Ch. 26: Mgmt of Pts w/ Dysrhythmias and Conduction Problems

A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? Clients with recurrent life-threatening bradycardias Clients with sinus tachycardia Clients with ventricular bradycardia Clients with recurrent life-threatening tachydysrhythmias

Correct response: Clients with recurrent life-threatening tachydysrhythmias Explanation: The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect.

The nurse is educating the client about a transvenous pacemaker. What is the best statement to explain why the client will have a transvenous pacemaker? "A transvenous pacemaker is used for a ventricular tachydysrhythmias." "A transvenous pacemaker is used in place of a transarterial pacemaker." "A transvenous pacemaker is a permanent pacemaker that is asynchronous." "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."

Correct response: "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs." Explanation: A transvenous pacemaker is a temporary pulse-generating device that sometimes is necessary to manage transient bradydysrhythmias such as those that occur during acute MIs or after coronary artery bypass graft surgery, or to override tachydysrhythmias. The transvenous pacemaker is a temporary pacemaker introduced into the venous system, not the arterial system. The pacemaker does not manage ventricular dysrhythmias.

The nurse is instructing on home care after placement of an automatic implanted cardioverter defibrillator (AICD). Which statement, made by the client, needs clarification by the nurse? "I need to stay away from microwaves." "I should opt for a hand search at the airport instead of metal detector scan." "I need to notify my cardiologist if I feel frequent kicks to the chest." "I can continue to work with my power tools."

Correct response: "I need to stay away from microwaves." Explanation: Similar to hand tools, microwaves have shields or are grounded, making them safe for clients with AICDs. There is no restriction from microwave use. All of the other options are correct.

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? "I should ask for a handheld device search when I go through airport security." "I'll watch the incision for swelling or redness and will report if either occurs." "I should avoid contact sports." "I should avoid large magnetic fields, such as an MRI machine or large motors."

Correct response: "I should ask for a handheld device search when I go through airport security." Explanation: 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 nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? "I need to stay at least 10 inches away from the microwave." "I'll keep a log of each time my ICD discharges." "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." "I can't wait to get back to my football league."

Correct response: "I'll keep a log of each time my ICD discharges." Explanation: The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD.

Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node."

Correct response: "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers.

The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response? "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase." "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." "This is okay as long as you are not having any symptoms." "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate."

Correct response: "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." Explanation: A client experiencing pacemaker malfunctioning may develop bradycardia as well as signs and symptoms of decreased cardiac output. The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate, which may indicate pacemaker malfunction. The client needs to be evaluated to avoid cardiac output problems. Walking will not keep the heart rate at a safe level.

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? "The P-R interval will be prolonged in sinus bradycardia." "The P waves will be shaped differently." "The only difference is the heart rate." "The QRS complex will be smaller in sinus bradycardia."

Correct response: "The only difference is the heart rate." Explanation: 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.

The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? "The rhythm is regular but fast." "It is when the heart conduction is primarily from the aterioventricular node." "The rhythm has a normal beat, then a premature beat pattern." "The heart rate is between 150 to 250 bpm."

Correct response: "The rhythm has a normal beat, then a premature beat pattern." Explanation: 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.

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? "When your spouse needs help, an alarm will go off at the desk." "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute." "The box is recording the heart's electrical activity, and a physician will review the tracing later." "The small box will transmit the heart rhythm to the central monitor all the time."

Correct response: "The small box will transmit the heart rhythm to the central monitor all the time." Explanation: 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 scheduled for a transesophageal echocardiogram with a diagnosis of atrial fibrillation. The client's spouse asks the nurse to explain the purpose of the test. What is the nurse's best response? "This test will show the specific area causing the atrial fibrillation and what can be done to stop it." "This test will let the doctor know if the client is at risk for hypotension." "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." "This test will show if the client needs a cardiac catheterization."

Correct response: "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." Explanation: The transesophageal echocardiogram will show if the client has blood clots and help determine if it is safe to use cardioversion. The transesophageal echocardiogram does not indicate which area is causing the atrial fibrillation or the need to evaluate coronary arteries, as with a cardiac catheterization. Hypotension is diagnosed with blood pressure readings.

A client with atrial fibrillation, who does not respond to conventional treatment measures and who is not a candidate for cardioversion, would have what procedure recommended? Angiography Maze procedure Heart transplantation Open heart surgery

Correct response: Maze procedure Explanation: Clients who are not candidates for cardioversion and fail to respond to conventional measures may be candidates for a surgical intervention referred to as the Maze procedure. Angiography, open heart surgery, and heart transplantation are not recommended surgeries for these clients.

A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond? "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." "Being that close to a rifle might make your ICD fire." "Enjoy your hunting trip." "You'll need to take an extra dose of your antiarrhythmic before you shoot."

Correct response: "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." Explanation: The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with the left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of an antiarrhythmic.

A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond? "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." "You'll need to take an extra dose of your antiarrhythmic before you shoot." "Enjoy your hunting trip." "Being that close to a rifle might make your ICD fire."

Correct response: "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." Explanation: The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with the left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of an antiarrhythmic.

The nurse cares for a 56-year-old client who received an implantable cardioverter defibrillator (ICD) 2 days prior. The client tells the nurse "My wife and I can never have sex again now that I have this ICD." What is the nurse best response by the nurse? "I will be sure to share your concerns with the physician." "Sex is permitted following the implantation of an ICD." "You really should speak to your wife about your concerns." "You seem apprehensive about resuming sexual activity."

Correct response: "You seem apprehensive about resuming sexual activity." Explanation: The client treated with an electronic device experiences not only lifestyle and physical changes but also emotional changes. At different times during the healing process, the client may feel angry, depressed, fearful, anxious, or a combination of these emotions. It is imperative for the nurse to observe the client's response to the device and provide the client and family members with emotional support and teaching as indicated. Identifying that the client appears apprehensive about resuming sexual activity acknowledges the client's concerns while allowing for further discussion. The remaining responses ignore the client's feelings and do not facilitate an ongoing conversation or explore the client's concern.

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? "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers." "You should avoid tennis; basketball or football would be a good substitute." "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity."

Correct response: "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." Explanation: 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).

The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds? 0.3 0.4 0.2 0.1

Correct response: 0.2 Explanation: Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second.

The nurse knows that what PR interval presents a first-degree heart block? 0.14 seconds 0.24 seconds 0.18 seconds 0.16 seconds

Correct response: 0.24 seconds Explanation: In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.

The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? 20 to 40 100 to 250 Not measurable 220 to 350

Correct response: 20 to 40 Explanation: The rate is 20 to 40. If the rate exceeds 40, the rhythm is known as accelerated idioventricular rhythm (AIVR). The rate is not measurable in asystole. Ventricular tachycardia has a rate of 100 to 250 per minute. Atrial flutter has a rate of 220 to 350.

The nurse would expect which of the following atrial rates to correlate with an idioventricular rhythm? Not measurable 20 to 40 220 to 350 100 to 250

Correct response: 20 to 40 Explanation: The rate is 20 to 40. If the rate exceeds 40, the rhythm is known as accelerated idioventricular rhythm (AIVR). The rate is not measurable in asystole. Ventricular tachycardia has a rate of 100 to 250 per minute. Atrial flutter has a rate of 220 to 350.

A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as 80 bpm. 70 bpm. 100 bpm. 90 bpm.

Correct response: 90 bpm. Explanation: An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90.

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? A new myocardial infarction client A client with atrial dysrhythmias A client with third-degree heart block A client with poor kidney perfusion

Correct response: A client with atrial dysrhythmias Explanation: The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker.

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? Prepare to client for cardioversion. Send the client to the cardiac catheterization laboratory. Administer an IV bolus of atropine. Review the client's medication record.

Correct response: Administer an IV bolus of atropine. Explanation: Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first. Cardioversion is used to treat a fast heart rate. Reviewing the medication record will not help the client initially.

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? Maintaining the client's intravenous fluids Identifying the client's code level status Alerting the healthcare provider of the third-degree heart block Assessing the client's blood pressure and heart rate frequently

Correct response: Alerting the healthcare provider of the third-degree heart block Explanation: 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 the priority. The identification of a code status during a heart block is not appropriate. The IV fluids are not helpful if the heart is not perfusing.

A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart? elevated temperature shock strenuous exercise All options are correct.

Correct response: All options are correct. Explanation: There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart, including fever, shock, and strenuous exercise.

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? cAltered patterns frequently turn into life-threatening arrhythmias. Altered patterns frequently affect the heart's ability to pump blood effectively. Altered patterns frequently cause a variety of home safety issues. Altered patterns frequently produce neurological deficits.

Correct response: Altered patterns frequently affect the heart's ability to pump blood effectively. Explanation: The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer.

What is the drug of choice for a stable client with ventricular tachycardia? Amiodarone Atropine Lidocaine Procainamide

Correct response: Amiodarone Explanation: Amiodarone administered IV is the antidysrhythmic medication of choice for a stable patient with ventricular tachycardia. Atropine is used for bradycardia. Procainamide is used to treat and prevent atrial and ventricular dysrhythmias. Lidocaine is used for treating ventricular dysrhythmias.

Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? Potassium supplement Anticoagulant Diuretic Antihypertensive

Correct response: Anticoagulant Explanation: Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation. The other options may be prescribed but not expected in most situations.

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? Atrial flutter Ventricular fibrillation Atrial fibrillation Ventricular tachycardia

Correct response: Atrial flutter Explanation: 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.

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? Ventricular tachycardia Atrial flutter Ventricular fibrillation Atrial fibrillation

Correct response: Atrial flutter Explanation: 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's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as Ventricular fibrillation Atrial fibrillation Ventricular tachycardia Atrial flutter

Correct response: Atrial flutter Explanation: The nurse correctly identifies the electrocardiogram (ECG) tracing as atrial flutter. 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 appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.

The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? Regular rhythm Normal PR interval P wave resent before each QRS Atrial rate of 300 to 400

Correct response: Atrial rate of 300 to 400 Explanation: ECG characteristics of atrial fibrillation include an atrial rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm, and no discernible P waves.

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? Cardizem Lidocaine Pronestyl Atropine

Correct response: Atropine Explanation: 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.

A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.) Record events that trigger a shock sensation. The patient may have a throbbing pain that is normal Call for emergency assistance if feeling dizzy. The patient will have to schedule monthly chest x-rays to make sure the device is patent. Avoid magnetic fields such as metal detection booths.

Correct response: Avoid magnetic fields such as metal detection booths. Call for emergency assistance if feeling dizzy. Record events that trigger a shock sensation. Explanation: The nurse should instruct the patient to avoid large magnetic fields such as those created by magnetic resonance imaging, large motors, arc welding, electrical substations, and so forth. Magnetic fields may deactivate the device, negating its effect on a dysrhythmia. The patient should call 911 for emergency assistance if a feeling of dizziness occurs. The patient should maintain a log that records discharges of an implantable cardioverter defibrillator (ICD). Record events that precipitate the sensation of shock. This provides important data for the physician to use in readjusting the medical regimen. Throbbing pain is not normal and should be reported immediately. An initial x-ray is indicated prior to discharge, but monthly x-rays are unnecessary.

Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? Keep moving the arm on the side where the pacemaker is inserted Keep the arm on the side of the pacemaker higher than the head Delay activities such as swimming and bowling for at least 3 weeks Avoid sources of electrical interference

Correct response: Avoid sources of electrical interference Explanation: 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.

A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? Administer intravenous epinephrine Begin cardiopulmonary resuscitation Prepare for endotracheal intubation Provide electrical cardioversion

Correct response: Begin cardiopulmonary resuscitation Explanation: In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the client as soon as possible. If defibrillation is not readily available, CPR is begun until the client can be defibrillated, followed by advanced cardiovascular life support (ACLS) intervention, which includes endotracheal intubation and administration of epinephrine. Electrical cardioversion is not indicated for a client in ventricular fibrillation.

The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record? Couplets Bigeminy Multifocal PVCs R-on-T phenomenon

Correct response: Bigeminy Explanation: The nurse is correct to note bigeminy on the permanent record when every other beat is a PVC. Couplets are two PVCs in a row. Multifocal PVCs originate from more than one location. R-on-T phenomenon occurs when the R wave falls on the T wave.

A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client's blood glucose level. Which medication is the client most likely taking? Procainamide Amiodarone Carvedilol Diltiazem

Correct response: Carvedilol Explanation: The nurse must monitor blood glucose levels closely in clients with type 2 diabetes who are taking beta-adrenergic blockers such as carvedilol, because beta-adrenergic blockers may mask the signs of hypoglycemia. The nurse should monitor QRS duration in clients taking procainamide and pulmonary function in clients taking amiodarone (because the drug may cause pulmonary fibrosis). Diltiazem may cause an increased PR interval or bradycardia.

After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? Decreased cardiac output and decreased systolic and diastolic blood pressure Decreased peripheral vascular resistance Increased cardiac output and increased systolic and diastolic blood pressure Decreased blood pressure with reflex tachycardia

Correct response: Decreased cardiac output and decreased systolic and diastolic blood pressure Explanation: As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia.

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication? Irregular rhythm P waves hidden within the QRS complex Variable heart rate, usually fewer than 90 bpm Delayed conduction, producing a prolonged PR interval

Correct response: Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.

The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? nadolol atropine sulfate diltazem atenolol

Correct response: Delayed conduction, producing a prolonged PR interval Explanation: 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).

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? An irregular rhythm P waves hidden with the QRS complex Delayed conduction, producing a prolonged PR interval A variable heart rate, usually fewer than 60 bpm

Correct response: Delayed conduction, producing a prolonged PR interval Explanation: 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 nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? Reposition the extremity and turn the client to left side Check the security of all connections and increase the milliamperage Document the findings and continue to monitor the client Obtain a 12-lead ECG and a portable chest x-ray

Correct response: Document the findings and continue to monitor the client Explanation: Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the client. Repositioning the client, placing the client on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape.

The nurse analyzes the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The client's ECG strip demonstrates PR intervals that measure 0.24 seconds. What is the nurse's most appropriate action? Document the findings and continue to monitor the patient Notify the client's primary care provider of the findings Apply oxygen via nasal cannula and obtain a 12-lead ECG Instruct the client to bear down as if having a bowel movement

Correct response: Document the findings and continue to monitor the patient Explanation: The client's electrocardiogram (ECG) tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block rarely causes any hemodynamic effect; the other blocks may result in decreased heart rate, causing a decrease in perfusion to vital organs, such as the brain, heart, kidneys, lungs, and skin. The most appropriate action by the nurse is to document the findings and continue to monitor the client.

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? Measure the client's blood pressure. Double-check the monitoring equipment. Suggest the need for a new beta-blocker to the doctor. Do nothing; there is no cause for alarm.

Correct response: Double-check the monitoring equipment. Explanation: One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

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? The procedure takes less time than a cardiac catheterization. During the procedure, the dysrhythmia will be reproduced under controlled conditions. After the procedure, the dysrhythmia will not recur. The procedure will occur in the operating room under general anesthesia.

Correct response: During the procedure, the dysrhythmia will be reproduced under controlled conditions. Explanation: 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.

Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? P wave PR interval QT interval QRS complex

Correct response: QRS complex Explanation: The QRS complex represents ventricular depolarization. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization.

The nurse and student nurse are observing a cardioversion procedure completed by a physician. At which time is the nurse most correct to identify to the student when the electrical current will be initiated? During the QRS complex During repolarization of the heart During ventricular depolarization During stimulation of the SA node

Correct response: During ventricular depolarization Explanation: The electrical current is initiated at the R wave when ventricular depolarization occurs. The electrical current completely depolarizes the entire myocardium with the goal of restoring the normal pacemaker of the heart. The other options focus on an incorrect timing that will not restore the normal electrical conduction.

A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? Mace procedure Elective electrical defibrillation Chemical cardioversion Elective electrical cardioversion

Correct response: Elective electrical cardioversion Explanation: Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure.

The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? Feeling tired Hypertension Change in mental status Tachycardia

Correct response: Feeling tired Explanation: The side effects of procainamide hydrochloride can include hypotension, GI upset, and feelings of tiredness. Procainamide does not cause hypertension, tachycardia, or a change in mental status.

The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? Fluttering Fever Nausea Hypotension

Correct response: Fluttering Explanation: Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever.

The nurse reads an athletic client's electrocardigram. What finding will be consistent with a sinus bradycardia? QR interval of 0.25 seconds. P-to-QR ratio of 1:2. Heart rate of 42 beats per minute (bpm). PR interval of 0.24 seconds.

Correct response: Heart rate of 42 beats per minute (bpm). Explanation: The heart rate of 42 bpm is slow but normal when it occurs in athletes with a sinus bradycardia. The PR interval is prolonged at 0.24 seconds, indicating a heart block. The QR interval is prolonged and indicates ventricular delay.The ratio of P to QR should be 1:1 in sinus bradycardia.

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? Alkalosis Hypovolemia Bradycardia Hypokalemia

Correct response: Hypokalemia Explanation: PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.

Which rhythm is also termed a ventricular escape rhythm? Ventricular fibrillation First degree AV block Ventriuclar asystole Idioventricular rhythm

Correct response: Idioventricular rhythm Explanation: Idioventricular rhythm is also called a ventricular escape rhythm.

A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client? Electric cardioversion Immediate CPR Chemical cardioversion IV lidocaine

Correct response: Immediate CPR Explanation: Immediate CPR is used during pulseless ventricular tachycardia and ventricular fibrillation.

What is the treatment of choice for ventricular fibrillation? Immediate bystander CPR Implanted defibrillator Atropine Pacemaker

Correct response: Immediate bystander CPR Explanation: 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 is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation? In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output. Sinus bradycardia means your heart is not beating fast enough to keep you alive. Sinus bradycardia is nothing to worry about. In many clients a heart rate slower than 70 beats per minute is considered to slow to maintain an adequate cardiac output.

Correct response: In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output. Explanation: A heart rate slower than 60 beats per minute is pathologic in clients with heart disorders, increased intracranial pressure, hypothyroidism, or digitalis toxicity. The danger in sinus bradycardia is that the slow rate may be insufficient to maintain cardiac output. Option B is incorrect as it is an incomplete answer to the client's question. Option C minimizes the client's concern so it is incorrect. Option D is incorrect as it gives the client incorrect information.

A patient has a persistent third-degree heart block and has had several periods of syncope. What priority treatment should the nurse anticipate for this patient? Administration of atropine Insertion of an implantable cardioverter defibrillator (ICD) Administration of epinephrine Insertion of a pacemaker

Correct response: Insertion of a pacemaker Explanation: Third-degree AV block, also known as a complete block, occurs when no atrial impulse is conducted through the AV node into the ventricles. A permanent pacemaker may be necessary if the block persists.

The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? It is used to eliminate ventricular dysrhythmias. It is a scheduled procedure 1 to 10 days in advance. It uses less electrical energy than cardioversion. The client is sedated before the procedure.

Correct response: It is used to eliminate ventricular dysrhythmias. Explanation: The only treatment for a life-threatening ventricular dysrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion.

Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? Document heart rate before and after administration Keep the client flat for one hour after administration Monitor vital signs and cardiac rhythm Administer every five minutes during cardiac resuscitation

Correct response: Monitor vital signs and cardiac rhythm Explanation: 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.

The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? Extended PR interval Atrial rate of 60 bpm or below Shortened QRS duration. More P waves than QRS complexes

Correct response: More P waves than QRS complexes Explanation: There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? Avoid undergoing magnetic resonance imaging (MRI). Avoid going through airport metal detectors. Never engage in activities that require vigorous arm and shoulder movement. Stay at least 5 feet away from microwave ovens.

Correct response: P wave Explanation: 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.

To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? T wave PR interval QRS complex P wave

Correct response: P wave Explanation: 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.

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply. QRT wave P-R interval P wave S-Q segment T wave

Correct response: P wave P-R interval T wave Explanation: The EKG cardiac complex waves include the P wave, the QRS complex, the T wave, and possibly the U wave. The intervals and segments include the PR interval, the ST segment, and the QT interval.

Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? Atrial flutter Atrial fibrillation Sinus tachycardia Paroxysmal atrial tachycardia

Correct response: Paroxysmal atrial tachycardia Explanation: Paroxysmal atrial tachycardia (PAT) is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate. Atrial flutter occurs in the atrium and creates an atrial rate between 250 to 400 times per minute. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature.

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? Flattened P waves Peaked T waves Prolonged QT interval Occasional U waves

Correct response: Peaked T waves Explanation: 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.

The nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II as well as a bizarre, abnormal shape to the QRS complex. The nurse has likely observed which ventricular dysrhythmia? Ventricular fibrillation Ventricular tachycardia Ventricular bigeminy Premature ventricular contraction

Correct response: Premature ventricular contraction Explanation: A premature ventricular contraction (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.

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? Ventricular fibrillation Premature ventricular contraction (PVC) Ventricular bigeminy Ventricular tachycardia

Correct response: Premature ventricular contraction (PVC) Explanation: 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.

The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up? QT interval that is 0. 46 seconds long QRS complex that is 0.10 seconds long PR interval that is 0.18 seconds long ST segment that is isoelectric in appearance

Correct response: QT interval that is 0. 46 seconds long Explanation: The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the client may be at risk for a lethal ventricular dysrhythmia, called torsades de pointes. The other findings are normal.

A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next? Question the client about alcohol and illicit drug use. Instruct the client to hold the breath and bear down. Place the client on supplemental oxygen. Prepare to administer a calcium channel blocker.

Correct response: Question the client about alcohol and illicit drug use. Explanation: The client is experiencing sinus tachycardia. Since the client's findings of tachycardia, dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the client about alcohol and illicit drug use. This information will direct the client's plan of care. Causes of tachycardia include medications that stimulate the sympathetic response, stimulants, and illicit drugs. The treatment goals for sinus tachycardia is usually determined by the severity of symptoms and directed at identifying and abolishing its cause. The other interventions may be implemented, but determining the cause of the tachycardia is essential.

The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? TP interval RR interval QT interval PP interval

Correct response: RR interval Explanation: The rhythm is often identified at the same time the rate is determined. The RR interval is used to determine ventricular rhythm and the PP interval to determine atrial rhythm. If the intervals are the same or if the difference between the intervals is less than 0.8 seconds throughout the strip, the rhythm is called regular. If the intervals are different, the rhythm is called irregular.

The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? Left side of sternum, fourth intercostal space Mid-clavicular line, fifth intercostal space Right side of sternum, fourth intercostal space Midway between V2 and V4

Correct response: Right side of sternum, fourth intercostal space Explanation: view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space. V2 is the left side of the sternum, fourth intercostal space. V3 is midway between V2 and V4. V4 is at the mid-clavicular line, fifth intercostal space.

An operating room nurse is caring for a client who is having a pacemaker implanted. Thehealth care provider has requested a demand mode pacemaker for this client. What is this type of pacemaker? Asynchronous Self-activated A temporary pacemaker A fixed-rate pacemaker

Correct response: Self-activated Explanation: Demand (synchronous) mode pacemakers self-activate when the client's pulse falls below a certain level. A fixed-rate pacemaker is asynchronous and permanent. Temporary pacemakers are used until a permanent pacemaker can be implanted.

The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button? Placing gel on the chest Shouts, "All clear" States, "Charging" Checking the ECG rhythm

Correct response: Shouts, "All clear" Explanation: Preceding pressing the discharge button, the nurse shouts "All clear" to ensure that no one is in contact with the client. The other options are correct but not the nursing action immediately preceding.

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe? AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers

Correct response: Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers Explanation: The correct sequence of conduction through the normal heart is the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers.

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? Sinus tachycardia Ventricular tachycardia Normal sinus rhythm Sinus bradycardia

Correct response: Sinus tachycardia Explanation: 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).

A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? The need to sit upright for 30 minutes after taking the medication The importance of adequate fluid intake The importance of taking the medication 1 hour before or 2 hours after a meal The need to have regular blood levels drawn

Correct response: The need to have regular blood levels drawn Explanation: One drawback of warfarin therapy is the need to have blood levels drawn on a regular basis. The medication does not need to be taken on an empty stomach, and the client does not have to sit upright. Adequate fluid intake is useful in a general way, but the need for fluids is not increased by taking warfarin.

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? The registered nurse stating to administer digoxin The registered nurse stating to administer all medications except those which are cardiotonics The registered nurse administering atropine sulfate intravenously The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute

Correct response: The registered nurse administering atropine sulfate intravenously Explanation: The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed.

The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed? Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 seconds. The sinoatrial (SA) node initiates the impulse. The ventricles depolarize in 0.5 seconds or less. Heart rate between 60 and 150 beats per minute.

Correct response: The sinoatrial (SA) node initiates the impulse. Explanation: The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats per minute; the SA node initiates the impulse; the impulse travels to the AV node in 0.12 to 0.2 seconds; the ventricles depolarize in 0.12 seconds or less; and each impulse occurs regularly.

The client has just been diagnosed with a dysrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm? The sinoatrial (SA) node initiates the impulse. The ventricles depolarize in 0.5 second or less. Heart rate between 60 and 150 beats/minute. Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 second.

Correct response: The sinoatrial (SA) node initiates the impulse. Explanation: The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats/minute, the SA node initiates the impulse, the impulse travels to the AV node in 0.12 to 0.2 second, the ventricles depolarize in 0.12 seconds or less, and each impulse occurs regularly.

When no atrial impulse is conducted through the AV node into the ventricles, the client is said to be experiencing which type of AV block? Second degree, type I First degree Third degree Second degree, type II

Correct response: Third degree Explanation: In third degree heart block, two impulses stimulate the heart, one impulse stimulates the ventricles and other stimulates the atria. In first degree heart block, all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. In second degree AV block, type I, all but one of the atrial impulses are conducted through the AV node into the ventricles. In second degree AV block, type II, only some of the atrial impulses are conducted through the AV node into the ventricles.

The nurse participates in the care of a client requiring emergent defibrillation. The nurse determines the steps should be completed in which order? Apply the multifunction conductor pads to the client's chest. Charge the defibrillator to the prescribed voltage. Call "clear" three times ensuring client and environmental safety. Turn on the defibrillator and place it in "not sync" mode. Deliver the prescribed electrical charge.

Correct response: Turn on the defibrillator and place it in "not sync" mode. Charge the defibrillator to the prescribed voltage. Apply the multifunction conductor pads to the client's chest. Call "clear" three times ensuring client and environmental safety. Deliver the prescribed electrical charge. Explanation: 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.

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? Ventricular tachycardia Atrial fibrillation Ventricular fibrillation Third-degree heart block

Correct response: Ventricular fibrillation Explanation: 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.

A client has a medical diagnosis of an advanced atrioventricular block, Mobitz Type II, and is symptomatic. What initial treatment will the nurse be prepared to complete? prepare the client for a cardioversion administer an IV bolus of atropine administer an IV bolus of furosemide prepare client for a cardiac catheterization

Correct response: administer an IV bolus of atropine Explanation: The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists. Cardioversion is done with a fast heart rate. Furosemide will be given for fluid overload. Cardiac catheterization is administered for chest pain.

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? maintaining intravenous fluids assessing blood pressure and heart rate frequently identifying a code-level status alerting the healthcare provider of the third-degree heart block

Correct response: alerting the healthcare provider of the third-degree heart block Explanation: 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 tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to apply supplemental oxygen. avoid caffeinated beverages. lie down and elevate the feet. request sublingual nitroglycerin.

Correct response: avoid caffeinated beverages. Explanation: If premature atrial complexes (PACs) are infrequent, no medical interventions are necessary. Causes of PACs include caffeine, alcohol, nicotine, stretched atrial myocardium (e.g., as in hypervolemia), anxiety, hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction. The nurse should instruct the client to avoid caffeinated beverages.

Which is not a likely origination point for cardiac dysrhythmias? bundle of His ventricles atria atrioventricular node

Correct response: bundle of His Explanation: Cardiac dysrhythmias may originate in the atria, atrioventricular node, or ventricles. They do not originate in the Bundle of His.

The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priorityaction? defibrillation IV bolus of atropine cardioversion IV bolus of dobutamine

Correct response: defibrillation Explanation: Advanced 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.

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? electrocardiogram electroencephalogram electrocautery echocardiogram

Correct response: electrocardiogram Explanation: An electrocardiogram is used to identify normal and abnormal cardiac rhythms.

The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? digoxin hypovolemia hypothyroidism vagal stimulation

Correct response: hypovolemia Explanation: 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.

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: inherent rhythmicity of all muscle tissue. inherent electrons in muscle tissue. inherent rhythmicity of cardiac muscle tissue. sufficient blood pressure.

Correct response: inherent rhythmicity of cardiac muscle tissue. Explanation: 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.

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: sufficient blood pressure. inherent electrons in muscle tissue. inherent rhythmicity of all muscle tissue. inherent rhythmicity of cardiac muscle tissue.

Correct response: inherent rhythmicity of cardiac muscle tissue. Explanation: 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 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 first-degree atrioventricular block. sinus tachycardia. normal sinus rhythm. junctional tachycardia.

Correct response: normal sinus rhythm. Explanation: 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.

The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect? postoperative site hematoma internal bleeding at pacemaker site pacemaker site infection normal postoperative healing

Correct response: pacemaker site infection Explanation: Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These symptoms include swelling, unusual tenderness, drainage, and increased warmth. When the site is healing normally, there will be no tenderness and throbbing. A hematoma forms a lump at the pacemaker insertion site. Mild bleeding will be drainage.

A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have? sinus bradycardia atrial bradycardia none heart block

Correct response: sinus bradycardia Explanation: Sinus bradycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual (less than 60 beats/minute) rate.

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 sinus tachycardia. sinus dysrhythmia. sinus bradycardia. normal sinus rhythm.

Correct response: sinus dysrhythmia. Explanation: 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.

During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during the QT interval. ventricular depolarization. ventricular repolarization. atrial depolarization.

Correct response: ventricular depolarization. Explanation: In cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) on the cardiac monitor so that the electrical impulse discharges during ventricular depolarization.

The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm below. What dysthymia should the nurse document? ventricular fibrillation sinus rhythm with third-degree atrioventricular block idioventricular rhythm atrial flutter sinus bradycardia

Correct response: ventricular fibrillation Explanation: The dysrhythmia is ventricular fibrillation because it is a rapid rhythm with no organization. This dysrhythmia causes ventricles to quiver and there is no atrial activity on the ECG. Atrial flutter will have atrial rate ranges between 250 and 400 bpm, ventricular rate between 75 and 150 bpm. The QRS shape and duration are usually normal, but may be abnormal or absent. The P-wave will be saw-toothed in shape. The PR-interval may be difficult to determine. Sinus Bradycardia will have a ventricular and atrial rate of less than 60 bpm. The ventricular and atrial rhythm will be regular. The QRS shape and duration is usually normal, but may be regularly abnormal. The P-wave will be normal and consistent in shape. The PR interval will have an interval between 0.12 and 0.20 seconds. Idioventricular rhythm will have a ventricular rate between 20 and 40 bpm. The ventricular rhythm will be regular. The QRS shape and duration will be abnormal shape, bizarre, and will have a duration of 0.12 seconds or more. Sinus rhythm with third-degree atrioventricular block will have a ventricular and atrial rhythm with a PP interval that is regular and the RR interval that is regular. The PP interval is not equal to the RR interval. The QRS shape and duration will depend on the escape rhythm. With junctional rhythm, the QRS shape and duration are usually normal; with an idioventricular rhythm, the QRS shape and duration are usually abnormal. The P-wave will depend on the underlying rhythm. The PR interval is very irregular. The P:QRS ratio will show more P-waves than QRS complexes.

The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal." "The two look very much alike; it is difficult to tell the difference." "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width."

orrect response: "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." Explanation: Ventricular fibrillation is irregular with undulating waves and no QRS complex, while ventricular tachycardia is usually regular and fast with wide QRS complexes. The rhythms look different on the electrocardiogram strip. The QRS is wide and bizarre or undefined in ventricular fibrillation. The P-R interval is not present in the ventricular dysrhythmias.

The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? "I will call the doctor if my incision becomes swollen and red." "We will be getting rid of our microwave oven so it will not affect my pacemaker." "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." "I will avoid any large magnets that may affect my pacemaker."

orrect response: "We will be getting rid of our microwave oven so it will not affect my pacemaker." Explanation: Permanent pacemaker generators have filters that protect them from electrical interference from most household devices, motors, and appliances, so the client can keep the microwave oven. Clients are taught to check pulses daily, avoid large magnets, and report any incisional redness or swelling.