Cardiac-pretest-nclex-rn
a-Hypotension and dizziness The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.
A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute. A nurse assesses the client for: a-Hypotension and dizziness b-Nausea and vomiting c-Hypertension and headache d-Flat neck veins
ANS: C When ventricular fibrillation appears, the nurse must immediately initiate CPR until the defibrillator is engaged, and should defibrillate up to three times if needed. The only true effective treatment for ventricular fibrillation is defibrillation, which should occur as soon as possible. DIF: Application/Applying REF: p. 1468 OBJ: Intervention MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities
A client in the CCU goes into sudden ventricular fibrillation. The priority action by the nurse would be to immediately administer a. a lidocaine bolus. b. atropine. c. cardiopulmonary resuscitation (CPR). d. intravenous (IV) magnesium.
ANS: D Procainamide may cause gastrointestinal upset and should be taken with meals. The other three options are not related to taking procainamide. DIF: Comprehension/Understanding REF: p. 1465 OBJ: Intervention MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care
A client is being discharged with a prescription for procainamide to treat atrial fibrillation. An important self-care measure the nurse would explain about this medication is to a. avoid milk products. b. drink large amounts of citrus juice. c. have blood pressure monitored frequently. d. take the medication with meals.
a-Blood pressure and peripheral perfusion Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and, if frequent enough, to decreased cardiac output. The client may be asymptomatic or may feel palpitations. PVCs can be caused by cardiac disorders or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by the intake of caffeine, alcohol, or nicotine.
A client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following items? a-Blood pressure and peripheral perfusion b-Sensation of palpitations c-Causative factors such as caffeine d-Precipitating factors such as infection
d-Widening of QRS complexes to 0.12 second or greater Bundle branch block interferes with the conduction of impulses from the AV node to the ventricle supplied by the affected bundle. Conduction through the ventricles is delayed, as evidenced by a widened QRS complex.
A client with a bundle branch block is on a cardiac monitor. The nurse should expect to observe: a-Sagging ST segments b-Absence of P wave configurations c-Inverted T waves following each QRS complex d-Widening of QRS complexes to 0.12 second or greater
ANS: D An abnormally high serum potassium level will cause the T wave to become very tall, sometimes the height of the QRS complex. DIF: Knowledge/Remembering REF: p. 1453 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology
A client with a serum potassium level of 6.6 mEq/L would have a characteristic ECG configuration of a. increased PR interval. b. inverted QRS complex. c. no change. d. tall T wave.
a-Vagus nerve to slow the heart rate Carotid sinus massage is one of the maneuvers used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. The others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy often is needed as an adjunct to keep the rate down or maintain the normal rhythm.
A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform carotid massage. The nurse responds that this procedure may stimulate the: a-Vagus nerve to slow the heart rate b-Vagus nerve to increase the heart rate; overdriving the rhythm c-Diaphragmatic nerve to slow the heart rate d-Diaphragmatic nerve to overdrive the rhythm
a-Normal sinus rhythm measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second, respectively.
A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as: a-Normal sinus rhythm b-Sinus bradycardia c-Sick sinus syndrome d-First-degree heart block.
b-Inhale deeply and cough forcefully every 1 to 3 seconds Cough cardiopulmonary resuscitation (CPR) sometimes is used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough CPR, if prescribed, by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a short time until other measures can be implemented.
A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the client to do which of the following, if prescribed, during an episode of ventricular tachycardia? a-Breathe deeply, regularly, and easily b-Inhale deeply and cough forcefully every 1 to 3 seconds c-Lie down flat in bed d-Remove any metal jewelry
c-Administer amiodarone (Cordarone) intravenously First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of anti-dysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Defibrillation is used with pulseless ventricular tachycardia. Epinephrine would stimulate and already excitable ventricle and is contraindicated.
A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following? a-Immediately defibrillate b-Prepare for pacemaker insertion c-Administer amiodarone (Cordarone) intravenously d-Administer epinephrine (Adrenaline) intravenously
b-Ventricular tachycardia Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular.
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing: a-Premature ventricular contractions b-Ventricular tachycardia c-Ventricular fibrillation d-Sinus tachycardia
b-Atrial fibrillation Atrial fibrillation is characterized by a loss of P waves; an undulating, wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate, which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled).
A nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as: a-Sinus tachycardia b-Atrial fibrillation c-Ventricular tachycardia d-Ventricular fibrillation
b-Ventricular fibrillation Ventricular fibrillation is characterized by irregular, chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.
A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves or definable QRS complexes. Instead there are coarse wavy lines of varying amplitude. The nurse assesses this rhythm to be: a-Ventricular tachycardia b-Ventricular fibrillation c-Atrial fibrillation d-Asystole
ANS: D Cardiac problems precipitating PAT include MI, cardiomyopathy, extreme emotions, caffeine ingestion, fatigue, smoking, and excessive alcohol intake. DIF: Application/Applying REF: pp. 1456-1457 OBJ: Intervention MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care
At the ambulatory care clinic, the nurse counseling a client who has presented with frequent episodes of paroxysmal atrial tachycardia would advise the client to a. avoid all aspirin and nonsteroidal anti-inflammatory drugs. b. eat a low-salt, low-fat diet that contains plenty of fiber. c. get 30 minutes of exercise and drink six glasses of water per day. d. quit smoking and avoid caffeine and alcohol.
ANS: B Atrial flutter is a dysrhythmia arising in an ectopic pacemaker or the site of a rapid reentry circuit in the atria, characterized by rapid "saw-toothed" atrial wave formations and usually a slower ventricular response. Atrial flutter differs from PAT in that it produces a much more rapid atrial rate. The P waves are actually inverted or bidirectional, producing a "picket fence" or saw-toothed pattern of "fluttering waves." The atrial rate generally ranges from 220 to 350 beats/min. DIF: Application/Applying REF: pp. 1453, 1459 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology
A client's ECG reveals a rapid atrial rate of 300 beats/min, and the P waves resemble a picket fence without 1:1 conduction. The nurse would identify this dysrhythmia as a. atrial fibrillation. b. atrial flutter. c. paroxysmal atrial tachycardia. d. sinoatrial block.
b-Defibrillate the client Ventricular fibrillation is a death-producing dysrhythmia and, once identified, must be terminated immediately by precordial shock (defibrillation). This is usually a standing physician's order in a CCU.
When ventricular fibrillation occurs in a CCU, the first person reaching the client should: a-Administer oxygen b-Defibrillate the client c-Initiate CPR d-Administer sodium bicarbonate intravenously
ANS: D Blood pools in the "quivering" atria because contraction of the atrial muscle is inadequate. This blood can clot, which increases the potential for cerebral and pulmonary vascular emboli. DIF: Analysis/Analyzing REF: p. 1458 OBJ: Assessment MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration
If a client admitted to the hospital for treatment of atrial fibrillation complains of dyspnea and chest pain, the nurse would suspect a. heart block. b. myocardial infarction. c. pulmonary edema. d. pulmonary emboli.
ANS: A Consecutive shocks at 200, 300, and 400 J is the normal protocol for treatment of ventricular fibrillation. DIF: Application/Applying REF: p. 1468 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies
If the first defibrillation shock at 200 J is not successful on a client with ventricular fibrillation, the nurse in charge of the code would a. administer a second shock at 300 J. b. reinitiate CPR. c. reposition the client and shock at 200 J. d. set the defibrillator to synchronous.
d-Syncope and slow ventricular rate Explanation: In complete atrioventricular block, the ventricles take over the pacemaker function in the heart but at a much slower rate than that of the SA node. As a result there is decreased cerebral circulation, causing syncope.
The adaptations of a client with complete heart block would most likely include: a-Nausea and vertigo b-Flushing and slurred speech c-Cephalalgia and blurred vision d-Syncope and slow ventricular rate
ANS: A If the client has been taking a digitalis preparation, a therapeutic drug level must be present. Digitalis toxicity may predispose the client to the development of ventricular dysrhythmias during cardioversion. DIF: Analysis/Analyzing REF: p. 1458 OBJ: Intervention MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures
The client who is to receive cardioversion in 3 days for treatment of continuous atrial fibrillation has laboratory values of Na 139 mEq/L, K 4.0 mEq/L, and Cl 98 mEq/L and is receiving digoxin 0.125 mg daily. Before the procedure the nurse would a. confirm an order for a digoxin level before cardioversion. b. monitor blood pressure more frequently. c. notify the physician regarding the potassium level. d. proceed with preparation for cardioversion.
ANS: B Some impulses are conducted and others are blocked in second-degree AV block, a dysrhythmia that results in intermittently dropped QRS complexes. First-degree AV block is a lengthened PR interval. Third-degree AV block is complete atrial-ventricular dissociation. There is no fourth-degree AV block. DIF: Comprehension/Understanding REF: p. 1461 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology
The client's ECG shows normal-appearing P waves that occur at regular intervals. Every third impulse from the atria is missing a QRS complex. The nurse would recognize this pattern as the dysrhythmia of a. first-degree AV block. b. second-degree AV block. c. third-degree AV block. d. fourth-degree AV block.
ANS: D 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. DIF: Application/Applying REF: p. 1453 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology
The nurse quickly calculating a client's heart rate by examining the electrocardiogram (ECG) would count the number of a. large squares between P waves and multiply by 10. b. large squares between R waves and multiply by 10. c. P waves in a 6-inch strip and multiply by 5. d. R waves in a 6-inch strip and multiply by 10.
ANS: D Ventricular dysrhythmias are generally more serious and life-threatening than atrial or junctional dysrhythmias. DIF: Knowledge/Remembering REF: p. 1463 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology
The nurse working on a telemetry floor would recognize that most dangerous dysrhythmias are a. atrial dysrhythmias. b. junctional dysrhythmias. c. nodal dysrhythmias. d. ventricular dysrhythmias.
ANS: A 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. DIF: Application/Applying REF: p. 1455 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems
The nurse would assess a heart rate of 55 beats/min as a normal finding in a client who a. is an athlete. b. is obese. c. takes a diuretic. d. weighs less than 90 pounds.
ANS: B The downward slope of the T wave is the most vulnerable period of the cardiac cycle. PVCs occurring during this vulnerable period can precipitate the more life-threatening dysrhythmias of ventricular tachycardia and ventricular fibrillation. DIF: Comprehension/Understanding REF: p. 1464 OBJ: Assessment MSC: Physiological Integrity Physiological Adaptation-Pathophysiology
The nurse would be most concerned about premature ventricular contractions (PVCs) that a. are uniform in appearance. b. fall on a T wave. c. occur at a rate of four per minute. d. occur with angina.
ANS: D Sinus arrest differs from SA exit block in that the SA node intermittently fails to fire at all with sinus arrest. DIF: Comprehension/Understanding REF: p. 1456 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Pathophysiology
The nurse would clarify to a client that sinus arrest differs from sinus block in that with sinus arrest, the a. atrial focus totally takes over pacing responsibility. b. atrioventricular (AV) node is the primary pacemaker. c. rhythm is regular. d. sinoatrial (SA) node occasionally fails to fire.
a-The RR intervals are relatively consistent b-One P wave precedes each QRS complex The consistency of the RR interval indicates regular rhythm. A normal P wave before each complex indicates the impulse originated in the SA node. The number of complexes in a 6 second strip is multiplied by 10 to approximate the heart rate; normal sinus rhythm is 60 to 100. Elevation of the ST segment is a sign of cardiac ischemia and is unrelated to the rhythm. The QRS duration should be less than 0.12 second; the PR interval should be 0.12 to 0.20 second.
What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Check all that apply. a-The RR intervals are relatively consistent b-One P wave precedes each QRS complex c-Four to eight complexes occur in a 6 second strip d-The ST segment is higher than the PR interval e-The QRS complex ranges from 0.12 to 0.20 second
ANS: A The goal of intervention is to increase the heart rate just enough to relieve manifestations but not enough to cause tachycardia. The intervention sequence for treating symptomatic bradycardia is atropine, transcutaneous pacing if available, dopamine, epinephrine, and isoproterenol or insertion of a temporary transvenous pacemaker. DIF: Application/Applying REF: p. 1455 OBJ: Intervention MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions
When a client develops sinus bradycardia after a myocardial infarction (MI), the nurse would anticipate the administration of a. atropine. b. digitalis. c. procainamide. d. propranolol.
ANS: A Ventricular tachycardia that cause loss of consciousness must be terminated immediately with defibrillation. Like ventricular fibrillation, the only effective treatment in this situation is defibrillation. DIF: Application/Applying REF: pp. 1466-1467 OBJ: Intervention MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities
When a client in the CCU develops ventricular tachycardia and loses consciousness, the priority action by the nurse would be to immediately administer a. defibrillation. b. lidocaine. c. quinidine. d. verapamil.
ANS: B Any maneuver that stimulates the vagus nerve can successfully terminate PAT or increase AV block. Vagotonic maneuvers include carotid sinus massage and the Valsalva maneuver (bearing down as with bowel movements). DIF: Analysis/Analyzing REF: p. 1457 OBJ: Intervention MSC: Physiological Integrity Physiological Adaptation-Illness Management
When a client in the cardiac care unit (CCU) suddenly develops paroxysmal atrial tachycardia (PAT) of 200 beats/min and clinical manifestations of severe dizziness, the nurse would help decrease the heart rate by a. administering digitalis intravenously. b. asking the client to perform the Valsalva maneuver. c. increasing the client's oxygen. d. lowering the head of the bed.
