CC ch. 8 Dysrhythmia Interpretation and Management
Interpret the following rhythm: a. Sinus rhythm with multifocal premature ventricular contractions b. Sinus rhythm with unifocal premature ventricular contractions c. Sinus rhythm with bigeminal premature ventricular contractions d. Sinus rhythm with paired premature ventricular contractions (couplets)
A
Because of the location of the AV node, the possible P waveforms that are associated with junctional rhythms include which of the following? (Select all that apply.) a. No P wave b. Inverted P wave c. Shortened PR interval d. P wave after the QRS complex e. Normal P wave and PR interval
ABCD
The nurse working on the night shift when notices sinus bradycardia on the patient's cardiac monitor. What initial action should the nurse take? a. Give atropine to increase heart rate. b. Begin transcutaneous pacing of the patient. c. Start a dopamine infusion to stimulate heart function. d. Assess for hemodynamic instability.
D
The patient is admitted with a condition that requires cardiac rhythm monitoring. To apply the monitoring electrodes, the nurse must first take what action? a. Apply a moist gel to the chest. b. Make certain that the electrode gel is dry. c. Avoid soaps to avoid skin irritation. d. Clip chest hair if needed.
D
Interpret the following rhythm: a. Normal sinus rhythm b. Sinus bradycardia c. Sinus tachycardia d. Sinus arrhythmia
B
Interpret the following rhythm: a. Normal sinus rhythm b. Sinus bradycardia c. Sinus tachycardia d. Sinus arrhythmia
A
Sinus bradycardia is a symptom of which of the following? (Select all that apply.) a. Calcium channel blocker medication b. Beta-blocker medication c. Athletic conditioning d. Hypothermia e. Hyperthyroidism
ABCD
The patient's heart rate is 70 beats per minute with the P waves coming after the QRS complex. The nurse correctly determines that the patient is demonstrating what heart rhythm? a. A normal junctional rhythm b. An accelerated junctional rhythm c. A junctional tachycardia d. Atrial fibrillation
B
What is one of the functions of the atrioventricular (AV) node? a. Pacing the heart if the ventricles fail b. Slowing the impulse arriving from the SA node c. Sending the impulse to the SA node d. Allowing for ventricular filling during systole
B
Interpret the following rhythm: a. Normal sinus rhythm b. Sinus bradycardia c. Sinus tachycardia d. Sinus arrhythmia
C
The patient's heart rate is 165 beats per minute and the cardiac monitor shows a rapid rate with narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patient's blood pressure has dropped from 124/62 to 78/30; skin is cold and diaphoretic and the patient is reporting nausea. The nurse prepares the patient for what intervention? a. Administration of beta-blockers b. Administration of atropine c. Transcutaneous pacemaker insertion d. Emergent cardioversion
D
Interpret the following rhythm: a. Junctional rhythm b. An accelerated junctional rhythm c. A junctional tachycardia d. Atrial fibrillation
A
The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular and there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is hemodynamically stable. The nurse realizes that the patient is demonstrating what rhythm? a. Atrial fibrillation b. Atrial flutter c. Atrial flutter with rapid ventricular response d. Junctional escape rhythm
A
Electrocardiogram (ECG) paper contains a standardized grid where the horizontal axis measures time and the vertical axis measures voltage or amplitude. The nurse must understand that each horizontal box indicates what? a. 200 milliseconds or 0.20 seconds duration b. 40 milliseconds or 0.04 seconds duration c. 3 seconds duration d. Millivolts of amplitude
B
Interpret the following rhythm: a. Atrial flutter with variable conduction b. Ventricular fibrillation c. Atrial fibrillation d. Atrial flutter with RVR (rapid ventricular response)
B
The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex. The nurse should take what action immediately? a. Defibrillate the patient immediately. b. Initiate basic life support. c. Initiate advanced life support. d. Assess the patient and the electrical leads.
D
The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute. How does the nurse interpret this? a. The pacemaker will pace only if the patient's intrinsic heart rate is less than 60 beats per minute. b. The demand mode often competes with the patient's own rhythm. c. The demand mode places the patient at risk for the R-on-T phenomenon. d. The fixed rate mode is safer and is the mode of choice.
A
The normal width of the QRS complex is which of the following? (Select all that apply.) a. 0.06 to 0.10 seconds. b. 0.12 to 0.20 seconds. c. 1.5 to 2.5 small boxes. d. 3.0 to 5.0 small boxes. e. 0.04 seconds or greater.
AC
The nurse notes the following rhythm on the heart monitor. The patient is unresponsive and not breathing. The nurse should be prepared to implement what action? a. Treat with intravenous amiodarone or lidocaine. b. Provide emergent basic and advanced life support. c. Provide electrical cardioversion. d. Ignore the rhythm because it is benign.
B
The nurse notices ventricular tachycardia on the heart monitor. When the patient is assessed, the patient is found to be unresponsive with no pulse. The nurse should take what action immediately? a. Treat with intravenous amiodarone or lidocaine. b. Begin cardiopulmonary resuscitation and advanced life support. c. Provide electrical cardioversion. d. Ignore the rhythm since it is benign.
B
The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS complexes following the spikes. The nurse realizes this as what? a. Normal pacemaker function b. Failure to capture c. Failure to pace d. Failure to sense
B
Interpret the following rhythm: a. Sinus rhythm with multifocal premature ventricular contractions b. Sinus rhythm with unifocal premature ventricular contractions c. Sinus rhythm with bigeminal premature ventricular contractions d. Sinus rhythm with paired premature ventricular contractions (couplets)
C
The nurse notices that a patient is in first-degree AV block but everything else about the rhythm is normal. The nurse should be prepared to take what action? a. Placing the patient on a transcutaneous pacemaker. b. Giving the patient atropine to shorten the PR interval. c. Monitor the rhythm and patient's condition. d. Giving the patient an antiarrhythmic medication.
C
When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to understand that the electrical activity is viewed in relation to the positive electrode of that particular lead. What is the effect on the inflection when an electrical signal is aimed directly at the positive electrode? a. Negative b. Upside down c. Upright d. Equally positive and negative
C
The patient is having premature ventricular contractions (PVCs). What is the nurse's greatest concern? a. The proximity of the R wave of the PVC to the T wave of a normal beat. b. The fact that PVCs are occurring, because they are so rare. c. If the number of PVCs are decreasing. d. If the PVCs are wider than 0.12 seconds.
A
Interpret the following rhythm: a. Sinus rhythm with multifocal premature ventricular contractions b. Sinus rhythm with unifocal premature ventricular contractions c. Sinus rhythm with bigeminal premature ventricular contractions d. Sinus rhythm with paired premature ventricular contractions (couplets)
B
The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P wave and 20 small boxes between each R wave. What is the ventricular rate? a. 50 beats/min b. 75 beats/min c. 85 beats/min d. 100 beats/min
B
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P waves are upright and look the same except one that has a different shape and is inverted. The nurse realizes that the P wave with the abnormal shape is probably a result of what? a. Originating from the SA node since all P waves come from the SA node. b. Originating from some area in the atria other than the SA node. c. Ventricular depolarization. d. Normal firing even though it is inverted in lead II.
B
The QT interval is the total time taken for ventricular depolarization and repolarization. Prolongation of the QT interval will result in what outcome? a. Decreased risk of lethal dysrhythmias b. Increase in heart rate c. Increase in the risk of lethal dysrhythmias. d. Will only be measured with irregular rhythms.
C
The nurse understands what to be true of a third-degree AV block? a. Every P wave is conducted to the ventricles b. Some P waves are conducted to the ventricles c. None of the P waves are conducted to the ventricles d. The PR interval is prolonged
C
The patient scheduled to have a permanent pacemaker implanted asks the nurse, "How long will the battery in this thing last?" What answer should the nurse provide? a. "Life expectancy is about 1 year. Then it will need to be replaced." b. "Pacemaker batteries can last up to 25 years with constant use." c. "Battery life varies depending on usage, but it can last up to 10 years." d. "Pacemakers are used to treat temporary problems so the batteries don't last long."
C
The patient is alert and talking when the nurse notices the following rhythm. The patient's blood pressure is 90/44 mm Hg. The nurse should take what action? a. Defibrillate immediately. b. Begin basic life support. c. Begin advanced life support. d. Treat with intravenous amiodarone or lidocaine.
D
13. Which statement is true about a patient diagnosed with sinus arrhythmia? a. The heart rate varies, dependent on vagal tone and respiratory pattern. b. Immediate treatment is essential to prevent death. c. Sinus arrhythmia is not well tolerated by most patients. d. PR and QRS interval measurements are prolonged.
A
Interpret the following rhythm: a. Atrial Fibrillation b. Atrial Flutter c. Atrial flutter with RVR d. Junctional escape rhythm
A
The nurse is caring for a patient diagnosed with atrial fibrillation. Sequelae that place the patient at greater risk for mortality/morbidity include which of the following? (Select all that apply.) a. Stroke b. Ashman beats c. Pulmonary emboli d. Prolonged PR interval e. Decreased cardiac output
ACE
The patient is admitted with a fever and rapid heart rate and a temperature of 103° F (39.4° C).The nurse places the patient on a cardiac monitor and finds the patient's atrial and ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is regular, and blood pressure is normal. What should be the nurse's initial focus? a. Medications to lower heart rate b. Treatment to lower temperature c. Treatment to lower cardiac output d. Treatment to reduce heart rate
B
The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient is on digitalis medication at home. The nurse should expect that action to be taken? a. The patient has had an anterior wall myocardial infarction. b. The physician will order the digitalis to be continued in the hospital. c. A digitalis level would be ordered upon admission. d. The patient will require a transcutaneous pacemaker.
C
Interpret the following rhythm: a. Idioventricular rhythm b. Accelerated idioventricular rhythm c. Ventricular tachycardia d. Ventricular fibrillation
A
Interpret the following rhythm: a. Sinus rhythm with PACs b. Normal sinus rhythm c. Sinus tachycardia d. Sinus bradycardia
A
The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse will take what action first? a. Identify the markers on the ECG paper that indicate a 6-second strip. b. Count the number of large boxes between two consecutive P waves. c. Count the number of small boxes between two consecutive QRS complexes. d. Divide the number of complexes in a 6-second strip by 10.
A
The patient is in chronic junctional escape rhythm with no atrial activity noted. Studies have demonstrated normal AV node function. This patient may be a candidate for which type of pacing? a. Atrial pacing b. Ventricular pacing c. Dual-chamber pacing d. Transcutaneous pacing
A
The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and understands that the rhythm is due to what cause? a. Loss of sinus node activity b. Increased rate of the AV node c. Increased rate of the SA node d. Decreased rate of the AV node
A
Why is the sinus node identified as the pacemaker of the heart? a. It contains the fastest pacemaker cell in the heart. b. It has the only pacemaker cell in the heart. c. It contains the only cell that does not affect the cardiac cycle. d. It is located in the left side of the heart.
A
Which of the following are common causes of sinus tachycardia? (Select all that apply.) a. Hyperthyroidism b. Hypovolemia c. Hypothyroidism d. Heart Failure e. Sleep
ABD
The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min. The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes. How does the nurse interpret this? a. Normal pacemaker function b. Failure to capture c. Failure to pace d. Failure to sense
C
The patient is admitted with sinus pauses causing periods of loss of consciousness. The patient is currently asymptomatic, awake and alert, but fatigued and answers questions appropriately. When admitting this patient, what should be the nurse's initial action? a. Prepare the patient for temporary pacemaker insertion. b. Prepare the patient for permanent pacemaker insertion. c. Assess the patient's medication profile. d. Apply transcutaneous pacemaker paddles.
C
The patient is in third-degree heart block (complete heart block) and is symptomatic. The treatment for this patient is which of the following? (Select all that apply.) a. Transcutaneous pacemaker b. Atropine IV c. Temporary transvenous pacemaker d. Permanent pacemaker e. Amiodarone IV
ACD
What is the normal rate for the SA node when the patient is at rest? a. 40 to 60 beats per minute b. 60 to 100 beats per minute c. 20 to 40 beats per minute d. More than 100 beats per minute
B
