedure; equipment should be checked on a routine basis. Defibrillation is done in asynchronous mode.

The nurse is assisting with resuscitation of a client. What priority intervention does the nurse perform before defibrillating a client?

Document the finding in the chart. R= Sinus dysrhythmia is noted when the heart rate increases slightly during inspiration and decreases slightly during expiration. Sinus dysrhythmia is a variant of normal sinus rhythm that is frequently observed in healthy children and adults. No other actions are needed.

The clients heart rate increases slightly during inspiration and decreases slightly during expiration. What action does the nurse take?

A short period of asystole R= Clients usually respond to this medication with a short period of asystole, bradycardia, hypotension, dyspnea, and chest pain.

The nurse has administered adenosine (Adenocard). What is the expected therapeutic response?

A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due R=The frequent firing of the ICD indicates that the patients ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first?

Diltiazem (Cardizem) R=Diltiazem, a calcium channel blocker, slows depolarization through the conduction system and is commonly used as an agent to terminate a sustained episode of supraventricular tachycardia.

The nurse identifies a clients rhythm to be a sustained supraventricular tachycardia. What medication does the nurse administer?

Perform defibrillation. R= The clients rhythm is ventricular fibrillation. This is a lethal rhythm that is best treated with immediate defibrillation. If the client does not already have an IV , other members of the team can insert one after defibrillation. Likewise, intubation can occur later if necessary. Atropine is not given for ventricular fibrillation.

The nurse is alerted to a clients telemetry monitor. After assessing the following ECG, what is the nurses priority intervention?

Sinus rhythm with premature ventricular contractions (PVCs) R=Sinus rhythm with PVCs has an underlying regular sinus rhythm with ventricular depolarization that sometime precedes atrial depolarization

The nurse is assessing a clients ECG. What is the nurses interpretation of the following ECG strip?

an athlete R=In some people, sinus bradycardia can be a normal condition. Athletes often have sinus bradycardia because their heart is an effective pump with a greater-than-normal stroke volume.

The nurse would assess a heart rate of 55 beats/min as a normal finding in a client who

Resuscitation cart R= Complications of this procedure include bradydysrhythmias, asystole, ventricular fibrillation, and cerebral damage. The resuscitation cart, complete with defibrillator, should be available whenever this procedure is initiated. The other equipment is not needed.

The physician is about to perform carotid sinus massage on a client with supraventricular tachycardia. What equipment is most important for the nurse to have ready?

P wave R= The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers. The QRS represents ventricular depolarization. The Q wave is the first negative deflection following the P wave and should be narrow and short.

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patients

Allow the student to participate on the soccer team R=In an aerobically trained individual, sinus bradycardia is normal. The students normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the familys health history. Dyspnea during an aerobic activity such as soccer is normal.

When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this patient.

Ask the patient about current stress level and caffeine use. R=In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.

A 19-year-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 premature ventricular contractions (PVCs). What action should the nurse take next?

Give supplemental O2 at 2 to 3 L/min via nasal cannula. R=Because this patient has dyspnea and chest pain in association with the new rhythm, the nurses initial actions should be to address the patients airway, breathing, and circulation (ABC) by starting with oxygen administration. The other actions also are important and should be implemented rapidly.

A patient who is on the progressive care 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?

Start cardiopulmonary resuscitation (CPR). R=The patients clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.

A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take?

Document the finding in the clients chart. R=A spike followed by a QRS complex indicates capture, meaning that the pacemaker has successfully depolarized or captured the ventricle. No action other than documentation of this finding is necessary.

The nurse is caring for a client with a temporary pacemaker. The clients bedside monitor shows a spike followed by a QRS complex. What is the nurses best action?

Client who is dismissed after coronary artery bypass surgery R=Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft (CABG) surgery. The other conditions do not place a client at higher risk for atrial fibrillation.

The nurse is assessing clients at a community clinic. Which client does the nurse assess most carefully for atrial fibrillation?

Speech alterations R=Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes in mentation, speech, sensory function, and motor function. Clients with atrial fibrillation often have a rapid ventricular response as a result. Fatigue is a nonspecific complaint. Clients with atrial fibrillation often have dyspnea as a result of the decreased cardiac output caused by the rhythm disturbance.

The nurse is caring for a client with atrial fibrillation. What manifestation most alerts the nurse to the possibility of a serious complication from this condition?

ventricular tachycardia. R=The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patients cardiac rhythm as

Ventricular and atrial depolarizations are initiated from different sites. R= Normal rhythm shows one P wave preceding each QRS, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization.

When analyzing a clients electrocardiograph (ECG) tracing, the nurse observes that not all QRS complexes are preceded by a P wave. What is the nurses interpretation of this observation?

QRS interval of 0.14 second. R=Because the normal QRS interval is 0.04 to 0.10 seconds, the patients QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval and Q-T interval are within normal range, and ST segment should be isoelectric (flat).

When analyzing the rhythm of a patients electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n)

1.)Turn the defibrillator on 2.)Select the appropraite energy level 3.)Place the paddles on the patients chest 4.)Check the location of other staff and call out all clear. 5.) deliver the elevtrical charge.

When preparing to defibrillate a patient. In which order will the nurse perform the following steps? (Put a comma and a space between each answer choice

Avoid bearing down or straining while having a bowel movement R=Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in slowing of the heart rate. Such a response is not desirable in a person who has bradycardia. The other instructions are not appropriate for this condition.

A client has a heart rate averaging 56 beats/min with no adverse symptoms. What activity modifications does the nurse suggest to avoid further slowing of the heart rate?

Minimize or abstain from caffeine. R=PACs usually have no hemodynamic consequences. For a client experiencing infrequent bouts of PACs, the nurse should explore possible lifestyle causes, such as excessive caffeine intake and stress. Lying on the side will not prevent or resolve PACs. Oxygen is not necessary. Although medications may be needed to control symptomatic dysrhythmias, for infrequent PACs, the client first should try lifestyle changes to control them.

A client experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. What instruction does the nurse include in the clients teaching plan?

Decrese in Cardiac Output, Decrease in blood pressure R=Consistently elevated heart rates initially cause blood pressure and cardiac output to increase. However, ventricular filling time, cardiac output, and blood pressure eventually decrease. As cardiac output and blood pressure decrease, urine output will fall.

A client has a consistently regular heart rate of 128 beats/min. Which related physiologic alterations does the nurse assess for? (Select all that apply.)

Loss of capture R= In epicardial pacing, the wires are threaded onto the epicardial surface of the heart and exit through the chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen without subsequent QRS complexes imply loss of capture.

A client has an epicardial pacemaker. The nurse observes the presence of a pacing spike but no QRS complex on the clients electrocardiograph (ECG) tracing. How does the nurse interpret this event?

Assess airway, breathing, and level of consciousness. R=The first action that the nurse should take when ventricular tachycardia is observed is to assess the clients airway, breathing, and level of consciousness. If the client is unconscious or has experienced respiratory arrest, defibrillation and CPR are begun.

A clients electrocardiograph (ECG) tracing shows a run of sustained ventricular tachycardia. What is the nurses first action?

The procedure will use electrical energy to destroy areas of the conduction system. R=Radiofrequency catheter ablation therapy uses electrical energy to burn or ablate areas of the conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and tachydysrhythmias. All other statements regarding the procedure are incorrect.

Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter?

3The nurse assists the patient to do active range of motion exercises for all extremities. R= The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.

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 education about care of patients with ICDs?

Serum potassium 2.9 mEq/L R=Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the patients PVCs and do not require immediate correction.

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?