Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems compact

A nurse has provided discharge instructions to a client who received an implantable cardioverter defibrillator (ICD). Which statement, made by the client, indicates the need for further teaching? A. "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." B. "I should tell close friends and family members that I have an ICD." C. "I will document the date and time if my ICD fires." D. "I can play golf with my son in about 2 or 3 weeks."

A. "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." The client does not need to take a CPR class. However, it is recommended that the family members and friends of a client who has an ICD learn CPR. The other statements indicate that the nurse's teaching was effective.

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? A. "I should ask for a handheld device search when I go through airport security." B. "I should avoid contact sports." C. "I should avoid large magnetic fields, such as an MRI machine or large motors." D. "I'll watch the incision for swelling or redness and will report if either occurs." SUBMIT ANSWER

A. "I should ask for a handheld device search when I go through airport security." 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? A. "I'll keep a log of each time my ICD discharges." B. "I need to stay at least 10 inches away from the microwave." C. "I can't wait to get back to my football league." D. "I have an appointment for magnetic resonance imaging of my knee scheduled for next week."

A. "I'll keep a log of each time my ICD discharges." 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.

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? A. "You seem apprehensive about resuming sexual activity." B. "Sex is permitted following the implantation of an ICD." C. "I will be sure to share your concerns with the physician." D. "You really should speak to your wife about your concerns."

A. "You seem apprehensive about resuming sexual activity." 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 would expect which of the following atrial rates to correlate with an idioventricular rhythm? A. 20 to 40 B. 100 to 250 C. Not measurable D. 220 to 350

A. 20 to 40 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 presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? A. Atrial flutter B. Asystole C. Premature ventricular contraction D. Ventricular fibrillation

A. Atrial flutter Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.

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? A. Delayed conduction, producing a prolonged PR interval B. P waves hidden within the QRS complex C. Irregular rhythm D. Variable heart rate, usually fewer than 90 bpm

A. Delayed conduction, producing a prolonged PR interval 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.

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? A. Document the findings and continue to monitor the client B. Check the security of all connections and increase the milliamperage C. Obtain a 12-lead ECG and a portable chest x-ray D. Reposition the extremity and turn the client to left side

A. Document the findings and continue to monitor the client 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 is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? A. Elective cardioversion B. Pacemaker implantation C. Maze procedure D. Defibrillation

A. Elective cardioversion Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Maze procedure is only a distractor for this question. Pacemakers are implanted for bradycardia.

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

A. Hypokalemia 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.

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? A. Insertion of a pacemaker B. Administration of epinephrine C. Insertion of an implantable cardioverter defibrillator (ICD) D. Administration of atropine

A. Insertion of a pacemaker 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.

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

A. Monitor vital signs and cardiac rhythm The nurse should monitor the client's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill client. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a client flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary.

A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? A. The medication increases the force of the myocardial contraction. B. The medication increases the heart rate. C. The medication causes the kidneys to retain fluid and increase intravascular volume. D. The medication helps the kidneys produce more urine.

A. The medication increases the force of the myocardial contraction. A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine.

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? A. The registered nurse administering atropine sulfate intravenously B. The registered nurse stating to administer all medications except those which are cardiotonics C. The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute D. The registered nurse stating to administer digoxin

A. The registered nurse administering atropine sulfate intravenously 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.

A client has an irregular heart rate of around 100 beats/minute and a significant pulse deficit. What component of the client's history would produce such symptoms? A. atrial fibrillation B. heart block C. atrial flutter D. bundle branch block

A. atrial fibrillation In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. Atrial flutter, heart block, and bundle branch block would not produce these symptoms.

Which is not a likely origination point for cardiac dysrhythmias? A. bundle of His B. ventricles C. atria D. atrioventricular node

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

When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be A. captured. B. triggered. C. nonsynchronous. D. inhibited.

A. captured. Capture is a term used to denote that the appropriate electrocardiogram (ECG) complex followed by the pacing spike. Triggered response means that the pacemaker will respond when it senses intrinsic heart activity. Inhibited response means that the response of the pacemaker is controlled by the activity of the client's heart.

The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: A. occur at a rate of more than six per minute B. occur during the QRS complex C. have the same shape D. are paired with a normal beat

A. occur at a rate of more than six per minute When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy.

A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? A. internal cardioverter defibrillator insertion B. radiofrequency ablation C. electrophysiological study D. pacemaker insertion

ANS: A Feedback: The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart.

What is the drug of choice for a stable client with ventricular tachycardia? A. Procainamide B. Amiodarone C. Atropine D. Lidocaine

B. Amiodarone 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.

The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? A. "The P-R interval will be prolonged in sinus bradycardia." B. "The only difference is the heart rate." C. "The QRS complex will be smaller in sinus bradycardia." D. "The P waves will be shaped differently."

B. "The only difference is the heart rate." 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? A. "The heart rate is between 150 to 250 bpm." B. "The rhythm has a normal beat, then a premature beat pattern." C. "It is when the heart conduction is primarily from the aterioventricular node." D. "The rhythm is regular but fast."

B. "The rhythm has a normal beat, then a premature beat pattern." 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.

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. A client with third-degree heart block B. A client with atrial dysrhythmias C. A new myocardial infarction client D. A client with poor kidney perfusion

B. A client with atrial dysrhythmias he 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 licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment? A. An ECG machine B. A defibrillator C. A suction machine D. Cardioversion equipment

B. A defibrillator The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death. A suction machine is used to remove respiratory secretions. Cardioversion is used in a planned setting for atrial dysrhythmias. An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed.

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? A. Prepare to client for cardioversion. B. Administer an IV bolus of atropine. C. Send the client to the cardiac catheterization laboratory. D. Review the client's medication record.

B. Administer an IV bolus of atropine 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.

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

B. 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 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.

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

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

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

B. Avoid undergoing magnetic resonance imaging (MRI). A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector.

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

B. Fluttering 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? A. QR interval of 0.25 seconds. B. Heart rate of 42 beats per minute (bpm). C. P-to-QR ratio of 1:2. D. PR interval of 0.24 seconds.

B. Heart rate of 42 beats per minute (bpm). 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.

Which rhythm is also termed a ventricular escape rhythm? A. First degree AV block B. Idioventricular rhythm C. Ventriuclar asystole D. Ventricular fibrillation

B. Idioventricular rhythm Idioventricular rhythm is also called a ventricular escape rhythm.

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. A. QRT wave B. P-R interval C. T wave D. S-Q segment E. P wave

B. P-R interval C. T wave E. P wave 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? A. Atrial fibrillation B. Paroxysmal atrial tachycardia C. Sinus tachycardia D. Atrial flutter

B. Paroxysmal atrial tachycardia 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 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.) A. The patient may have a throbbing pain that is normal B. Record events that trigger a shock sensation. C. Call for emergency assistance if feeling dizzy. D. Avoid magnetic fields such as metal detection booths. E. The patient will have to schedule monthly chest x-rays to make sure the device is patent.

B. Record events that trigger a shock sensation. C. Call for emergency assistance if feeling dizzy. D. Avoid magnetic fields such as metal detection booths. 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.

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? A. Mid-clavicular line, fifth intercostal space B. Right side of sternum, fourth intercostal space C. Midway between V2 and V4 D. Left side of sternum, fourth intercostal space

B. Right side of sternum, fourth intercostal space 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.

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? A. SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches B. Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers C. SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers D. AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers

B. Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers 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.

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? A. Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 second. B. The sinoatrial (SA) node initiates the impulse. C. The ventricles depolarize in 0.5 second or less. D. Heart rate between 60 and 150 beats/minute.

B. The sinoatrial (SA) node initiates the impulse. 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

A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?\ A. Ventricular tachycardia B. Ventricular fibrillation C. Atrial fibrillation D. Third-degree heart block

B. Ventricular fibrillation 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 patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? A. Atropine B. Warfarin C. Amiodarone D. Adenosine

B. Warfarin Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone, flecainide, ibutilide, propafenone, or sotalol prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation

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? A. diltazem B. atropine sulfate C. atenolol D. nadolol

B. atropine sulfate Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation. The client will be treated with an anticholinergic that blocks the effects of the vagal nerve. Atenolol and nadolol are beta blockers that are used for chest pain, myocardial infarction, and hypertension. Diltazem is a calcium channel blocker used to treat angina or slow the heart rate.

A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? A. electrocautery B. electrocardiogram C. echocardiogram D. electroencephalogram

B. electrocardiogram An electrocardiogram is used to identify normal and abnormal cardiac rhythms.

A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: A. inherent rhythmicity of all muscle tissue. B. inherent rhythmicity of cardiac muscle tissue. C. inherent electrons in muscle tissue. D. sufficient blood pressure.

B. inherent rhythmicity of cardiac muscle tissue. 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 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? A. "I need to notify my cardiologist if I feel frequent kicks to the chest." B. "I should opt for a hand search at the airport instead of metal detector scan." C. "I need to stay away from microwaves." D. "I can continue to work with my power tools."

C. "I need to stay away from microwaves." 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.

A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? A. "I will cut back on my smoking and drinking alcohol." B. "If I take my metoprolol daily, I will be able to control my heart rate." C. "I will drink coffee with only two of my meals." D. "I will take my levothyroxine daily."

C. "I will drink coffee with only two of my meals." Stimulation of the sympathetic nervous system with caffeinated beverages, smoking, and drinking alcohol increases heart rate.The client is still drinking caffeine with two meals, increasing the risk for a fast heart rate. Taking medications such as metoprolol and levothyroxine will help the client maintain a normal heart rate by decreasing stimulation of the sympathetic nervous system.

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? A. "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." B. "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." C. "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." D. "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node."

C. "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." 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? A. "This is okay as long as you are not having any symptoms." B. "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase." C. "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." D. "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate."

C. "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." 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.

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? A. Vibration under the skin B. Quality of the pulse C. "Spike" on the rhythm strip D. Scar on the chest

C. "Spike" on the rhythm strip Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin.

A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? A. "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute." B. "The box is recording the heart's electrical activity, and a physician will review the tracing later." C. "The small box will transmit the heart rhythm to the central monitor all the time." D. "When your spouse needs help, an alarm will go off at the desk."

C. "The small box will transmit the heart rhythm to the central monitor all the time." 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 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? A. "The P-R interval will be prolonged in ventricular fibrillation, while in ventricular tachycardia the P-R interval is normal." B. "The two look very much alike; it is difficult to tell the difference." C. "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." D. "The QRS complex in ventricular fibrillation is always narrow, while in ventricular tachycardia the QRS is of normal width."

C. "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." 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 knows that what PR interval presents a first-degree heart block? A. 0.16 seconds B. 0.14 seconds C. 0.24 seconds D. 0.18 seconds

C. 0.24 seconds 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 is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? A. Assessing the client's blood pressure and heart rate frequently B. Maintaining the client's intravenous fluids C. Alerting the healthcare provider of the third-degree heart block D. Identifying the client's code level status

C. Alerting the healthcare provider of the third-degree heart block 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.

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

C. Altered patterns frequently affect the heart's ability to pump blood effectively. 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.

A patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. What does the nurse determine this rhythm to be? A. Sinus tachycardia B. Nonparoxysmal junctional tachycardia C. Atrial flutter D. Ventricular flutter

C. Atrial flutter Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Ventricular rhythm may be irregular, and P waves may be absent. Ventricular rate usually ranges between 75 and 150 bpm.

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

C. Avoid sources of electrical interference 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 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? A. Delay activities such as swimming and bowling for at least 3 weeks. B. Keep the arm on the side of the pacemaker higher than the head. C. Avoid sources of electrical interference. D. Keep moving the arm on the side where the pacemaker is inserted.

C. Avoid sources of electrical interference. The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc.

The nurse recognizes which as being true of cardioversion? A. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time. B. Electrical impulse can be discharged during the T wave. C. Defibrillator should be set to deliver a shock during the QRS complex. D. Amount of voltage used should exceed 400 watts/second.

C. Defibrillator should be set to deliver a shock during the QRS complex. Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation.

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

C. Delayed conduction, producing a prolonged PR interval 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 preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching? A. After the procedure, the dysrhythmia will not recur. B. The procedure takes less time than a cardiac catheterization. C. During the procedure, the dysrhythmia will be reproduced under controlled conditions. D. The procedure will occur in the operating room under general anesthesia.

C. During the procedure, the dysrhythmia will be reproduced under controlled conditions. During EP studies, the patient is awake and may experience symptoms related to the dysrhythmia.The client does not receive general anesthesia. The EP procedure time is not easy to determine. EP studies do not always include ablation of the dysrhythmia.

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

C. It is used to eliminate ventricular dysrhythmias. 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.

A client asks the nurse about complications associated with use of a cardiac pacemaker. What does the nurse include in their response? Select all that apply. A. Positive Kernig's sign B. Negative Babinski reflex C. Localized infection D. Hiccuping E. Twiddler syndrome

C. Localized infection D. Hiccuping E. Twiddler syndrome Complications associated with pacemakers include infection at entry site, pneumothorax, bleeding and hematoma, hemothorax, ventricular ectopy and tachycardia, phrenic nerve/diaphragmatic(hiccupping)/skeletal stimulation, cardiac perforation, Twiddler syndrome, and hemodynamic instability. A positive Kernig's sign is an indication of meningitis. A positive Babinski reflex is normal in neonates, but indicates a central nervous system disorder in adults.

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

C. P wave 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 healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response? A. Atrial flutter B. Ventricular fibrillation C. Premature atrial complex D. Sinus tachycardia

C. Premature atrial complex A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.

The nurse 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? A. ST segment that is isoelectric in appearance B. PR interval that is 0.18 seconds long C. QT interval that is 0. 46 seconds long D. QRS complex that is 0.10 seconds long

C. QT interval that is 0. 46 seconds long 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.

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? A. A temporary pacemaker B. Asynchronous C. Self-activated D. A fixed-rate pacemaker

C. Self-activated 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 proving discharge instructions for a client with a new arrhythmia. Which statement should the nurse include? A. It is not necessary to learn how to take your own pulse. B. If you miss a dose of your antiarrhythmia medication, double up on the next dose. C. Your family and friends may want to take a CPR class. D. Do not be concerned if you experience symptoms of lightheadedness and dizziness.

C. Your family and friends may want to take a CPR class. Having friends and family learn to perform CPR will help the client manage the arrhythmia. Monitoring pulse rate at home also helps the client manage the condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness should be reported to the provider.

The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? A. hypertension B. tachycardia C. feeling tired D. change in mental status

C. feeling tired 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.

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 electrocardigram as an indicator of sinus tachycardia? A. Q wave of 0.04 seconds B. PR interval of 0.1 seconds C. heart rate of 118 bpm D. QRS duration of 0.16 seconds

C. heart rate of 118 bpm The sinus node creates an impulse at a faster-than-normal rate. The PR interval of 0.1 seconds, QRS duration of 0.16 seconds and Q wave of 0.04 seconds are consistent with a normal sinus rhythm. Sinus tachycardia occurs when the heart rate is over 100 bpm

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

C. hypovolemia 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.

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? A. normal postoperative healing B. internal bleeding at pacemaker site C. pacemaker site infection D. postoperative site hematoma

C. pacemaker site infection 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? A. atrial bradycardia B. heart block C. sinus bradycardia D. none

C. sinus bradycardia Sinus bradycardia is a dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual (less than60 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 A. sinus tachycardia. B. sinus bradycardia. C. sinus dysrhythmia. D. normal sinus rhythm.

C. sinus dysrhythmia. Sinus dysrhythmia occurs when the sinus node creates an impulse at an irregular rhythm. Normal sinus rhythm occurs when the electrical impulse starts at a regular rate and rhythm in the SA node and travels through the normal conduction pathway. Sinus bradycardia occurs when the sinus node regularly creates an impulse at a slower-than-normal rate. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate.

The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? A. Early ventricular repolarization B. Ventricular depolarization C. Ventricular repolarization D. Atrial depolarization

D. Atrial depolarization The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave.

The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? A. Date and time of insertion B. Model number C. Location of the generator D. Pacer rate

D. Pacer rate After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.

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

D. ventricular depolarization. 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 is caring for a 32-year-old client admitted with a medical diagnosis of atrial fibrillation, related to "holiday heart" syndrome. A nursing student working with the nurse asks for information about "holiday heart" syndrome. Which is the best response by the nurse? A. "This is the association of heart dysrhythmias, especially atrial fibrillation, with physical activity the client is not used to." B. "This is the association of heart dysrhythmias, especially atrial fibrillation, with very heavy meals." C. "This is the association of heart dysrhythmias, especially atrial fibrillation, with extramarital sex." D. "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking."

D. "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." Atrial fibrillation may be found in people with acute moderate to heavy ingestion of alcohol.

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? A. "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." B. "I will avoid any large magnets that may affect my pacemaker." C. "I will call the doctor if my incision becomes swollen and red." D. "We will be getting rid of our microwave oven so it will not affect my pacemaker."

D. "We will be getting rid of our microwave oven so it will not affect my pacemaker." 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.

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? A. "You'll need to take an extra dose of your antiarrhythmic before you shoot." B. "Being that close to a rifle might make your ICD fire." C. "Enjoy your hunting trip." D. "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."

D. "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." 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 is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? A. "There is a long list of clients in line to be cardioverted." B. "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." C. "The doctor wants to see if your heart will switch back to its normal rhythm by itself." D. "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion."

D. "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion. The doctor will not wait for a change in rhythm. Resting the heart will not change the rhythm. There is no delay but safer for the clots to be dissolved with the anticoagulant.

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? A. 0.4 B. 0.3 C. 0.1 D. 0.2

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

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 A. Atrial fibrillation B. Ventricular tachycardia C. Ventricular fibrillation D. Atrial flutter

D. Atrial flutter 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 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? A. R-on-T phenomenon B. Multifocal PVCs C. Couplets D. Bigeminy

D. Bigeminy 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? A. Procainamide B. Diltiazem C. Amiodarone D. Carvedilol

D. Carvedilol 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.

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? A. Clients with recurrent life-threatening bradycardias B. Clients with sinus tachycardia C. Clients with ventricular bradycardia D. Clients with recurrent life-threatening tachydysrhythmias

D. Clients with recurrent life-threatening tachydysrhythmias 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.

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? A. Decreased peripheral vascular resistance B. Increased cardiac output and increased systolic and diastolic blood pressure C. Decreased blood pressure with reflex tachycardia D. Decreased cardiac output and decreased systolic and diastolic blood pressure

D. Decreased cardiac output and decreased systolic and diastolic blood pressure 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.

A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? A. Measure the client's blood pressure. B. Suggest the need for a new beta-blocker to the doctor. C. Do nothing; there is no cause for alarm. D. Double-check the monitoring equipment.

D. Double-check the monitoring equipment. One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

A nurse is caring for a client with atrial fibrillation. What procedure would the nurse educate the patient about for termination of the dysrhythmia? A. Pacemaker implantation B. Defibrillation C. Mace procedure D. Elective cardioversion

D. Elective cardioversion Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Mace procedure is only a distractor for this question. Pacemakers are implanted for bradycardia.

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

D. Immediate CPR Immediate CPR is used during pulseless ventricular tachycardia and ventricular fibrillation

Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? A. Administer digitalis and diuretics 24 hours before cardioversion B. Monitor blood pressure every 4 hours C. Facilitate CPR until the client is prepared for cardioversion D. Instruct the client to restrict food and oral intake

D. Instruct the client to restrict food and oral intake The nurse should instruct the client to restrict food and oral intake before the cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion. When the client is in cardiopulmonary arrest, the nurse should facilitate CPR until the client is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a client with cardiac dysrhythmia.

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? A. Faulty generator B. Sensitivity is too low C. Fracture of the lead wire D. Lead wire dislodgement

D. Lead wire dislodgement Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation.

A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding? A. Prolonged QT interval B. Occasional U waves C. Flattened P waves D. Peaked T waves

D. Peaked T waves 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? A. Ventricular bigeminy B. Ventricular fibrillation C. Ventricular tachycardia D. Premature ventricular contraction

D. Premature ventricular contraction 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.

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

D. QRS complex 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.

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? A. Instruct the client to hold the breath and bear down. B. Place the client on supplemental oxygen. C. Prepare to administer a calcium channel blocker. D. Question the client about alcohol and illicit drug use.

D. Question the client about alcohol and illicit drug use. 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.

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? A. Second degree, type II B. First degree C. Second degree, type I D. Third degree

D. Third degree 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? A. Charge the defibrillator to the prescribed voltage. B. Apply the multifunction conductor pads to the client's chest. C. Deliver the prescribed electrical charge. D. Turn on the defibrillator and place it in "not sync" mode. E. Call "clear" three times ensuring client and environmental safety.

D. Turn on the defibrillator and place it in "not sync" mode. A. Charge the defibrillator to the prescribed voltage. B. Apply the multifunction conductor pads to the client's chest. E. Call "clear" three times ensuring client and environmental safety. C. Deliver the prescribed electrical charge. This is the sequence of events the nurse should implement when delivering emergent defibrillation. If not followed correctly, the client and health care team may be placed in danger.

The nurse is admitting a client to a telemetry unit with an atrial dysrhythmia. What symptoms will the nurse further evaluate? A. leg pain B. hypertension C. hypocarbia D. chest pain

D. chest pain Clients with atrial dysrhythmias may have chest pain, shortness of breath, and low blood pressure. Leg pain is not common with atrial dysrhythmias. Hypocarbia is seen with reduced carbon dioxide, not common with chrpulmonary disease.

The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as A. junctional tachycardia. B. first-degree atrioventricular block. C. sinus tachycardia. D. normal sinus rhythm.

D. normal sinus rhythm. The electrocardiogram (ECG) tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1.

A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? A. atrial flutter B. sinus tachycardia C. heart block D. supraventricular tachycardia

D. supraventricular tachycardia Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (over 150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill. These symptoms do not suggest sinus tachycardia, heart block, or atrial flutter.

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? (Rhythm of qrs complexes that are very disorganized) A. atrial flutter B. sinus bradycardia C. idioventricular rhythm D. ventricular fibrillation E. sinus rhythm with third-degree atrioventricular block

D. ventricular fibrillation he 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.

A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response? A. Call a code and obtain the crash cart. B. Call for assistance and begin CPR. C. Administer a pericardial thump. D.Assess the client and monitor leads.

D.Assess the client and monitor leads. The nurse should assess the client and monitor leads first. It is important that the nurse "treat the client, not the monitor." Ventricular asystole may often appear on the monitor when leads are displaced. The other interventions are not necessary.