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A client is diagnosed with sinus bradycardia. The nurse knows that the client's atrial rate is at or below what number?
60
A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response? a. "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia" b. "To detect and treat bradycardia, which is an excessively slow heart rate" c. "To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently" d. "To shock your heart if you have a heart attack at home"
A The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia.
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? a. hypovolemia b. vagal stimulation c. hypothyroidism d. digoxin
a The causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, hypothyroidism, and digoxin will cause a sinus bradycardia.
When planning the care of a client with an implanted pacemaker, what assessment should the nurse prioritize? a. Core body temperature b. Heart rate and rhythm c. Blood pressure d. Oxygen saturation level
b For clients with pacemakers, close monitoring of the heart rate and rhythm is a priority, even though each of the other listed vital signs must be assessed.
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? a. Date and time of insertion b. Location of the generator c. Model number d. Pacer rate
d After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.
A cardiac care nurse is caring for a client who is experiencing positive chronotropy. What effect should the nurse prepare for? a. Exacerbation of an existing dysrhythmia b. Initiation of a new dysrhythmia c. Resolution of ventricular tachycardia d. Increased heart rate
d Stimulation of the sympathetic system increases heart rate. This phenomenon is known as positive chronotropy. It does not influence dysrhythmias.
When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? a. Premature ventricular contraction (PVC) b. Ventricular bigeminy c. Ventricular tachycardia d. Ventricular fibrillation
a A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? a. The medication increases the force of the myocardial contraction. b. The medication causes the kidneys to retain fluid and increase intravascular volume. c. The medication increases the heart rate. d. The medication helps the kidneys produce more urine.
a A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine.
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response? a. Premature atrial complex b. Atrial flutter c. Sinus tachycardia d. Ventricular fibrillation
a 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 witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action? a. defibrillation b. cardioversion c. IV bolus of atropine d. IV bolus of dobutamine
a Adavnced cardiac lifesupport recommends early defibrillation for witnessed ventricular fibrillation. A cardioversion is used with a client who has a pulse. Atropine is used for bradycardia and dobutamine is an intropic medication used to increased cardiac output.
The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? a. "The only difference is the heart rate." b. "The P waves will be shaped differently." c. "The QRS complex will be smaller in sinus bradycardia." d. "The P-R interval will be prolonged in sinus bradycardia."
a All characteristics of sinus bradycardia are the same as those of normal sinus rhythm except for the rate, which will be below 60 in sinus bradycardia. The P waves will be shaped differently in other dysrhythmias. The QRS is the same voltage for sinus rhythms. The P-R interval is prolonged in aterioventricular blocks.
Which is not a likely origination point for cardiac dysrhythmias? a. bundle of His b. ventricles c. atria d. atrioventricular node
a Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His.
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? a. Double-check the monitoring equipment. b. Do nothing; there is no cause for alarm. c. Suggest the need for a new beta-blocker to the doctor. d. Measure the client's blood pressure.
a One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.
A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings? a. Atropine b. Lidocaine c. Pronestyl d. Cardizem
a The client 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.
What is the treatment of choice for ventricular fibrillation? a. Immediate bystander CPR b. Pacemaker c. Implanted defibrillator d. Atropine
a The treatment of choice for ventricular fibrillation is immediate bystander cardiopulmonary resuscitation (CPR), defibrillation as soon as possible, and activation of emergency services.
The nurse participates in the care of a client requiring emergent defibrillation. The nurse determines the steps should be completed in which order? a. Turn on the defibrillator and place it in "not sync" mode. b. Charge the defibrillator to the prescribed voltage. c. Apply the multifunction conductor pads to the client's chest. d. Call "clear" three times ensuring client and environmental safety. e. Deliver the prescribed electrical charge.
a, b, c, d, e This is the sequence of events the nurse should implement when delivering emergent defibrillation. If not followed correctly, the client and health care team may be placed in danger.
The nurse is caring for a client with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the client's most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best interpret this finding? a. Recognize that the procedure was unsuccessful. b. Recognize this as a therapeutic goal of the procedure. c. Liaise with the care team in preparation for repeating the maze procedure. d. Prepare the client for pacemaker implantation.
b The maze procedure is an open heart surgical procedure for refractory atrial fibrillation. Small transmural incisions are made throughout the atria. The resulting formation of scar tissue prevents reentry conduction of the electrical impulse. Consequently, scar formation would constitute a successful procedure. There is no indication for repeating the procedure or implanting a pacemaker.
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? a. Atrial fibrillation b. Atrial flutter c. Ventricular tachycardia d. Ventricular fibrillation
b Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects (Fuster, Walsh et al., 2011).
The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? a. "It is when the heart conduction is primarily from the aterioventricular node." b. "The rhythm has a normal beat, then a premature beat pattern." c. "The rhythm is regular but fast." d. "The heart rate is between 150 to 250 bpm."
b Bigeminy is a rhythm in which every other complex is a premature ventricular contraction (PVC). In trigeminy, every third complex is a PVC. The rhythm is not regular and the rate should not be 150-250 bpm.
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm? a. 0.05 and 0.1 seconds. b. 0.12 and 0.2 seconds. c. 0.15 and 0.3 seconds. d. 0.25 and 0.4 seconds.
b 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 converts from normal sinus rhythm at 80 beats/min to atrial fibrillation with a ventricular response at 166 beats/min. Blood pressure is 162/74. Respiratory rate is 20/min with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the primary goal of treatment is what? a. Decrease SA node conduction b. Control ventricular rate c. Improve oxygenation d. Maintain anticoagulation
b Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice followed by anticoagulation with heparin and then Coumadin.
A patient has been admitted to the unit for an electrophysiology (EP) study. For what is an electrophysiology study primarily performed? a. To facilitate cardioversion b. To freeze hypersensitive cells c. To diagnose the dysrhythmia d. To determine the nursing plan of care
c A patient may undergo an EP study in which electrodes are placed inside the heart to obtain an intracardiac electrocardiogram (ECG). This is used not only to diagnose the dysrhythmia, but also to determine the most effective treatment plan. However, because an EP study is invasive, it is performed in the hospital and may require that the patient be admitted. The primary purpose of an EP is not freezing hypersensitive cells, facilitating cardioversion, or determining the plan of nursing care.
The nurse is caring for a client who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment? a. Assessing the client's mobility b. Facilitating transthoracic echocardiography c. Vigilant monitoring of the client's ECG d. Close monitoring of the client's peripheral perfusion
c After a permanent electronic device (pacemaker or ICD) is inserted, the client's heart rate and rhythm are monitored by ECG. This is a priority over peripheral circulation and mobility because the consequences of abnormalities are more serious. Echocardiography is not indicated.
The nurse is caring for a client who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output? a. Increased blood pressure b. Bounding peripheral pulses c. Changes in level of consciousness d. Skin flushing
c The nurse conducts a physical assessment to confirm the data obtained from the history and to observe for signs of diminished cardiac output (CO) during the dysrhythmic event, especially changes in level of consciousness. Blood pressure tends to decrease with lowered CO and bounding peripheral pulses are inconsistent with this problem. Pallor, not skin flushing, is expected.
The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? a. Stay at least 5 feet away from microwave ovens. b. Never engage in activities that require vigorous arm and shoulder movement. c. Avoid going through airport metal detectors. d. Avoid undergoing magnetic resonance imaging (MRI).
d 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. 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 recognizes which as being true of cardioversion? a. Amount of voltage used should exceed 400 watts/second. b. Electrical impulse can be discharged during the T wave. c. Defibrillator should be set to deliver a shock during the QRS complex. d. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time.
d Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation.
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? a. Ventricular tachycardia b. Atrial fibrillation c. Third-degree heart block d. Ventricular fibrillation
d 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.
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? a. Keep the arm on the side of the pacemaker higher than the head b. Delay activities such as swimming and bowling for at least 3 weeks c. Keep moving the arm on the side where the pacemaker is inserted d. Avoid sources of electrical interference
d The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the client 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 nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? a. Keep the client flat for one hour after administration b. Administer every five minutes during cardiac resuscitation c. Document heart rate before and after administration d. Monitor vital signs and cardiac rhythm
d The nurse should monitor the client'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 client. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a client flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? a. electrocardiogram b. electroencephalogram c. echocardiogram d. electrocautery
a An electrocardiogram is used to identify normal and abnormal cardiac rhythms.
A nurse is caring for a client who is exhibiting ventricular tachycardia (VT). Because the client is pulseless, the nurse should prepare for what intervention? a. Defibrillation b. ECG monitoring c. Implantation of a cardioverter defibrillator d. Angioplasty
a Any type of VT in a client who is unconscious and without a pulse is treated in the same manner as ventricular fibrillation: Immediate defibrillation is the action of choice. ECG monitoring is appropriate, but this is an assessment, not an intervention, and will not resolve the problem. An ICD and angioplasty do not address the dysrhythmia.
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? a. "I should ask for a handheld device search when I go through airport security." b. "I should avoid large magnetic fields, such as an MRI machine or large motors." c. "I should avoid contact sports." d. "I'll watch the incision for swelling or redness and will report if either occurs."
a 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.
A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. What does the nurse determine this rhythm to be? a. Atrial flutter b. Ventricular flutter c. Sinus tachycardia d. Nonparoxysmal junctional tachycardia
a Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Ventricular rhythm may be irregular, and P waves may be absent. Ventricular rate usually ranges between 75 and 150 bpm.
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? a. Instruct the client to restrict food and oral intake b. Administer digitalis and diuretics 24 hours before cardioversion c. Facilitate CPR until the client is prepared for cardioversion d. Monitor blood pressure every 4 hours
a The nurse should instruct the client 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 client is in cardiopulmonary arrest, the nurse should facilitate CPR until the client is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a client with cardiac dysrhythmia.
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. A variable heart rate, usually fewer than 60 bpm b. An irregular rhythm c. Delayed conduction, producing a prolonged PR interval d. P waves hidden with the QRS complex
c 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 with an ICD calls his cardiologist's office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the client to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what? a. Infection b. Failure to capture c. Premature battery depletion d. Oversensing of dysrhythmias
d Inappropriate delivery of ICD therapy, usually due to oversensing of atrial and sinus tachycardias with a rapid ventricular rate response, is the most frequent complication of ICD. Infections, failure to capture, and premature battery failure are less common.
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? a. Atrial flutter b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia
a Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in shape. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.
A client who has been monitored for sinus bradycardia for over a year has presented with a dangerously low heart rate and will be administered intravenous atropine sulfate. What dosage is the physician likely to initially order? a. 0.5 mg every 3 to 5 minutes b. 2 mg daily c. 2 to 3 mg every 1 to 2 hours d. 0.5 to 1.0 mg twice daily
a Atropine 0.5 mg IV may be given every 3 to 5 minutes to increase the heart rate, until a maximum dose of 3.0 mg.
A client is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this client is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine? a. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. b. Administer atropine as a continuous infusion until symptoms resolve. c. Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours. d. Administer atropine 1.0 mg sublingually.
a Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.
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: a. inherent rhythmicity of cardiac muscle tissue. b. inherent rhythmicity of all muscle tissue. c. sufficient blood pressure. d. inherent electrons in muscle tissue.
a 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.
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? a. Begin cardiopulmonary resuscitation (CPR) b. Administer epinephrine c. Administer atropine 0.5 mg d. Defibrillate with 360 joules (monophasic defibrillator)
a 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.
The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching? a. During the procedure, the dysrhythmia will be reproduced under controlled conditions. b. The procedure will occur in the operating room under general anesthesia. c. The procedure takes less time than a cardiac catheterization. d. After the procedure, the dysrhythmia will not recur.
a During EP studies, the patient is awake and may experience symptoms related to the dysrhythmia.The client does not receive general anesthesia. The EP procedure time is not easy to determine. EP studies do not always include ablation of the dysrhythmia.
The nurse is caring for a client who has had an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. How should the nurse best respond? a. Recognize that the view of the electrical current changes in relation to the lead placement. b. Recognize that the electrophysiological conduction of the heart differs with lead placement. c. Inform the technician that the ECG equipment has malfunctioned. d. Inform the physician that the client is experiencing a new onset of dysrhythmia.
a Each lead offers a different reference point to view the electrical activity of the heart. The lead displays the configuration of electrical activity of the heart. Differences between leads are not necessarily attributable to equipment malfunction or dysrhythmias.
The nurse and the other members of the team are caring for a client who converted to ventricular fibrillation (VF). The client was defibrillated unsuccessfully and the client remains in VF. The nurse should anticipate the administration of what medication? a. Epinephrine 1 mg IV push b. Lidocaine 100 mg IV push c. Amiodarone 300 mg IV push d. Sodium bicarbonate 1 amp IV push
a Epinephrine should be given as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and lidocaine are given if ventricular dysrhythmia persists.
The nurse is caring for a client who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment? a. Cardiac monitoring b. Monitoring the implanted device signal c. Pain assessment d. Monitoring the client's level of consciousness (LOC)
a Following catheter ablation therapy, the client is closely monitored to ensure the dysrhythmia does not reemerge. This is a priority over monitoring of LOC and pain, although these are valid and important assessments. Ablation does not involve the implantation of a device.
A client has an irregular heart rate of around 100 beats/minute and a significant pulse deficit. What component of the client's history would produce such symptoms? a. atrial fibrillation b. atrial flutter c. heart block d. bundle branch block
a In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. Atrial flutter, heart block, and bundle branch block would not produce these symptoms.
A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? a. "The small box will transmit the heart rhythm to the central monitor all the time." b. "When your spouse needs help, an alarm will go off at the desk." c. "The box is recording the heart's electrical activity, and a physician will review the tracing later." d. "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute."
a In telemetry, a small box transmits the client's heart rhythm to the central unit for constant monitoring. Telemetry has nothing to do with the client needing help. A holter monitor is a device that records the heart's electrical activity and for later review by a physician. The telemetry transmits the heart rhythm regardless of the client's heart rate.
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? a. "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." b. "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." c. "You should avoid tennis; basketball or football would be a good substitute." d. "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers."
a It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (eg, basketball, football, hockey).
A client will be undergoing elective electrical cardioversion. Which nursing intervention will be included in the client's plan of care? a. Ensure the client has not eaten or drunk before the procedure. b. Administer an opioid analgesic as prescribed. c. Assist the client into an upright position. d. Administer a prescribed dose of digitalis 30 before the procedure.
a Oral intake is limited prior to cardioversion. Digitalis is usually held for 1 to 3 days prior to the procedure. Sedatives, not opioids, are often prescribed, and the client will be supine.
A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response? a. "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia" b. "To detect and treat bradycardia, which is an excessively slow heart rate" c. "To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently" d. "To shock your heart if you have a heart attack at home"
a The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia.
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? a. P wave b. PR interval c. QRS complex d. T wave
a 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 cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? a. Atrial depolarization b. Early ventricular repolarization c. Ventricular depolarization d. Ventricular repolarization
a 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.
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as a. normal sinus rhythm. b. sinus tachycardia. c. junctional tachycardia. d. first-degree atrioventricular block.
a The electrocardiogram (ECG) tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1.
A client the nurse is caring for has a permanent pacemaker implanted with the identification code beginning with VVI. What does this indicate? a. Ventricular paced, ventricular sensed, inhibited b. Variable paced, ventricular sensed, inhibited c. Ventricular sensed, ventricular situated, implanted d. Variable sensed, variable paced, inhibited
a The identification of VVI indicates ventricular paced, ventricular sensed, inhibited.
A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? a. internal cardioverter defibrillator insertion b. pacemaker insertion c. radiofrequency ablation d. electrophysiological study
a 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 who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart.
The nurse is assessing a client with symptomatic bradycardia. What medication does the nurse anticipate will be ordered by the healthcare provider to treat the bradycardia? a. atropine b. lidocaine c. diltezam d. adenosine
a The treatment of symptomatic bradycardia includes transcutaneous pacing and atropine. Lidocaine may be used in the treatment of ventricular fibrillation. Diltezam and adenosine are medications used to treat clients with atrial fibrillation.
A client arrived at the hospital with symptoms of chest and jaw pain. After stabilizing the client's condition, the nurse discusses the client's symptoms, indicating that the most common cause of cardiac arrhythmias is: a. ischemic heart disease. b. electrolyte disturbances. c. hypothermia. d. degenerative age-related changes.
a There are a number of causes of cardiac dysrhythmias, but the most common is ischemic heart disease.
The ECG of a new patient shows a P wave slightly different than normal. The nurse is considering the possibility of premature atrial contractions (PAC). The nurse will ask about which factors when taking this client's history? a. All options are correct. b. caffeine c. nicotine d. hyperthyroidism or other metabolic disorders
a There are a number of causes of premature atrial contractions (PAC), which is why it is so important to know and review a patient's complete history when examining for dysrhythmias.
An adult client with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show? a. PP interval and RR interval are irregular. b. PP interval is equal to RR interval. c. Fewer QRS complexes than P waves d. PR interval is constant.
c In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis.
A client has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this client's care, what nursing diagnosis is most appropriate? a. Acute pain b. Risk for unilateral neglect c. Risk for activity intolerance d. Risk for fluid volume excess
c Sinus bradycardia causes decreased cardiac output that is likely to cause activity intolerance. It does not typically cause pain, fluid imbalances, or neglect of a unilateral nature.
A client has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this client? a. Chest pain b. Bleeding at the implantation site c. Malignant hyperthermia d. Bradycardia
b Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.
A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? a. Fracture of the lead wire b. Lead wire dislodgement c. Faulty generator d. Sensitivity is too low
b Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation.
The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the client's heart? a. P wave b. T wave c. U wave d. QRS complex
b The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding? a. Occasional U waves b. Peaked T waves c. Flattened P waves d. Prolonged QT interval
b The client'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 client'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 client'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 client'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 client's serum potassium level.
When the nurse observes that the client's heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating a. normal sinus rhythm. b. sinus bradycardia. c. sinus dysrhythmia. d. sinus tachycardia.
c Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm. Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway. Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.
The nurse is planning discharge teaching for a client with a newly inserted permanent pacemaker. What is the priority teaching point for this client? a. Start lifting the arm above the shoulder right away to prevent chest wall adhesion. b. Avoid cooking with a microwave oven. c. Avoid exposure to strong electromagnetic fields d. Avoid walking through store and library antitheft devices.
c High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows clients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so clients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function.
The nursing educator is presenting a case study of an adult client who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? a. P wave b. T wave c. QRS complex d. U wave
c The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.
The nurse is providing care to a client who has just undergone an electrophysiologic (EP) study. The client states that she is nervous about "things going wrong" during the procedure. What is the nurse's best response? a. "This is basically a risk-free procedure." b. "Thousands of clients undergo EP every year." c. "Remember that this is a step that will bring you closer to enjoying good health." d. "The whole team will be monitoring you very closely for the entire procedure."
d Clients who are to undergo an EP study may be anxious about the procedure and its outcome. A detailed discussion involving the client, the family, and the electrophysiologist usually occurs to ensure that the client can give informed consent and to reduce the client's anxiety about the procedure. It is inaccurate to state that EP is "risk-free" and stating that it is common does not necessarily relieve the client's anxiety. Characterizing EP as a step toward good health does not directly address the client's anxiety.
A patient comes to the emergency department with reports 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? a. Sinus bradycardia b. Ventricular tachycardia c. Normal sinus rhythm d. Sinus tachycardia
d 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 nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? a. assessing blood pressure and heart rate frequently b. identifying a code-level status c. maintaining intravenous fluids d. alerting the healthcare provider of the third-degree heart block
d The client may experience low cardiac output with third-degree AV block. The healthcare provider needs to intervene to preserve the client's cardiac output. Monitoring the blood pressure and heart rate are important, but not a priority. The identification of a code status during a heart block is not appropriate. IV fluids are not helpful if the heart is not perfusing.
A client's electrocardiogram reveals an irregular rhythm of 75 bpm with a normal QRS and P wave. The nurse who is caring for the client should anticipate: a. administration of epinephrine. b. a bolus of warmed normal saline. c. administration of a beta-adrenergic blocker. d. no immediate treatment.
d This client's ECG suggests sinus dysrhythmia. Sinus dysrhythmia does not cause any significant hemodynamic effect and therefore is not typically treated.
