Chapter 26: Caring for Clients with Cardiac Dysrhythmias Med Surg Prep - U
A client is diagnosed with sinus bradycardia. The nurse knows that the client's atrial rate is at or below what number?
60
The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the client's heart?
T wave
A nurse is caring for a client who is exhibiting ventricular tachycardia (VT). Because the client is pulseless, the nurse should prepare for what intervention?
Defibrillation
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action?
defibrillation
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."
The nurse is providing teaching to a client with an implanted cardiac device. Which client statement indicates that teaching has been effective?
"I will not place my cell phone in my chest pocket."
The nurse is providing discharge instructions for a client with a newly implanted cardiac defibrillator. What statement made by the client indicates the need for further teaching?
"I will report if I feel lightheaded and dizzy at my next doctor's appointment."
A patient is undergoing preoperative teaching before cardiac surgery. The nurse explains that a temporary pacemaker will be placed later that day, and it will be removed after the surgery. The patient asks the nurse what will happen if the pacemaker quits functioning. What is the nurse's best response?
"Monitoring for pacemaker malfunctioning and battery failure is something the nurse caring for you does."
The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response?
"The F waves are flutter waves representing atrial activity."
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 only difference is the heart rate."
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 has a normal beat, then a premature beat pattern."
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?
"The small box will transmit the heart rhythm to the central monitor all the time."
The nurse is providing care to a client who has just undergone an electrophysiologic (EP) study. The client reports being nervous about "things going wrong" during the procedure. What is the nurse's best response?
"The whole team will be monitoring you very closely for the entire procedure."
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."
A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best?
"Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
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?
"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
After performing an ECG on an adult client, the nurse reports that the PR interval reflects normal sinus rhythm. What is the PR interval for a normal sinus rhythm?
0.12 and 0.2 seconds.
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?
Atropine
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?
Administer an IV bolus of atropine.
A client is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this client is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine?
Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
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?
Alerting the healthcare provider of the third-degree heart block
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?
All options are correct.
The nurse is caring for a client who has been resistant to past antidysrhythmic therapy. Which cardiac dysrhythmic medication is administered for ventricular dysrhythmias when other mediations have failed?
Amiodarone
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?
Atrial depolarization
A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at a rate of 150 bpm, with no discernible P waves. What does the nurse determine this rhythm to be?
Atrial fibrillation
A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as
Atrial flutter
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?
Atrial flutter
A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia?
Atropine
Which medication is the drug of choice for sinus bradycardia?
Atropine
The nurse is planning discharge teaching for a client with a newly inserted permanent pacemaker. What is the priority teaching point for this client?
Avoid exposure to strong electromagnetic fields
Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker?
Avoid sources of electrical interference
A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker?
Avoid sources of electrical interference.
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).
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?
Begin cardiopulmonary resuscitation
A client has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this client?
Bleeding at the implantation site
When planning the care of a client with an implanted pacemaker, what assessment should the nurse prioritize?
Heart rate and rhythm
The nurse is caring for a client who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output?
Changes in level of consciousness
A client converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and diltiazem are given. The nurse caring for the client understands that the treatment has what main goal?
Control ventricular heart rate.
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?
P wave
The nurse and the other members of the team are caring for a client who converted to ventricular fibrillation (VF). The client was defibrillated unsuccessfully and the client remains in VF. The nurse should anticipate the administration of what medication?
Epinephrine 1 mg IV push
The nurse assesses a client returning from the post anesthesia unit with a new onset of sinus tachycardia with a heart rate of 138 beats per minute and a blood pressure of 128/80mmHg after elevating the head of the bed. What intervention does the nurse consider?
Evaluating laboratory values
An adult client with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
Fewer QRS complexes than P waves
The nurse recognizes which as being true of cardioversion?
Defibrillator should be set to deliver a shock during the QRS complex.
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?
Delayed conduction, producing a prolonged PR interval
A client is scheduled for catheter ablation therapy. When describing this procedure to the client's family, the nurse should address which aspect of the treatment?
Destruction of specific cardiac cells
The nurse is caring for a client with a cardiac arrhythmia whose cardiac function is being continuously monitored. In which order will the nurse analyze the rhythm strip?
Determine the ventricular rate. Determine the ventricular rhythm. Determine the QRS duration. Determine consistency of the QRS duration. Identify the shape of the QRS. Identify P waves and presence before QRS complexes. Identify P wave consistency and shape. Determine the atrial rate. Determine the atrial rhythm Determine the PR interval for consistency and number for each QRS complex
A client is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the client's care?
Diagnose the dysrhythmia.
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?
Double-check the 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?
During the procedure, the dysrhythmia will be reproduced under controlled conditions.
The nurse is caring for a client who is in the recovery room following the implantation of an ICD. The client has developed ventricular tachycardia (VT). What should the nurse assess and document?
ECG to compare time of onset of VT and onset of device's shock
The nurse reads an athletic client's electrocardiogram. What finding will be consistent with a sinus bradycardia?
Heart rate of 42 beats per minute (bpm).
What is the treatment of choice for ventricular fibrillation?
Immediate bystander CPR
A cardiac care nurse is caring for a client who is experiencing positive chronotropy. What effect should the nurse prepare for?
Increased heart rate
The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During the client's most recent follow-up appointment, the nurse identifies data that suggest the client may be socially isolated and depressed. What nursing diagnosis is suggested by these data?
Ineffective coping related to pacemaker implantation
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?
Insertion of a pacemaker
Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion?
Instruct the client to restrict food and oral intake
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
Monitor vital signs and cardiac rhythm
A client is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurse's responsibility in the care of the client's pacemaker?
Monitoring for pacemaker malfunction or battery failure
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?
Pacer rate
A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat." The nurse believes that the client is experiencing what condition?
Premature atrial contraction
The nursing educator is presenting a case study of an adult client who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG?
QRS complex
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?
QRS complex
The nurse is caring for a client who has had an ECG. The nurse notices that leads I, II, and III differ from one another on the cardiac rhythm strip. How should the nurse best respond?
Recognize that the view of the electrical current changes in relation to the lead placement.
The nurse is caring for a client with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the client's most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best interpret this finding?
Recognize this as a therapeutic goal of the procedure.
A client has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this client's care, which nursing diagnosis is most appropriate?
Risk for activity intolerance
The nurse is assisting with the monitoring of a client with a dysrhythmia that shows the pattern in the accompanying image. What dysrhythmia does the client have?
Sinus bradycardia
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
Nursing students are reviewing characteristics of a normal sinus rhythm. Which of the following characteristics would they accurately identify as true statements?
The SA node initiates the impulse. Impulse travels to the AV node in 0.12 to 0.2 second. Each impulse occurs regularly (evenly spaced).
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response?
The medication increases the force of the myocardial contraction.
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 have regular blood levels drawn
A patient has been admitted to the unit for an electrophysiology (EP) study. For what is an electrophysiology study primarily performed?
To diagnose the dysrhythmia
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 fibrillation
The nurse is caring for a client who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment?
Vigilant monitoring of the client's ECG
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi?
Warfarin
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
avoid caffeinated beverages.
When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be
captured.
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 cardiac muscle tissue.
The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document?
ventricular tachycardia
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
A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardiogram as an indicator of sinus tachycardia?
heart rate of 118 bpm
The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?
hypovolemia
A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation?
internal cardioverter defibrillator insertion
A client arrived at the hospital with symptoms of chest and jaw pain. After stabilizing the client's condition, the nurse discusses the client's symptoms, indicating that the most common cause of cardiac arrhythmias is:
ischemic heart disease.
Which condition is likely to predispose a client with congestive heart failure to developing a serious arrhythmia?
myocardial ischemia
A client's electrocardiogram reveals an irregular rhythm of 75 bpm with a normal QRS and P wave. The nurse who is caring for the client should anticipate:
no immediate treatment.
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
normal sinus rhythm.
A client had a permanent pacemaker implanted and has been doing well for over six months. Today, the client calls in, worried about not feeling well. Which symptom indicates that the nurse should immediately perform a telephone check on this client's pacemaker?
prolonged hiccups
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What type of arrhythmia would the cardiologist likely diagnose?
sinus tachycardia
A client has been using the recumbent bicycle as part of therapy after cardiac surgery. The client reports chest palpitations and fluttering. Which type of arhythmia might the client be experiencing?
tachyarrhythmia
During electrical cardioversion, the defibrillator is set to synchronize with the electrocardiogram (ECG) so that the electrical impulse discharges during
ventricular depolarization.