Complex PREP U chp 26

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. Never engage in activities that require vigorous arm and shoulder movement. c. Stay at least 5 feet away from microwave ovens. d. Avoid undergoing magnetic resonance imaging (MRI).

a 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.

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. Premature atrial complex b. Sinus tachycardia c. Atrial flutter d. Ventricular fibrillation

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

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

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

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

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

a 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 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. atropine sulfate b. nadolol c. atenolol d. diltazem

a 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.

When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be a. captured. b. nonsynchronous. c. triggered. d. inhibited.

a 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.

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 cardiac muscle tissue. b. sufficient blood pressure. c. inherent rhythmicity of all muscle tissue. d. inherent electrons in muscle tissue.

a 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.

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

a 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.

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

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

A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? a. Atropine b. Amiodarone c. Lidocaine d. Dobutamine

a I.V. push atropine is used to treat symptomatic bradycardia. Dobutamine is used to treat heart failure and low cardiac output. Amiodarone is used to treat ventricular fibrillation and unstable ventricular tachycardia. Lidocaine is used to treat ventricular ectopy, ventricular tachycardia, and ventricular fibrillation.

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 dysrhythmia. b. sinus bradycardia. c. sinus tachycardia. d. normal sinus rhythm.

a 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.

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 needed for the SA node impulse to depolarize the atria and travel through the AV node." b. "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." c. "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." d. "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node."

a 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.

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 can't wait to get back to my football league." c. "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." d. "I need to stay at least 10 inches away from the microwave."

a 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 is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first? a. A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV b. A client diagnosed with new onset of atrial fibrillation, requiring scheduled IV diltiazem c. A client who received elective cardioversion 1 hour ago and whose heart rate (HR) is 115 bpm d. A client returned from an electrophysiology procedure 2 hours ago, reporting constipation

a The client's implantable cardioverter defibrillator (ICD) that has fired on the previous shift should be seen first. This client is in need of antidysrhythmic medication, which is the priority intervention. The remaining clients should be seen after this client and are in no acute distress.

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. Peaked T waves b. Prolonged QT interval c. Occasional U waves d. Flattened P waves

a 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 is providing discharge instructions for a client with a newly implanted cardiac defibrillator. What statement made by the client indicates the need for further teaching? a. "I will report if I feel lightheaded and dizzy at my next doctor's appointment." b. "I will try to have my family take a cardiopulmonary resuscitation class." c. "I will carry an identification card so I can avoid a handheld security device at the airport." d. "I will not be able to have a magnetic resonance imaging study."

a The clients with newly implanted devices are told to treat lightheadedness and dizziness as an emergency so these symptoms should be reported as an emergency. Handheld security devices should be avoided because of the electromagnetic interference. Magnetic resonance imaging studies may deactivate the device so they need to be avoided. The CPR training is recommended for family as an emergency backup.

A client has a medical diagnosis of an advanced first-degree atrioventricular block and is symptomatic. What initial treatment will the nurse be prepared to complete? a. administer an IV bolus of atropine b. administer an IV bolus of furosemide c. prepare the client for a cardioversion d. prepare client for a cardiac catheterization

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

The 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. Bigeminy b. Multifocal PVCs c. Couplets d. R-on-T phenomenon

a 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.

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. A defibrillator b. Cardioversion equipment c. A suction machine d. An ECG machine

a 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.

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. Administer every five minutes during cardiac resuscitation d. Keep the client flat for one hour after administration

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

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

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

The nurse cares for a client following the insertion of a permanent pacemaker. What discharge instruction(s) should the nurse review with the client? Select all that apply. a. Avoid handheld screening devices in airports b. Check pulse daily, reporting sudden slowing or increase c. Refrain from walking through antitheft devices d. Wear a medical alert, noting the presence of a pacemaker e. Avoid the usage of microwave ovens and electronic tools

a, b, d Handheld screening devices used in airports may interfere with the pacemaker. Patients should be advised to ask security personnel to perform a hand search instead of using the handheld screening device. With a permanent pacemaker, the client should be instructed initially to restrict activity on the side of implantation. Clients also should be educated to perform a pulse check daily and to wear or carry medical identification to alert personnel to the presence of the pacemaker. Client should walk through antitheft devices quickly and avoid standing in or near these devices. Client can safely use microwave ovens and electronic tools.

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. Hiccuping b. Positive Kernig's sign c. Negative Babinski reflex d. Localized infection e. Twiddler syndrome

a, d, e 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.

A 26-year-old client, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is treated in the emergency department. The client is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the client becomes lightheaded but does not lose consciousness. Which maneuver(s) may be used to interrupt the client's atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. a. Placing the client's face in cold water b. Stimulating the client's gag reflex c. Instructing the client to vigorously exercise d. Performing carotid massage e. Instructing the client to breathe deeply

a,b,d The following vagal maneuvers can be used to interrupt atrioventricular nodal reentry tachycardia (AVNRT): stimulating the client's gag reflex, having the client hold the breath, cough, bear down, placing the face in cold water, or performing carotid massage. These measures elicit a vagal response, which will slow AV conduction time and help restore a regular rhythm. Because of the risk of a cerebral embolic event, carotid massage is contraindicated in clients with carotid bruits. If the vagal maneuvers are ineffective, the client may receive a bolus of adenosine to correct the rhythm; this is nearly 100% effective in terminating AVNRT. Overexertion and deep inspirations are measures that could precipitate supraventricular tachycardia (SVT).

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. 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 c. SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers d. SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches

b

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. Decreased cardiac output and decreased systolic and diastolic blood pressure c. Increased cardiac output and increased systolic and diastolic blood pressure d. Decreased blood pressure with reflex tachycardia

b 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 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. Premature ventricular contraction b. Atrial flutter c. Asystole d. Ventricular fibrillation

b 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.

A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that don't precede a beat. Which condition should the nurse suspect? a. Failure to pace b. Failure to capture c. Failure to sense d. Asystole

b Extra pacemaker spikes that don't precede a beat may indicate failure to capture, in which the pacemaker fires but the heart doesn't conduct the beat. In failure to pace, the pacemaker doesn't fire when it should; this causes hypotension and other signs of low cardiac output accompanied by bradycardia or a heart rate slower than the pacemaker's preset rate. In failure to sense, the pacemaker can't sense the client's intrinsic heartbeat; on the rhythm strip, spikes may fall on T waves, or they may fall regularly but at points at which they shouldn't appear. An absent heart rate or rhythm, reflected as a flat line on the rhythm strip, characterizes asystole.

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. A variable heart rate, usually fewer than 60 bpm b. Delayed conduction, producing a prolonged PR interval c. P waves hidden with the QRS complex d. An irregular rhythm

b 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).

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 I b. Third degree c. Second degree, type II d. First degree

b 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 identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? a. Bradycardia b. Hypokalemia c. Hypovolemia d. Alkalosis

b 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.

The nurse is administering propanolol to a client on a telemetry unit. What will the nurse monitor the client for? a. tachycardia b. heart block c. bleeding d. change in level of consciousness

b Propanolol and other beta blockers can interfere with conduction and the client should be evaluated for heart block. Propanolol has a desired effect of lowering heart rate, not tachycardia. Bleeding and change in consciousness level are not common side effects of propanolol.

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. heart block b. supraventricular tachycardia c. atrial flutter d. sinus tachycardia

b 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.

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

b 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.

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

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

The nurse analyzes 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. QRS complex that is 0.10 seconds long b. QT interval that is 0. 46 seconds long c. PR interval that is 0.18 seconds long d. ST segment that is isoelectric in appearance

b 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.

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

d 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.

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 will document the date and time if my ICD fires." b. "I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD." c. "I can play golf with my son in about 2 or 3 weeks." d. "I should tell close friends and family members that I have an ICD."

b 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.

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. Prepare to administer a calcium channel blocker. b. Question the client about alcohol and illicit drug use. c. Place the client on supplemental oxygen. d. Instruct the client to hold the breath and bear down.

b 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.

A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as a. Atrial fibrillation b. Atrial flutter c. Ventricular tachycardia d. Ventricular fibrillation

b The nurse correctly identifies the electrocardiogram (ECG) tracing as atrial flutter. Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.

The nurse is caring for a client with a dysrhythmia. While assessing the data in the history of the chart, the nurse anticipates the cause of the dysrhythmia to be which of the following? a. Peripheral vascular disease b. Ischemic heart disease c. Atherosclerotic heart disease d. Aortic stenosis

b The nurse realizes that the most common cause of dysrhythmias is ischemic heart disease. When the heart does not obtain sufficient blood to meet demands, the heart works harder to circulate body fluids and becomes inefficient in the process. Problems with the peripheral vessels, narrowing of the aorta and plaque buildup in the vessels may be a component of the disease process but not the best answer.

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 helps the kidneys produce more urine. b. The medication causes the kidneys to retain fluid and increase intravascular volume. c. The medication increases the force of the myocardial contraction. d. The medication increases the heart rate.

c 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.

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

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

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

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

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

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

A 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 box is recording the heart's electrical activity, and a physician will review the tracing later." b:"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." d: "The heart's electrical activity will be recorded when the heart rate exceeds 60 beats per minute."

c 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.

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. bundle branch block b. heart block c. atrial flutter d. atrial fibrillation

d 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.

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

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

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. Sensitivity is too low b. Faulty generator c. Lead wire dislodgement d. Fracture of the lead wire

c 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 patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? a. Sinus bradycardia b. Normal sinus rhythm c. Sinus tachycardia d. Ventricular tachycardia

c Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy).

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 turn into life-threatening arrhythmias. b. Altered patterns frequently cause a variety of home safety issues. c. Altered patterns frequently affect the heart's ability to pump blood effectively. d. Altered patterns frequently produce neurological deficits.

c 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.

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

c 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.

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

c 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.

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

c 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.

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. Left side of sternum, fourth intercostal space b. Mid-clavicular line, fifth intercostal space c. Right side of sternum, fourth intercostal space d. Midway between V2 and V4

c 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.

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

d

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

d 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.

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias? a. Ventricular fibrillation b. Ventricular bigeminy c. Ventricular tachycardia d. Premature ventricular contraction (PVC)

d A PVC is an impulse that starts in a ventricle before the next normal sinus impulse. Ventricular bigeminy is a rhythm in which every other complex is a PVC. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Ventricular fibrillation is a rapid but disorganized ventricular rhythm that causes ineffective quivering of the ventricles.

A client scheduled for a catheter ablation procedure confides to the nurse that he is worried about having some of his heart cells destroyed. The best response by the nurse is which of the following? a. "The doctor knows best; just let her worry about which heart cells to destroy." b. "Everything will turn out fine; do not worry about your heart cells." c. "Don't worry. All resuscitation equipment is kept nearby when these procedures are being done." d. "Only the specific cells causing your dysrhythmia are destroyed; your heart will function better without these cells."

d Ablation therapy destroys specific cells that are the cause of a tachydysrhythmia.

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

d 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 nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? a. Ventricular tachycardia b. Atrial fibrillation c. Ventricular fibrillation d. Atrial flutter

d Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects

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. "It is when the heart conduction is primarily from the aterioventricular node." c. "The rhythm is regular but fast." d. "The rhythm has a normal beat, then a premature beat pattern."

d Bigeminy is a rhythm in which every other complex is a premature ventricular contraction (PVC). In trigeminy, every third complex is a PVC. The rhythm is not regular and the rate should not be 150-250 bpm.

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

d 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.

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. Quality of the pulse b. Scar on the chest c. Vibration under the skin d. "Spike" on the rhythm strip

d 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.

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

d 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 nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? a. Pacemaker implantation b. Maze procedure c. Defibrillation d. Elective cardioversion

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

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. Do nothing; there is no cause for alarm. c. Suggest the need for a new beta-blocker to the doctor. d. Double-check the monitoring equipment.

d One of the reasons for lack of pacemaker spikes is faulty monitoring equipment.

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

The nurse 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. hypothyroidism d. hypovolemia

d The causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, hypothyroidism, and digoxin will cause a sinus bradycardia.

A client 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. electrophysiological study b. pacemaker insertion c. radiofrequency ablation d. internal cardioverter defibrillator insertion

d 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.

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. Atrial fibrillation b. Ventricular tachycardia c. Third-degree heart block d. Ventricular fibrillation

d 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.

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 new myocardial infarction client c. A client with poor kidney perfusion d. A client with atrial dysrhythmias

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

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 moving the arm on the side where the pacemaker is inserted. c. Keep the arm on the side of the pacemaker higher than the head. d. Avoid sources of electrical interference.

d 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 knows that synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of which of the following? a. Purkinje fiber repolarization b. Atrial depolarization c. Ventricular depolarization d. Ventricular repolarization

d The synchronization of cardioversion prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in ventricular tachycardia (VT) or ventricular fibrillation. The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The U wave represents repolarization of the Purkinje fibers.