Ventricular Dysrhythmias

How does the nurse correctly explain the pathophysiology behind an apneic patient with asystole? "Altered innervation of the diaphragm." "Depolarization of the ventricles does not occur." "The sinoatrial node is not functioning correctly." "The atrioventricular node is functioning properly."

"Depolarization of the ventricles does not occur." Asystole represents the total absence of ventricular electrical activity where depolarization does not occur.

The nurse assesses the electrocardiogram (ECG) strip shown here and notes the patient has a palpable peripheral pulse. Which action should the nurse take first? An ECG tracing consisting of a large, wide peak followed by a large valley. This pattern repeats 23 times. Initiate CPR and ACLS protocol. Provide electrolyte replacement. Obtain an order for an IV β-blocker. Apply 100% oxygen via non-rebreather.

Apply 100% oxygen via non-rebreather. The patient has ventricular tachycardia. Hypoxia can contribute to the development of ventricular tachycardia. Additional oxygen is administered to help ensure effective perfusion of cardiac muscle.

The nurse is caring for a patient whose recent lab results show higher than therapeutic levels of digitalis. The patient has normal vital signs, denies chest pain, and has no physical abnormalities. The nurse notes an idioventricular rhythm on the ECG tracing. Which intervention is most appropriate? Administer atropine Administer amiodarone Prepare for cardioversion Continue to monitor the patient

Continue to monitor the patient Accelerated idioventricular rhythm is typically asymptomatic and does not need to be treated. If the patient experiences symptoms atropine would be administered.

Which pathological occurrence explains why this electrocardiogram (ECG) strip is concerning? Absence of ventricular electrical activity Increased excitability of myocardial cells Myocardial cells with decreased irritability PVC is firing during a depolarization phase

Increased excitability of myocardial cells R-on-T phenomenon occurs when premature ventricular contractions fall on T wave of a proceeding beat. Increased excitability increases the risk for premature ventricular contractions to start ventricular tachycardia or ventricular fibrillation.

A nurse sees an asystolic rhythm on a patient's heart monitor. What should the nurse do next? Notify the patient's family. Call for help and begin CPR. Call the rapid response team. Determine level of consciousness.

Determine level of consciousness. The nurse should treat the patient not the monitor. If the patient is alert and oriented then the monitor leads should be assessed to assure they are applied correctly, however if the patient is not alert and oriented, then BLS measures may be necessary.

A patient is diagnosed with ventricular fibrillation. Upon review of the patient history, the nurse expects which medical history from the patient? Hypokalemia Myocardial ischemia Prolonged QT interval Deep vein thrombus (DVT)

Myocardial ischemia Ventricular fibrillation is associated with myocardial ischemia, which leads to irritability of the heart muscle.

Why is the heart rate undetermined for a patient in ventricular fibrillation (VF)? QRS interval is irregular. P waves are visible but irregular. Hyperkalemia causes atrial fibrillation. P-to-P intervals and QRS complexes are not measurable.

P-to-P intervals and QRS complexes are not measurable. Because the P-to-P intervals and QRS complexes are not measurable, the heart rate cannot be determined in ventricular fibrillation.

Why should the patient with a history of myocardial infarction (MI) be monitored closely when premature ventricular contractions (PVCs) are seen on the electrocardiogram (ECG) strip? PVCs may develop into atrial fibrillation. PVCs may develop into a junctional rhythm. PVCs may develop into ventricular tachycardia. PVCs may develop into a first-degree heart block.

PVCs may develop into ventricular tachycardia. Ventricular tachycardia (VT) occurs when there are multiple consecutive PVCs.

Which action is priority for the nurse caring for a patient with this electrocardiogram (ECG) tracing? An ECG tracing. The line consists of a series of small hills, and very small valleys. Some of the small hills are jagged and some are smooth. There is no discernible overall pattern to the hills and valleys. Call for help and initiate CPR. Palpate the patient's carotid pulse. Call the primary health care provider. Auscultate the patient's respiratory sounds.

Palpate the patient's carotid pulse. The patient's ECG tracing shows ventricular fibrillation. The nurse should palpate for a pulse and note the patient's responsiveness.

For which reasons may the nurse confuse ventricular fibrillation for asystole? Select all that apply. Patients are unresponsive in ventricular fibrillation and asystole. Patients are usually apneic with ventricular fibrillation and asystole. The prognosis for patients in both ventricular fibrillation and asystole is very poor. The irregularly shaped waves of ventricular fibrillation look similar to occasional P waves in asystole. Patients experiencing ventricular fibrillation and systole have a second-degree AV block prior to the event.

Patients are unresponsive in ventricular fibrillation and asystole. Patients experiencing either asystole or ventricular fibrillation may be unresponsive and pulseless. Patients are usually apneic with ventricular fibrillation and asystole. Patients experiencing either asystole or ventricular fibrillation may be in an apneic state. The irregularly shaped waves of ventricular fibrillation look similar to occasional P waves in asystole. VF's irregularly shaped waves may be confused for asystole's occasional p waves.

A patient in ventricular fibrillation (VF) is receiving CPR. What is the priority intervention? Prepare to defibrillate. Administer IV epinephrine. Administer IV potassium bolus. Notify family members of the change in patient status.

Prepare to defibrillate. Treatment consists of immediate initiation of CPR and advanced cardiac life support (ACLS) with the use of defibrillation. When ventricular fibrillation is identified, the nurse should apply the external defibrillator pads and prepare to deliver a shock.

A patient is in sinus rhythm with multifocal PVCs. The patient's heart rate is 90 bpm with 2+ radial pulses and SpO2 of 85%. Which treatment should be most appropriate for this patient? Call for help and initiate CPR. Prepare for tracheal intubation. Activate the rapid response team. Start O2 at 2 L/minutes by nasal cannula.

Start O2 at 2 L/minutes by nasal cannula. The multifocal PVCs are likely related to the low oxygen saturation. Treatment relates to the cause of the PVCs and includes oxygen therapy.