Dysrhythmias

A primary health care provider (PHCP) prescribed digoxin 0.25 mg for a client with atrial fibrillation. The medication is available as 0.125-mg tablets. The nurse calculates that the client will receive 2 tablets of digoxin. When the nurse hands the medication to the client, the client looks at the medication and states, "Every time I get chest pain, I will take 1 of these heart pills." After double-checking the dosage calculation, the nurse should make which decision? 1.The medication should not be administered as prescribed and calculated. 2.Administer one half tablet of the medication instead of the dosage calculated. 3.Administer the medication as prescribed and calculated, and proceed with further client teaching. 4.Administer the medication as prescribed and calculated, and monitor for adverse effects, such as seizures.

3.Administer the medication as prescribed and calculated, and proceed with further client teaching. Rationale:It is appropriate to treat atrial fibrillation with the prescribed and calculated dose of digoxin as indicated in the question. Therefore, the nurse should administer the medication as prescribed. The question indicates that the client verbalizes inaccurate and unsafe knowledge regarding this medication and the treatment for chest pain. This client needs further education regarding the safe administration of medications for episodes of chest pain.

The nurse notes that a client's cardiac rhythm shows absent P waves, no PR interval, and an irregular rhythm. How should the nurse interpret this rhythm? 1.Bradycardia 2.Tachycardia 3.Atrial fibrillation 4.Normal sinus rhythm (NSR)

3.Atrial fibrillation Rationale:In atrial fibrillation, the P waves are absent and replaced by fibrillatory waves. There is no PR interval, and the QRS duration usually is normal and constant and the rhythm is irregular. Bradycardia is a slowed heart rate, and tachycardia is a fast heart rate. In NSR, a P wave precedes each QRS complex, the rhythm is essentially regular, the PR interval is 0.12 to 0.20 second, and the QRS interval is 0.06 to 0.10 second.

A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? 1.Causative factors, such as caffeine 2.Sensation of fluttering or palpitations 3.Blood pressure and oxygen saturation 4.Precipitating factors, such as infection

3.Blood pressure and oxygen saturation Rationale:Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders; states of hypoxemia; any number of physiological stressors, such as infection, illness, surgery, or trauma; and intake of caffeine, nicotine, or alcohol.

A chaotic small, irregular, disorganized cardiac pattern suddenly appears on a client's cardiac monitor. Which is the nurse's first action? 1.Call the cardiologist. 2.Check the blood pressure. 3.Check the client and the chest leads. 4.Initiate cardiopulmonary resuscitation (CPR).

3.Check the client and the chest leads. Rationale:This type of pattern on the cardiac monitor indicates either ventricular fibrillation or lead displacement. The first action of the nurse is always to check the client and the chest leads. If the client is nonresponsive and the leads are not the problem, CPR would be the next choice, along with designating another person to contact the cardiologist.

A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment? 1.Flat neck veins 2.Nausea and vomiting 3.Hypotension and dizziness 4.Clubbed fingertips and headache

3.Hypotension and dizziness Rationale:The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output due to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

A client develops atrial fibrillation with a ventricular rate of 140 beats/minute and signs of decreased cardiac output. Which medication should the nurse anticipate administering first? 1.Warfarin 2.Lidocaine 3.Metoprolol 4.Atropine sulfate

3.Metoprolol Rationale:Beta blockers such as metoprolol slow conduction of impulses through the atrioventricular node and decrease the heart rate. In rapid atrial fibrillation, the goal first is to slow the ventricular rate and improve the cardiac output and then attempt to restore normal sinus rhythm. Atropine sulfate will further increase the heart rate and will further decrease the cardiac output. Although warfarin is administered to clients with atrial fibrillation to prevent clots from forming in the atria, it will have no effect in decreasing the ventricular rate or restoring normal sinus rhythm. Lidocaine is useful only in suppressing ventricular dysrhythmias.

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 seconds, and QRS complexes measure 0.06 seconds. The overall heart rate is 64 beats per minute. Which action should the nurse take? 1.Check vital signs. 2.Check laboratory test results. 3.Monitor for any rhythm change. 4.Notify the primary health care provider.

3.Monitor for any rhythm change. Rationale:Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats per minute. The PR and QRS measurements are normal, measuring between 0.12 and 0.20 seconds and 0.04 and 0.10 seconds, respectively. There are no irregularities in this rhythm currently, so there is no immediate need to check vital signs or laboratory results, or to notify the primary health care provider. Therefore, the nurse would continue to monitor the client for any rhythm change.

Cardiopulmonary resuscitation (CPR) is immediately initiated on a client who is unconscious and has no pulse. A monitor is attached, it is determined that the rhythm is shockable, and defibrillation with 1 shock is delivered. Which action should the nurse plan to take next? 1.Defibrillate 1 more time, and then terminate the resuscitation effort. 2.Administer a bolus of fluid intravenously, and resume defibrillation attempts. 3.Perform CPR for 5 cycles, and then defibrillate again if the rhythm is shockable. 4.Perform CPR for 1 minute, assess, and then defibrillate up to 3 more times.

3.Perform CPR for 5 cycles, and then defibrillate again if the rhythm is shockable. Rationale:If a client is unconscious and has no pulse, the nurse would shout for help (activate emergency response) and immediately initiate CPR. If the rhythm is shockable, a shock is delivered and CPR is delivered for 5 cycles. This pattern is repeated 2 more times if the rhythm remains shockable. Treatment with medications is also done during this time to reverse the cause of the ventricular fibrillation. Each of the other options is incorrect.

Which laboratory test results may be associated with peaked or tall, tented T waves on a client's electrocardiogram (ECG)? 1.Chloride level of 98 mEq/L (98 mmol/L) 2.Sodium level of 135 mEq/L (135 mmol/L) 3.Potassium level of 6.8 mEq/L (6.8 mmol/L) 4.Magnesium level of 1.6 mEq/L (0.8 mmol/L)

3.Potassium level of 6.8 mEq/L (6.8 mmol/L) Rationale:Hyperkalemia can cause tall, peaked, or tented T waves on the ECG. Potassium levels of 5.0 mEq/L (5.0 mmol/L) or greater indicate hyperkalemia. Options 1, 2, and 4 are normal levels.

The nurse is preparing to ambulate a client on the third day after cardiac surgery. What should the nurse plan to do to enable the client to best tolerate the ambulation? 1.Remove telemetry equipment. 2.Provide the client with a walker. 3.Premedicate the client with an analgesic. 4.Encourage the client to cough and breathe deeply.

3.Premedicate the client with an analgesic. Rationale:The nurse should encourage regular use of pain medication for the first 48 to 72 hours after cardiac surgery because analgesia will promote rest, decrease myocardial oxygen consumption resulting from pain, and allow better participation in activities such as coughing, deep breathing, and ambulation. Providing the client with a walker and encouraging the client to cough and breathe deeply will not help in tolerating ambulation. Removal of telemetry equipment is contraindicated unless prescribed.

The nurse is reinforcing instructions to a hospitalized client with heart block about the fundamental concepts regarding the cardiac rhythm. The nurse explains to the client that the normal site in the heart responsible for initiating electrical impulses is which site? 1.Bundle of His 2.Purkinje fibers 3.Sinoatrial (SA) node 4.Atrioventricular (AV) node

3.Sinoatrial (SA) node Rationale:The SA node is responsible for initiating electrical impulses that are conducted through the heart. The impulse leaves the SA node and travels down through internodal and interatrial pathways to the AV node. From there, impulses travel through the bundle of His to the right and left bundle branches and then to the Purkinje fibers. This group of specialized cardiac cells is referred to as the cardiac conduction system. The ability of this specialized tissue to generate its own impulses is called automaticity.

A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/minute. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse report this rhythm? 1.Sinus tachycardia 2.Sinus bradycardia 3.Sinus dysrhythmia 4.Normal sinus rhythm

3.Sinus dysrhythmia Rationale:Sinus dysrhythmia has all of the characteristics of normal sinus rhythm except for the presence of an irregular PP interval. This irregular rhythm occurs because of phasic changes in the rate of firing of the sinoatrial node, which may occur with vagal tone and with respiration. Cardiac output is not affected.

The nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves, no definable QRS complexes, and coarse wavy lines of varying amplitude. How should the nurse interpret this rhythm? 1.Asystole 2.Atrial fibrillation 3.Ventricular fibrillation 4.Ventricular tachycardia

3.Ventricular fibrillation Rationale:Ventricular fibrillation is characterized by irregular chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.

The nurse is watching the cardiac monitor and notices that a client's rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but more than 140 beats per minute. The nurse determines that the client is experiencing which dysrhythmia? 1.Sinus tachycardia 2.Ventricular fibrillation 3.Ventricular tachycardia 4.Premature ventricular contractions

3.Ventricular tachycardia Rationale:Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (longer than 0.12 seconds), and typically a rate between 140 and 180 impulses per minute. The rhythm is regular.

The home health nurse makes a home visit to a client who has an implanted cardioverter-defibrillator (ICD) and reviews the instructions concerning pacemakers and dysrhythmias with the client. Which client statement indicates that further teaching is necessary? 1."If I feel an internal defibrillator shock, I should sit down." 2."I won't be able to have a magnetic resonance imaging test (MRI)." 3."My wife knows how to call the emergency medical services (EMS) if I need it." 4."I can stop taking my antidysrhythmic medicine now because I have a pacemaker."

4."I can stop taking my antidysrhythmic medicine now because I have a pacemaker." Rationale:Clients with an ICD usually continue to receive antidysrhythmic medications after discharge from the hospital. The nurse should stress the importance of continuing to take these medications as prescribed. The nurse should provide clear instructions about the purposes of the medications, dosage schedule, and side effects or adverse effects to report. Clients should sit down if they feel an internal defibrillator shock. They cannot have an MRI because of the possible magnetic properties of the device. Also, knowledge of how to reach EMS is important.

The nurse has completed an educational course covering first-degree heart block. Which statement by the nurse indicates that teaching has been effective? 1."Presence of Q waves indicates first-degree heart block." 2."Tall, peaked T waves indicate first-degree heart block." 3."Widened QRS complexes indicate first-degree heart block." 4."Prolonged, equal PR intervals indicate first-degree heart block."

4."Prolonged, equal PR intervals indicate first-degree heart block." Rationale:Prolonged and equal PR intervals indicate first-degree heart block. The development of Q waves indicates myocardial necrosis. Tall, peaked T waves may indicate hyperkalemia. A widened QRS complex indicates a delay in intraventricular conduction, such as bundle branch block. An electrocardiogram (ECG) taken during a pain episode is intended to capture ischemic changes, which also include ST segment elevation or depression.

The nurse has given the client with atrial fibrillation instructions to take 1 aspirin daily. The client says to the nurse, "Why do I need to take this? I don't get any pain with my heart rhythm. "Which response by the nurse is the most appropriate? 1."This will keep you from experiencing chest pain." 2."This will most likely keep you from ever having a heart attack." 3."This will prevent any inflammation from occurring on the walls of your heart." 4."This will help prevent clot formation in your heart as a result of your heart's rhythm."

4."This will help prevent clot formation in your heart as a result of your heart's rhythm." Rationale:Atrial fibrillation puts the client at risk for mural thrombi because of the sluggish blood flow through the atria that occurs as a result of loss of the atrial kick. In atrial fibrillation, the primary health care provider may prescribe a daily aspirin. This will prevent clot formation along the walls of the atria and resultant embolus. Aspirin will not prevent chest pain or keep a client from ever having a heart attack. Although aspirin does have anti-inflammatory properties, it cannot prevent any inflammation from occurring, as stated in option 3.

A client with a complete heart block has had a permanent demand ventricular pacemaker inserted. The nurse assesses for proper pacemaker function by examining the electrocardiogram (ECG) strip for the presence of pacemaker spikes at what point? 1.Before each P wave 2.Just after each P wave 3.Just after each T wave 4.Before each QRS complex

4.Before each QRS complex Rationale:If a ventricular pacemaker is functioning properly, there will be a pacer spike followed by a QRS complex. An atrial pacemaker spike precedes a P wave if an atrial pacemaker is implanted.

The nurse is documenting information in a client's chart when the electrocardiogram telemetry alarm sounds, and the nurse notes that the client is in ventricular tachycardia (VT). The nurse rushes to the client's bedside and should perform which assessment first? 1.Heart rate 2.Blood pressure 3.Respiratory rate 4.Check responsiveness

4.Check responsiveness Rationale:VT is associated with a significant decrease in cardiac output. Assessing for unresponsiveness determines whether the client is affected by the decreased cardiac output. Therefore, the first action is to determine responsiveness of the client. Then the nurse should check the client's pulse to determine the next treatment strategy.

The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the pad on the client's chest and before discharge, which intervention is a priority? 1.Ensure that the client has been intubated. 2.Set the defibrillator to the "synchronize" mode. 3.Administer an amiodarone bolus intravenously. 4.Confirm that the rhythm is actually ventricular fibrillation.

4.Confirm that the rhythm is actually ventricular fibrillation. Rationale:Until the defibrillator is attached and charged, the client is resuscitated by using cardiopulmonary resuscitation. Once the defibrillator has been attached, the electrocardiogram is checked to verify that the rhythm is ventricular fibrillation or pulseless ventricular tachycardia. Leads also are checked for any loose connections. A nitroglycerin patch, if present, is removed. The client does not have to be intubated to be defibrillated. The machine is not set to the synchronous mode because there is no underlying rhythm with which to synchronize. Amiodarone may be given subsequently but is not required before defibrillation.

The nurse is assisting to defibrillate a client in ventricular fibrillation. After placing the pads on the client's chest and before discharging the device, which intervention is a priority? 1.Ensure that the client has been intubated. 2.Set the defibrillator to the "synchronize" mode. 3.Administer an amiodarone bolus intravenously. 4.Confirm that the rhythm is ventricular fibrillation.

4.Confirm that the rhythm is ventricular fibrillation. Rationale:Until the defibrillator is attached and charged, the client is resuscitated by using cardiopulmonary resuscitation. Once the defibrillator has been attached, the electrocardiogram is checked to verify that the rhythm is ventricular fibrillation or pulseless ventricular tachycardia. Leads also are checked for any loose connections. A nitroglycerin patch, if present, is removed. The client does not have to be intubated to be defibrillated. The machine is not set to the synchronous mode because there is no underlying rhythm with which to synchronize.

A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. Which nursing action should be included in the client's plan of care? 1.Limiting oral and intravenous fluids 2.Measuring the client's pulse each shift 3.Providing the client with short, frequent walks 4.Eliminating sources of caffeine from meal trays

4.Eliminating sources of caffeine from meal trays Rationale:Sinus tachycardia often is caused by fever, physical and emotional stress, heart failure, hypovolemia, certain medications, nicotine, caffeine, and exercise. Fluid restriction and exercise will not alleviate tachycardia. Measuring the pulse each shift will not decrease the heart rate. In addition, the pulse should be taken more frequently than each shift.

A client has frequent runs of ventricular tachycardia. The primary health care provider has prescribed flecainide. What is the best nursing action related to the effects of this medication while the client is hospitalized? 1.Monitor the client's urinary output. 2.Assess the client for neurological changes. 3.Keep the call bell within the client's reach. 4.Monitor vital signs and cardiac rhythm frequently.

4.Monitor vital signs and cardiac rhythm frequently. Rationale:Flecainide is an antidysrhythmic medication that slows conduction and decreases excitability, conduction velocity, and automaticity. The nurse needs to monitor the client's vital signs for changes and cardiac rhythm for the development of a new or a worsening dysrhythmia. The remaining options are components of standard care.

An external public access defibrillator (PAD) interprets that the rhythm of a pulseless victim is ventricular fibrillation and advises defibrillation. Which action should the rescuer take next? 1.Administer rescue breathing during the defibrillation. 2.Perform cardiopulmonary resuscitation (CPR) for 1 minute before defibrillating. 3.Charge the machine and immediately push the discharge buttons on the console. 4.Order people away from the client, charge the machine, and depress the discharge buttons.

4.Order people away from the client, charge the machine, and depress the discharge buttons. Rationale:If the victim is in ventricular fibrillation, defibrillation is necessary. If the PAD advises to defibrillate, the rescuer orders all people away from the client, charges the machine, and pushes both of the discharge buttons on the console at the same time. The charge is delivered through the patch electrodes, so this method is known as "hands off" defibrillation, which is safer for the rescuer. The sequence of charges is similar to that of conventional defibrillation.

Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse anticipate in this client if PVCs are occurring? 1.A P wave preceding every QRS complex 2.QRS complexes that are short and narrow 3.Inverted P waves before the QRS complexes 4.Premature beats followed by a compensatory pause

4.Premature beats followed by a compensatory pause Rationale:PVCs are abnormal ectopic beats originating in the ventricles. They are characterized by an absence of P waves, the presence of wide and bizarre QRS complexes, and a compensatory pause that follows the ectopy.

A client in sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mm Hg, reports dizziness. Which intervention should the nurse anticipate will be prescribed? 1.Administer digoxin. 2.Defibrillate the client. 3.Continue to monitor the client. 4.Prepare for transcutaneous pacing.

4.Prepare for transcutaneous pacing. Rationale:Sinus bradycardia is noted with a heart rate less than 60 beats per minute. This rhythm becomes a concern when the client becomes symptomatic. Hypotension and dizziness are signs of decreased cardiac output. Transcutaneous pacing provides a temporary measure to increase the heart rate and thus perfusion in the symptomatic client. Defibrillation is used for treatment of pulseless ventricular tachycardia and ventricular fibrillation. Digoxin will further decrease the client's heart rate. Continuing to monitor the client delays necessary intervention.

The nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? 1.Serum chloride level of 98 mEq/L (98 mmol/L) 2.Serum sodium level of 145 mEq/L (145 mmol/L) 3.Serum calcium level of 10.5 mg/dL (2.75 mmol/L) 4.Serum potassium level of 2.8 mEq/L (2.8 mmol/L)

4.Serum potassium level of 2.8 mEq/L (2.8 mmol/L) Rationale:The nurse should check the client's serum laboratory study results for hypokalemia. The client may experience PVCs in the presence of hypokalemia because this electrolyte imbalance increases the electrical instability of the heart. The values noted in the remaining options are normal.

A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if which finding is noted with regard to the PVCs? 1.They occur in pairs. 2.They appear to be multifocal. 3.They fall on the second half of the T wave. 4.They decrease to a frequency of less than 6 per minute.

4.They decrease to a frequency of less than 6 per minute. Rationale:PVCs are considered dangerous when they are frequent (more than 6 per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. In each of these instances, the client's cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly dysrhythmias.

The client has developed atrial fibrillation, with a ventricular rate of 150 beats per minute. The nurse should assess the client for which associated signs and/or symptoms? Select all that apply. 1.Syncope 2.Dizziness 3.Palpitations 4.Hypertension 5.Flat neck veins

1,2,3 Rationale:The client with uncontrolled atrial fibrillation with a ventricular rate more than 100 beats per minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. Hypertension and flat neck veins are not associated with the loss of cardiac output.

A client is at risk for vasovagal attacks that cause brady dysrhythmias. The nurse would tell the client to avoid which actions to prevent this occurrence? Select all that apply. 1.Applying pressure on the eyes 2.Raising the arms above the head 3.Taking stool softeners on a daily basis 4.Bearing down during a bowel movement 5.Simulating a gag reflex when brushing the teeth

1,2,4,5 Rationale:Vasovagal attacks or syncope occurs when the client faints because the body overreacts to certain triggers. The vasovagal syncope trigger causes the heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to the brain, causing the client to briefly lose consciousness. The client at risk should be taught to avoid actions that stimulate the vagus nerve. Actions to avoid include raising the arms above the head, applying pressure over the carotid artery, applying pressure over the eyes, stimulating a gag reflex when brushing the teeth or putting objects into the mouth, and bearing down or straining during a bowel movement. Taking stool softeners is an important measure to prevent the bearing down and straining during a bowel movement.

A new nursing graduate is caring for a client who is attached to a cardiac monitor. While assisting the client with bathing, the nurse observes the sudden development of ventricular tachycardia (VT), but the client remains alert and oriented and has a pulse. Which interventions would the nurse take? Select all that apply. 1.Administer oxygen. 2.Defibrillate the client. 3.Obtain an electrocardiogram (ECG). 4.Contact the primary health care provider (PHCP). 5.Assess circulation, airway, and breathing. 6.Initiate cardiopulmonary resuscitation (CPR).

1,3,4,5 Rationale:With VT in a stable client, the nurse assesses circulation, airway, and breathing; administers oxygen; and confirms the rhythm via a 12-lead ECG. The PHCP is contacted, and antidysrhythmics may be prescribed. With pulseless VT, the PHCP or a specially trained nurse must immediately defibrillate the client or initiate CPR followed by defibrillation as soon as possible.

A client with rapid-rate atrial fibrillation asks the nurse why the cardiologist is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective? 1."The vagus nerve slows the heart rate." 2."The diaphragmatic nerve slows the heart rate." 3."The diaphragmatic nerve overdrives the rhythm." 4."The vagus nerve increases the heart rate, overdriving the rhythm."

1."The vagus nerve slows the heart rate. Rationale:Carotid sinus massage is one maneuver used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia. Others include inducing the gag reflex and asking the client to strain or bear down. Medication therapy is often needed as an adjunct to keep the rate down or maintain the normal rhythm. The remaining options are incorrect descriptions of this procedure.

The nurse should evaluate that defibrillation of a client was most successful if which observation was made? 1.Arousable, sinus rhythm, blood pressure (BP) 116/72 mm Hg 2.Nonarousable, sinus rhythm, BP 88/60 mm Hg 3.Arousable, marked bradycardia, BP 86/54 mm Hg 4.Nonarousable, supraventricular tachycardia, BP 122/60 mm Hg

1.Arousable, sinus rhythm, blood pressure (BP) 116/72 mm Hg Rationale:After defibrillation, the client requires continuous monitoring of electrocardiographic rhythm, hemodynamic status, and neurological status. Respiratory and metabolic acidosis develop during ventricular fibrillation because of lack of respiration and cardiac output. These can cause cerebral and cardiopulmonary complications. Arousable status, adequate BP, and a sinus rhythm indicate successful response to defibrillation.

The nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse interpret the client's heart rhythm? 1.Atrial fibrillation 2.Sinus tachycardia 3.Ventricular fibrillation 4.Ventricular tachycardia

1.Atrial fibrillation Rationale:Atrial fibrillation is characterized by a loss of P waves and fibrillatory waves before each QRS complex. The atria quiver, which can lead to thrombus formation.

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a rapid ventricular rate of 150 beats/minute. The nurse should next assess the client for which finding? 1.Hypotension 2.Flat neck veins 3.Complaints of nausea 4.Complaints of headache

1.Hypotension Rationale:The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the nurse be most concerned about with this dysrhythmia? 1.It can develop into ventricular fibrillation at any time. 2.It is almost impossible to convert to a normal rhythm. 3.It is uncomfortable for the client, giving a sense of impending doom. 4.It produces a high cardiac output with cerebral and myocardial ischemia.

1.It can develop into ventricular fibrillation at any time. Rationale:Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. Ventricular tachycardia can deteriorate into ventricular fibrillation at any time. Clients frequently experience a feeling of impending doom. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Ventricular tachycardia is treated with antidysrhythmic medications, cardioversion (if the client is awake), or defibrillation (loss of consciousness).

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats per minute. The PR interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are regular. How should the nurse interpret this rhythm? 1.Sinus tachycardia 2.Sinus bradycardia 3.Sinus dysrhythmia 4.Normal sinus rhythm

1.Sinus tachycardia Rationale:Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats per minute.

The new registered nurse (RN) is reviewing cardiac rhythms with a mentor. Which statement by the new RN indicates that teaching about ventricular fibrillation has been effective? 1."Ventricular fibrillation appears as irregular beats within a rhythm." 2."Ventricular fibrillation does not have P waves or QRS complexes." 3."Ventricular fibrillation is a regular pattern of wide QRS complexes." 4."Ventricular fibrillation has recognizable P waves, QRS complexes, and T waves."

2."Ventricular fibrillation does not have P waves or QRS complexes." Rationale:Ventricular fibrillation is characterized by the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen. Premature ventricular contractions (PVCs) appear as irregular beats within a rhythm. Ventricular tachycardia is a regular pattern of wide QRS complexes. Sinus tachycardia has a recognizable P wave, QRS complex, and T wave. Each of the incorrect options has a recognizable complex that appears on the monitoring screen.

The nurse is evaluating a client's response to cardioversion. Which assessment would be the priority? 1.Blood pressure 2.Airway patency 3.Oxygen flow rate 4.Level of consciousness

2.Airway patency Rationale:Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection.

The nurse is performing cardiopulmonary resuscitation (CPR) on a client who has had a cardiac arrest. An automatic external defibrillator (AED) is available to treat the client. Which activity will allow the nurse to assess the client's cardiac rhythm? 1.Hold the defibrillator paddles firmly against the chest. 2.Apply adhesive patch electrodes to the chest and move away from the client. 3.Connect standard electrocardiographic electrodes to a transtelephonic monitoring device. 4.Apply standard electrocardiographic monitoring leads to the client, and observe the rhythm.

2.Apply adhesive patch electrodes to the chest and move away from the client. Rationale:The nurse or rescuer puts two adhesive patch electrodes on the client's chest in the usual defibrillator positions. The nurse stops CPR and requests that anyone near the client move away and not touch the client. The defibrillator then analyzes the rhythm, which may take up to 30 seconds. The machine then indicates whether defibrillation is necessary.

A client's electrocardiogram shows that the ventricular rhythm is irregular and there are no discernible P waves. The nurse recognizes that this pattern is associated with which condition? 1.Atrial flutter 2.Atrial fibrillation 3.Third-degree atrioventricular (AV) block 4.First-degree AV block

2.Atrial fibrillation Rationale:With atrial fibrillation, the ventricular rhythm is irregular and there are usually no discernible P waves. Therefore, an atrial rhythm cannot be determined. In atrial flutter, the QRS complexes may be either regular or irregular, and the P waves occur as flutter waves. A client in third-degree AV block (also known as complete heart block) has regular atrial and ventricular rhythms, but there is no connection between the P waves and the QRS complexes. In other words, the PR interval is variable and the QRS complexes are normal or widened, with no relationship with the P waves. With first-degree AV block, the PR interval is longer than normal, and there is a connection between the occurrence of P waves and that of QRS complexes.

The nurse has completed 5 cycles of compressions after beginning cardiopulmonary resuscitation (CPR) on a hospitalized adult client who experienced unmonitored cardiac arrest. What should the nurse plan to do next? 1.Prepare epinephrine. 2.Charge the defibrillator. 3.Check the client's heart rhythm. 4.Pause CPR for 20 seconds and reassess.

2.Charge the defibrillator. Rationale:For witnessed adult cardiac arrest when a defibrillator is immediately available, it is reasonable that the defibrillator be used as soon as possible. For adults with unmonitored cardiac arrest or for whom a defibrillator is not immediately available, it is reasonable that CPR be initiated while the defibrillator equipment is being retrieved and applied, and that defibrillation, if indicated, be attempted as soon as the device is ready for use. After completing 5 cycles of compressions and ventilations, the nurse should reassess the client by checking the heart rhythm. Defibrillation may be warranted depending on the assessed rhythm. Epinephrine may be prepared depending on the rhythm, but this would be prescribed by a primary health care provider (PHCP). Chest compressions should not be interrupted for more than 10 seconds.

A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no electrocardiographic complexes on the screen. Which is the priority nursing action? 1.Call a code. 2.Check the client's status. 3.Call the primary health care provider. 4.Document the lack of complexes.

2.Check the client's status. Rationale:Sudden loss of electrocardiographic complexes indicates ventricular asystole or possibly electrode displacement. Accurate assessment of the client is necessary to determine the cause and identify the appropriate intervention. The remaining options are secondary to client assessment.

A client with rapid-rate atrial fibrillation has a new prescription for diltiazem hydrochloride by intravenous (IV) bolus followed by a continuous IV infusion of the same medication. What should the nurse plan for with the administration of this medication? 1.Applying a nonrebreather mask 2.Discontinuing the infusion after 24 hours 3.Monitoring the cardiac rhythm every hour 4.Administering the IV bolus over 2 to 3 seconds

2.Discontinuing the infusion after 24 hours Rationale:Diltiazem hydrochloride is a calcium channel blocker used in the treatment of atrial flutter and fibrillation. It decreases myocardial contractility and workload, thereby decreasing the need for oxygen. A bolus of 0.25 mg/kg is given slowly over 2 minutes, and a continuous infusion of 5 to 10 mg/hour may be administered for up to 24 hours. Therefore, the nurse should prepare to discontinue the infusion after 24 hours. Upon discontinuation of infusion, heart rate reduction may last from 0.5 hours to more than 10 hours (median duration 7 hours). A nonrebreather mask is not necessary. The client's cardiac rhythm is monitored continuously.

Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1.Vitamin K 2.Protamine sulfate 3.Potassium chloride 4.Aminocaproic acid

2.Protamine sulfate Rationale:The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

A client is scheduled for elective cardioversion to treat chronic high-rate atrial fibrillation. Which finding indicates that further preparation is needed for the procedure? 1.The client's digoxin has been withheld for the last 48 hours. 2.The client is wearing a nasal cannula delivering oxygen at 2 L/min. 3.The defibrillator has the synchronizer turned on and is set at 120 joules (J). 4.The client has received an intravenous dose of a conscious sedation medication.

2.The client is wearing a nasal cannula delivering oxygen at 2 L/min. Rationale:During the procedure, any oxygen is removed temporarily because oxygen supports combustion, and a fire could result from electrical arcing. Digoxin may be withheld for up to 48 hours before cardioversion because it increases ventricular irritability and may cause ventricular dysrhythmias after the countershock. The defibrillator is switched to synchronizer mode to time the delivery of the electrical impulse to coincide with the QRS and avoid the T wave, which could cause ventricular fibrillation. Energy level typically is set at 120 to 200 J for a biphasic machine. The client typically receives a dose of an intravenous sedative or antianxiety agent.