Chapter 34 Care of Patients With Dysrhythmias
Which is an expected finding for a normal PR interval? 0.16 seconds 0.22 seconds 0.10 seconds 0.04 seconds
0.16 seconds
What component of a normal electrocardiogram represents early ventricular repolarization? U wave QT interval ST segment QRS complex
ST segment
The nurse is providing discharge instructions to a patient diagnosed with vasovagal bradycardia. Which instruction should the nurse include? -'It is important to avoid constipation.' -'If you feel your heart slowing, raise your hands over your head.' -'If you feel lightheaded or faint, it is important to try to bear down.' -'Gentle pressure over your carotid artery may help with increasing your heart rate.'
'It is important to avoid constipation.'
A 12-lead electrocardiogram (ECG) is being performed on a female patient for the purpose of cardiac evaluation. What should the nurse include in the teaching when instructing the patient about the ECG test? Select all that apply. 'Remain as still as possible.' 'You will not be permitted to eat.' 'Breathe normally without repetitive movement.' 'Your bed will be moved into the Trendlenburg position.' 'You may need to move your breasts so leads can be placed on your chest.'
'Remain as still as possible.' 'Breathe normally without repetitive movement.' 'You may need to move your breasts so leads can be placed on your chest.'
The registered nurse teaches a student nurse about continuous electrocardiogram (ECG) monitoring and the skin and electrode preparations that could affect the ECG recordings. Which statement by the student nurse indicates the need for further teaching? -'The area for electrode placement must be moist.' -'Electrodes should not be placed on irritated skin or over scar tissue.' -'The skin should be cleaned and the hair should be clipped if needed.' -'The electrode is attached to the lead cable and then to the contact site.'
'The area for electrode placement must be moist.'
Which steps are involved in the electrocardiographic rhythm analysis of P waves? Select all that apply. -Looking for the presence of P waves -Analyzing the similarity in appearance of P waves -Assessing whether P waves are greater than 0.20 seconds -Assessing the consistent occurrence of one P wave for each QRS complex -Placing one caliper point at the start of the P wave and the other at the end of the PR segment
-Looking for the presence of P waves -Analyzing the similarity in appearance of P waves -Assessing the consistent occurrence of one P wave for each QRS complex
The nurse is caring for a patient who is undergoing synchronized cardioversion. Which interventions are the nurse responsible for after the cardioversion? Select all that apply. -Maintaining a patent airway -Monitoring for dysrhythmias -Assessing the need for further cardioversion -Assessing the chest for burns from electrodes -Ordering a post-cardioversion transesophageal echocardiogram
-Maintaining a patent airway -Monitoring for dysrhythmias -Assessing the chest for burns from electrodes
The nurse is analyzing the electrocardiographic rhythm of a patient and identifies an abnormal T wave. What problems are potential causes for this abnormality? Select all that apply. -Anxiety -Nicotine use -Myocardial infarction -Ventricular hypertrophy -Chronic obstructive pulmonary disease (COPD)
-Myocardial infarction -Ventricular hypertrophy
The nurse administers lidocaine to a patient experiencing trigeminal premature ventricular contractions (PVCs). After providing this treatment, what actions are priority? Select all that apply. -Insert artificial airway -Observe patient for seizures -Monitor for hypomagnesemia -Assess for numbness or tingling -Assess for swelling of the extremities
-Observe patient for seizures -Assess for numbness or tingling
What interventions should a nurse prepare when caring for a patient experiencing stable ventricular tachycardia? Select all that apply. -Oxygen -Atropine -Adenosine -Bi-ventricular pacing -12-lead electrocardiogram (ECG)
-Oxygen -12-lead electrocardiogram (ECG)
The emergency room nurse is caring for a patient with a suspected myocardial infarction. What component of the patient's cardiac rhythm should be evaluated further for this suspected diagnosis? Select all that apply. -P wave -T wave -PR interval -ST segment -QRS complex
-T wave -ST segment
In electrocardiography, what is the normal time measurement of the PR interval? 0.04-0.12 second 0.12-0.20 second 0.20-0.28 second 0.28-0.36 second
0.12-0.20 second
The nurse prints out the following 6-second strip and analyzes the rhythm using the eight-step method. How many seconds is the PR interval? 0.04 seconds 0.08 seconds 0.12 seconds 0.16 seconds
0.16 seconds
The nurse is evaluating a patient's electrocardiogram (ECG) rhythm strip. The nurse notes the presence of a U wave. What action by the nurse is priority? -Check the patient's lead placement -Prepare to administer magnesium sulfate -Document the findings in the patient's chart -Request that a stat potassium level is obtained
Request that a stat potassium level is obtained
What is the primary pacemaker of the heart? -Bundle of His -Purkinje fibers -Sinoatrial (SA) node -Atrioventricular (AV) node
Sinoatrial (SA) node
Which property of the heart is considered its mechanical activity? -Excitability -Conductivity -Automaticity -Contractility
Contractility
In which location would the nurse place lead II for a positive deflection electrocardiogram (ECG)? Left arm or under the heart Left leg or lowest rib, left midclavicular line Fifth intercostal space, left midclavicular line Fourth intercostal space, left of the sternal border
Fourth intercostal space, left of the sternal border
The registered nurse is teaching a student nurse about the causes of artifacts on an electrocardiogram (ECG). Which statement by the student nurse needs correction? -'Using loose electrodes during recording causes artifacts.' -'Grounding the equipment during recording causes artifacts.' -'Unnecessary patient movements during recording cause artifacts.' -'Faulty electrodes and equipment used during recording cause artifacts.'
'Grounding the equipment during recording causes artifacts.'
A patient is being continuously monitored on the telemetry unit and has had stable rhythm, as noted on the electrocardiogram (ECG) strip. The patient asks when his monitor can be discontinued. What is an appropriate response by the nurse? 'Monitoring can be discontinued at bedtime.' 'Monitoring cannot be discontinued for any reason.' 'You can determine when monitoring can be discontinued.' 'Monitoring can usually be suspended for showering and transport to other units.'
'Monitoring can usually be suspended for showering and transport to other units.'
Determine the heart rate for a patient with 12 QRS complexes in the 6-second strip. 12 100 110 120
120
The nurse is attempting to analyze an electrocardiogram (ECG) strip. How many large blocks represent a 6-second strip? 5 15 25 30
30
Which technique is used by the nurse to calculate the accurate heart rate for a patient who shows irregular rhythms on the electrocardiogram (ECG) strip? Memory method Big block method Rule of 300 method 6-second strip method
6-second strip method
The nurse is calculating the patient's heart rate from a 6-second rhythm strip. There are eight QRS complexes in the strip. How does the nurse document the patient's estimated heart rate? Record your answer using a whole number.
80 beats per minute
The nurse is assigned the following four patients. Which patient should the nurse see first? -A patient diagnosed with a bradydysrhythmia who has a pulse of 62 bpm at this time -A patient admitted with chest pain in normal sinus rhythm who has no discernible P waves at this time -A patient who presents uncontrolled atrial fibrillation and underwent a successful cardioversion yesterday -A patient waiting for discharge who was in torsades de pointes when admitted, who is now in normal sinus rhythm
A patient admitted with chest pain in normal sinus rhythm who has no discernible P waves at this time
The nurse is caring for a patient with a ventricular fibrillation. The patient has had three cycles of CPR after receiving an initial shock. When should the nurse plan to administer another shock? -In approximately 4 minutes -After two more cycles of CPR -Defibrillation cannot be used twice -After the adenosine has been administered
After two more cycles of CPR
Which statements are true regarding artifacts seen on the monitor or rhythm strip? Select all that apply. An artifact may look like a fuzzy baseline. An artifact may look like a straight, narrow line. An artifact may mimic a lethal dysrhythmia. The monitor is more reliable than patient assessment. An artifact can be caused by patient movement or loose electrodes.
An artifact may look like a fuzzy baseline. An artifact may mimic a lethal dysrhythmia. An artifact can be caused by patient movement or loose electrodes.
How should the nurse analyze the ventricular rhythm on an electrocardiogram (ECG) tracing? Measure the duration of the QRS complex. Assess the RR intervals throughout the ECG tracing. Evaluate the PP intervals throughout the ECG tracing. Count the number of QRS complexes in 6 seconds and multiply by 10.
Assess the RR intervals throughout the ECG tracing.
The nurse looks at the monitor and notices ventricular tachycardia. What action should the nurse take first? -Call for help -Assess the patient -Begin cardiopulmonary resuscitation (CPR) -Prepare to administer intravenous (IV) lidocaine
Assess the patient
The nurse notices this rhythm on a patient's cardiac monitor. Which action should the nurse take first? Administer oxygen Prepare for defibrillation Begin cardiopulmonary resuscitation Assess the patient's airway, breathing, and circulation
Assess the patient's airway, breathing, and circulation
Which action is occurring in a patient's conduction system during the circled part of the electrocardiogram (ECG) waveform? -Atrial kick -Atrial depolarization -Ventricular contraction -T-cell (transitional cell) impulse slowing
Atrial depolarization
Which parameter is determined by analyzing the P waves on an electrocardiogram (ECG) using the walking out technique? Tachycardia Bradycardia Atrial rhythm Intensity of atrial depolarization
Atrial rhythm
The nurse is caring for a patient diagnosed with a vagally-induced symptomatic bradydysrhythmia. Which medication does the nurse anticipate will be ordered for this patient? -Digoxin -Atropine -Adenosine -Magnesium sulfate
Atropine
What is the ability of the cardiac cells to generate an electrical impulse spontaneously and repetitively called? Excitability Conductivity Contractility Automaticity
Automaticity
What specialized function of myocardial cells gives them a pacing function? Excitability Contractility Conductivity Automaticity
Automaticity
When placing electrodes on the patient for continuous electrocardiographic monitoring, the nurse places the electrodes on which locations? Select all that apply. Below the scapula Near the metatarsal Below the left clavicle Below the right clavicle On the lowest palpable rib, left mid-clavicular line On the lowest palpable rib, right mid-clavicular line
Below the left clavicle Below the right clavicle On the lowest palpable rib, left mid-clavicular line On the lowest palpable rib, right mid-clavicular line
The patient has two premature ventricular contractions (PVCs) that are repeating in their cardiac rhythm every 3 seconds. The nurse correctly documents this as which type of rhythm? -Unifocal PVC -Multifocal PVC -Bigeminal PVCs -Nonsustained ventricular tachycardia
Bigeminal PVCs
The nurse is administering adenosine to a patient with supraventricular tachycardia. While administering the drug, the patient has a short period of asystole and then returns to normal sinus rhythm. What action by the nurse is priority? Continue to monitor the patient Contact the health care professional Prepare to administer atropine sulfate Place defibrillation pads on the patient's chest
Continue to monitor the patient
The nurse is caring for a patient 2 hours postoperatively. The patient appears confused and has the following vital signs: blood pressure 88/40, pulse 125, oxygen saturation 94%, and respiratory rate 24. The nurse analyzes the cardiac rhythm and determines the patient is in sinus tachycardia. What action should the nurse take first? -Call for assistance -Administer digoxin IV -Decrease the IV fluids -Initiate the Valsalva maneuver
Call for assistance
How does the nurse establish that an impulse from one focus is responsible for both atrial and ventricular depolarization? -Analyze whether the P wave shape is consistent. -Determine whether impulses originate from the SA node. -Determine whether intervals are greater than 0.20 seconds. -Check that one P wave occurs before each QRS complex.
Check that one P wave occurs before each QRS complex.
The nurse is caring for a patient who just had a 12-lead electrocardiogram (ECG). The nurse notices that the ECG is different from the previous ECG reading in most leads. Which action should the nurse take first? Contact the health care provider Perform a full head-to-toe physical Check the electrode placement on the patient Ask the unlicensed assistive personnel to repeat the ECG
Check the electrode placement on the patient
The nurse is caring for a patient diagnosed with supraventricular tachycardia associated with excessive beta-adrenergic stimulation. Which class of antidysrhythmic drugs does the nurse anticipate being ordered for this patient? Class I Class II Class III Class IV
Class II
The nurse is caring for a patient who requires a 12-lead electrocardiogram (ECG). Which interventions should the nurse perform to ensure the best signal transmission? Select all that apply. Clean and dry skin Avoid areas with scar tissue Clip hair in the area being used Use non-scented lotions on chest Ensure gel on electrodes is not moist
Clean and dry skin Avoid areas with scar tissue Clip hair in the area being used
The nurse is preparing to perform a 12-lead electrocardiogram (ECG) on a patient. Where does the nurse place the first V-lead (precordial lead)? Left leg toward the ankle Left arm toward the wrist Fourth intercostal space, right sternal border Fourth intercostal space, left sternal border
Fourth intercostal space, right sternal border
What drug is an antidysrhythmic drug used to slow ventricular conduction? -Diltiazem -Apixaban -Atropine sulfate -Magnesium sulfate
Diltiazem
The patient's telemetry reading shows a P wave before each QRS complex, and the rate is 78 beats/minute. Which action should the nurse implement? Prepare to administer digoxin PO Assess the patient's cardiac enzymes Request a 12-lead electrocardiogram Document it as normal sinus rhythm (NSR)
Document it as normal sinus rhythm (NSR)
A patient admitted with a new diagnosis of hypertension demonstrates sinus bradycardia with a heart rate of 52 bpm on the electrocardiogram (ECG) monitor. The nurse assesses the patient and determines if the patient is asymptomatic. What actions by the nurse are priorities? Select all that apply. Increase the patient's IV fluids Administer the prescribed digoxin Document the assessment findings Contact the primary health care provider Assess the medication administration record
Document the assessment findings Contact the primary health care provider Assess the medication administration record
The nurse is reviewing the patient's continuous ECG and notes a depression of the ST segment. About which conditions should the nurse be concerned? Select all that apply. Pericarditis Hypokalemia Hyperkalemia Myocardial infarction Ventricular hypertrophy
Hypokalemia Myocardial infarction Ventricular hypertrophy
What does the PR interval represent on the electrocardiogram (ECG)? Atrial depolarization Ventricular depolarization Impulse traveling to the base of the ventricle Impulse traveling from the atrium to the ventricles
Impulse traveling to the base of the ventricle
Many acute care hospitals have monitor technicians on their telemetry floors to follow patients being monitored by continuous electrocardiogram (ECG). What are the responsibilities of the monitor technician? Select all that apply. -Interpret rhythms and report -Assess monitored patients every 4 hours -Print ECG rhythm strips routinely and as needed -Have ongoing communication with the physicians -Continually watch the bank of monitors on the acute care unit -Report the patient's rhythm and significant changes to the nurse
Interpret rhythms and report Print ECG rhythm strips routinely and as needed Continually watch the bank of monitors on the acute care unit Report the patient's rhythm and significant changes to the nurse
The nurse initiates cardiac monitoring for a patient with a potassium level of 2.5 mEq/L. What electrocardiogram (ECG) change does the nurse anticipate? Absent P waves Inverted T wave Prolonged PR interval Premature atrial contractions
Inverted T wave
What represents no electrical current flow in the heart on the electrocardiogram (ECG)? Cardiac axis Isoelectric line Positive deflections Negative deflections
Isoelectric line
The nurse is reviewing the medical history of a patient recently admitted to the floor and notes the patient has sinus arrhythmia. The nurse knows which information about sinus arrhythmia is true? Select all that apply. It is an irregular rhythm. It means absence of rhythm. It has all the characteristics of normal sinus rhythm. It is frequently observed in patients with coronary heart disease. The heart rate increases and decreases slightly during respirations.
It is an irregular rhythm. The heart rate increases and decreases slightly during respirations.
Which criteria does the normal sinus rhythm meet? Select all that apply. It originates from the SA node. The QRS duration is 0.04-0.10 seconds. The PR interval measures 0.10-0.20 seconds. It has atrial and ventricular rates of 70-100 beats/min. Atrial and ventricular rhythms may be regular or irregular.
It originates from the SA node. The QRS duration is 0.04-0.10 seconds.
The nurse is caring for a patient who develops torsades de pointes. What medication should the nurse administer? -Digoxin -Amiodarone -Atropine sulfate -Magnesium sulfate
Magnesium sulfate
The nurse analyzes a patient's electrocardiography (ECG) rhythm strip. During the analysis, the nurse determines that the patient has bradycardia and assesses for atrial regularity. Then the nurse measures the PR interval, the QRS duration, and identifies that the patient has ST depression. Which analyses must the nurse still perform to complete this ECG rhythm strip review? Select all that apply. Determining the heart rate Measuring the QT interval Observing the heart rhythm Examining the ST segment Noting the shape and height of the T wave
Measuring the QT interval Noting the shape and height of the T wave
The nurse observes abnormal T waves in the electrocardiogram of a patient with dysrhythmia. What is the possible reason for the patient's dysrhythmia? Ectopic focus Myocardial infarction Electrolyte imbalances Coronary artery disease
Myocardial infarction
The nurse is preparing to administer adenosine to a patient experiencing supraventricular tachycardia (SVT). The nurse should have what other items readily available? Select all that apply. Lamin AC Rivaroxaban Normal saline bolus Blood for transfusion Emergency equipment
Normal saline bolus Emergency equipment
How would the nurse interpret the cardiac rhythm in the figure? Sinus arrhythmia Sinus tachycardia Sinus bradycardia Normal sinus rhythm
Normal sinus rhythm
The nurse is caring for a patient diagnosed with bradycardia. The patient's pulse rate is between 50 to 55 bpm. The patient is hypotensive and complains of dizziness and weakness. The cause of the bradycardia is undetermined. Which treatment would be given to this patient? Select all that apply. Oxygen IV fluids Adenosine 6 mg IV push Atropine 0.5 mg IV bolus Synchronized cardioversion
Oxygen IV fluids Atropine 0.5 mg IV bolus
What complexes make up a normal electrocardiogram (ECG)? Select all that apply. S wave P wave T wave U wave QRS complex
P wave T wave QRS complex
The nurse supervises as a student nurse places electrodes on a patient for continuous electrocardiographic monitoring. Which action made by the student nurse causes the nurse to intervene? -Placing the left leg electrode on the lowest palpable rib. -Placing the left arm electrode just above the left clavicle. -Placing the right leg electrode on the lowest palpable rib. -Placing the right arm electrode just below the right clavicle.
Placing the left arm electrode just above the left clavicle.
A patient's rhythm strip shows a heart rate of 116 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.16 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? Sinus tachycardia Sinus bradycardia Normal sinus rhythm Sinus rhythm with premature ventricular contractions
Sinus tachycardia
The nurse correctly identifies which medications as Class II antidysrhythmics used to decrease heart rate and conduction velocity? Select all that apply. Sotalol hydrochloride Esmolol hydrochloride Tocainide hydrochloride Propranolol hydrochloride Amiodarone hydrochloride
Sotalol hydrochloride Esmolol hydrochloride Propranolol hydrochloride
Which situation is appropriate for a nurse to perform synchronized countershock? Select all that apply. Ventricular fibrillation Stable atrial tachydysrhythmias Ventricular asystole or standstill Premature ventricular contractions Unstable ventricular tachydysrhythmias
Stable atrial tachydysrhythmias Unstable ventricular tachydysrhythmias
The nurse is educating a patient diagnosed with premature ventricular contractions (PVCs). The patient has been experiencing 1000-1500 PVCs in a 24-hour period. Which treatment education should be included in the teaching? -Stress management -Low potassium diet -Beta-adrenergic blocking agent -Battery replacement for a biventricular pacemaker
Stress management
Which statement accurately describes the area of the heart that initiates the cardiac cycle? -The ventricles' Purkinje fibers are responsible for the initial cardiac impulse. -The bundle of His acts to initiate cardiac contraction in the atria with a resulting QRS complex. -The atrioventricular area acts as the primary pacemaker and produces the P wave on the ECG. -The sinoatrial (SA) node is the primary pacemaker of the heart whose activity is reflected in the P wave on the ECG.
The sinoatrial (SA) node is the primary pacemaker of the heart whose activity is reflected in the P wave on the ECG.
The nurse reviews a patient's electrocardiogram (ECG) and notes that there is no current flow in the heart after complete depolarization as well as after complete repolarization. What does the nurse understand about this finding? This is the patient's isoelectric line. The patient has a positive deflection. This is the representative negative deflection. The patient is experiencing distress in the lead axis.
This is the patient's isoelectric line.
To accurately monitor the patient's heart rhythm, the nurse must be able to analyze the electrocardiogram (ECG) strip. Which statements are true regarding ECG paper? Select all that apply. Time is measured horizontally Each large box measures 0.20 seconds Each small box measures 0.04 seconds One large block includes four small boxes Each large box measures 1 mm height and 1 mm width
Time is measured horizontally Each large box measures 0.20 seconds Each small box measures 0.04 seconds
Which cardiac dysrhythmia results from a prolonged QT interval? -Torsades de pointe -Ventricular standstill -Ventricular fibrillation -Premature ventricular contractions
Torsades de pointe
The nurse is caring for a patient with hypokalemia. Which abnormality does the nurse notice on the electrocardiogram (ECG)? U wave present Prolonged PR interval An elevated ST segment Abnormally present Q wave
U wave present
A 12-lead electrocardiogram (ECG) is ordered for a patient in an outpatient clinic. The patient expresses some concern and nervousness about the test. What should the nurse include in the teaching to decrease the patient's potential anxiety? Electrodes will be placed on the chest and legs Acetaminophen must be given an hour before the test A contrast agent will be injected, but it will not cause pain No food or liquids are permitted up to 4 hours before the test
Electrodes will be placed on the chest and legs
Which medication is prescribed to a patient who is at high risk of emboli? Digoxin Diltiazem Metoprolol Enoxaparin
Enoxaparin
The nurse is documenting an admission assessment of a patient scheduled for an elective cardioversion. Which statement by the patient should be reported to the health care provider immediately? -'I am really worried about feeling the shock.' -'I have not taken my digoxin since yesterday.' -'The last time I ate was a small spinach salad last night.' -'I have been taking my anticoagulant for the past 5 weeks.'
'I have not taken my digoxin since yesterday.'
The nurse teaches a patient diagnosed with atrial fibrillation about verapamil hydrochloride, a new prescription the patient will be taking orally at home. Which statement by the patient indicates the teaching was successful? -'I will need to check my pulse every 8 hours.' -'I should lay flat for an hour after I take the medicine.' -'I will bear down if I feel my heart starting to beat fast.' -'I will take my time getting up and changing positions.'
'I will take my time getting up and changing positions.'
A patient is recovering from a myocardial infarction but has developed a dysrhythmia. The patient asks the nurse what caused the change in rhythm. Which explanation by the nurse is accurate? -'Negatively charged cells have gained a positive charge.' -'The heart rate has increased, causing a change in rhythm.' -'The dysrhythmia was caused by blood moving through the heart efficiently.' -'Other cardiac cells in addition to the SA node create electrical impulses, causing a dysrhythmia.'
'Other cardiac cells in addition to the SA node create electrical impulses, causing a dysrhythmia.'
The nurse is caring for an older adult patient who is on continuous cardiac monitoring. The patient is watching the monitor and expresses concern about a wide area that has occurred twice in the last 10 minutes. The nurse recognizes that this is a premature ventricular contraction (PVC). Which statement by the nurse is appropriate? -'It is OK, you are probably just moving around.' -'PVCs are common and increase as we get older.' -'I will have your health care provider come in and talk to you about this.' -'You may have underlying chronic obstructive pulmonary disease (COPD).'
'PVCs are common and increase as we get older.'
The nurse is performing chest compressions on a patient in asystole. Another nurse enters the room with the defibrillator. What action by the first nurse is priority? -Continue compressions -Clear the area of movable items -Analyze the patient's cardiac rhythm -Step away to allow the defibrillator to be set up
Continue compressions
The nurse is reviewing the electrocardiogram (ECG) of a patient with cardiac dysrhythmias and observes shape changes in the P wave in the given lead. What is the possible reason for these changes in the P wave? Ectopic focus Myocardial ischemia Electrolyte imbalances Coronary artery disease
Ectopic focus
The nurse is caring for a patient who was admitted with chest pain. While performing a cardiac assessment, the nurse determines that the patient's apical pulse is 90, and the radial pulse is 75. What action by the nurse is priority? -Contact the health care provider -Document the findings in the chart -Assess the patient's blood pressure -Administer PRN nitroglycerin sublingual
Contact the health care provider
The emergency department nurse is caring for a healthy adult patient with supraventricular tachycardia (SVT). The nurse is preparing to administer adenosine and notices a normal sinus rhythm. What action by the nurse is appropriate? Administer the medication Re-apply the leads of the ECG Document the change in rhythm Encourage the patient to bear down
Document the change in rhythm
Using calipers, the nurse has marked out the P to P intervals. The nurse recognizes a variation of two small blocks. Which action should the nurse take first? -Contact the health care provider -Document the rhythm as regular -Verify that the leads are still attached to the patient -Ask the patient if they would like PRN pain medication
Document the rhythm as regular
A female patient who is on amiodarone medication complains of chest pain, dizziness, and heart palpitations. The electrocardiogram (ECG) of the patient shows QT interval abnormalities. What condition do these findings indicate? Torsades de pointes (TDP) Congestive heart failure (CHF) Hypertrophic cardiomyopathy (HCM) Paroxysmal supraventricular tachycardia (PSVT)
Torsades de pointes (TDP)
What is important for the nurse to know about the P wave in sinus rhythm when examining a rhythm strip? It precedes the QRS complex. It is always positively deflected. It is followed immediately by a T wave. It is a deflection representing atrial repolarization.
It precedes the QRS complex.
The nurse is helping to care for a patient with a heart rate of 34 bpm who is not responding to atropine. The health care provider wants to prepare for transvenous pacing. What supplies should the nurse prepare for this procedure? Select all that apply. Adenosine Pacing pads Pacing wires A central venous catheter A battery-operated pulse generator
Pacing wires A central venous catheter A battery-operated pulse generator
A patient is transported to the emergency department because of supraventricular tachycardia. The patient is confused, and the peripheral pulses are weak. The vital signs are as follows: blood pressure of 78/35, pulse of 250, and no registration of oxygen saturation. Which action by the nurse is priority? Prepare for synchronized cardioversion Prepare diltiazem hydrochloride 0.25 mg/kg Ensure the OR is ready for immediate ablation Draw stat blood including arterial blood gas (ABG)
Prepare for synchronized cardioversion
The nurse enters a patient's room and notices a patient is confused, diaphoretic, and has a pulse rate of 41 bpm. Which action should the nurse take first? -Initiate chest compressions -Assess the MAR for drugs that slow conduction -Request informed consent for a transcutaneous pacing -Prepare to administer 0.5 mg of atropine intravenously
Prepare to administer 0.5 mg of atropine intravenously
The nurse is caring for a patient newly diagnosed with atrial fibrillation. The patient is being admitted for ibutilide fumarate treatment. For what findings should the nurse contact the health care provider? Select all that apply. Potassium of 3.7 Prolonged QT interval Previous history of atrial fibrillation Atrial fibrillation lasting for two weeks Patient report of taking anticoagulants for five days
Prolonged QT interval Patient report of taking anticoagulants for five days
What part of the cardiac conduction system is responsible for ventricular depolarization? -Purkinje fibers -Sinoatrial (SA) node -Transitional cell zone -Atrioventricular (AV) node
Purkinje fibers
What part of the conduction system is responsible for the contraction of ventricles? -Purkinje fibers -Sinoatrial (SA) node -Transitional cell zone -Atrioventricular (AV) node
Purkinje fibers
Which finding on an electrocardiogram (ECG) strip is characterized as normal? -PR interval of 0.25 seconds -Ventricular rate of 105 bpm -QRS duration of 0.05 seconds -P waves present after QRS complex
QRS duration of 0.05 seconds
Which finding on a cardiac rhythm strip indicates there is a delay in conduction of the electrical impulse? PR interval 0.16 second PR interval of 0.08 second QRS duration of 0.10 second QRS duration of 0.24 second
QRS duration of 0.24 second
When analyzing a cardiac rhythm strip, which component on the waveform varies with changes in heart rate? PR interval ST segment QT interval QRS duration
QT interval
The nurse is placing leads on a patient for a 12-lead electrocardiogram (ECG). Which lead acts as the ground electrode? Chest lead Positive lead Right leg lead Precordial lead
Right leg lead
What is the true isoelectric interval in the electrocardiogram (ECG)? PR segment ST segment TP segment TU segment
TP segment
What is the function of T cells in the atrioventricular junction area? -T cells cause the ventricles to contract -The T cells help to speed up impulses to the ventricles -The T cells generate impulses spontaneously and rhythmically -The T cells cause a delay in the conduction of impulses to the atrioventricular (AV) node
The T cells cause a delay in the conduction of impulses to the atrioventricular (AV) node
A patient is having a 12-lead electrocardiogram (ECG) to rule out a heart dysrhythmia. The patient shows a positive deflection on the ECG strip. How does the nurse interpret this result? -The cardiac axis is moving neither toward nor away from the axis. -There is no current flow after complete depolarization and repolarization. -The electrical current flow in the heart (cardiac axis) is toward the positive pole. -The electrical current flow in the heart (cardiac axis) is toward the negative pole.
The electrical current flow in the heart (cardiac axis) is toward the positive pole.
The nurse evaluates the placement of the electrodes to ensure clarity of monitoring. What ensures appropriate electrode preparation and placement? Select all that apply. The electrode gel is moist The doctor placed the electrodes Electrodes were placed on scar tissue No lotion is present on the patient's skin The nurse selected the leads and checked placement Chest hair is shaved or clipped where electrodes will be placed
The electrode gel is moist No lotion is present on the patient's skin The nurse selected the leads and checked placement Chest hair is shaved or clipped where electrodes will be placed
What would happen if the sinoatrial (SA) node generates electrical impulses at a higher rate? The heart rate will increase The blood pressure will decrease The atrial depolarization will not occur The ventricular depolarization will not occur
The heart rate will increase
The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? The patient is instructed to lie still. The patient is semi-recumbent in bed. Chest leads are placed as for the previous ECG. The patient is instructed to breathe deeply through the mouth.
The patient is instructed to breathe deeply through the mouth.
The nurse is reviewing the electrocardiography (ECG) strip after it is printed. How does the nurse interpret the data of the strip? Speed is measured on the vertical axis. Time is measured on the horizontal axis. Five small blocks make up five large blocks. Vertical lines at the top represent 2-second segments.
Time is measured on the horizontal axis.
