EKG Prep-U
A nurse and nursing student are caring for a client with coronary heart disease and providing information about the disease process to the client. When client care is completed, the student asks the nurse what things stimulate the heart to beat faster. The correct response would be which of the following? a) "Beta-adrenergic blocking agents" b) "Anything that stimulates the parasympathetic nervous system (negative chronotropy)" c) "Hypothyroidism" d) "Anything that stimulates the sympathetic nervous systerm (positive chronotropy)"
"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)" Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic stimulation reduces heart rate. Administration of beta-adrenergic blocking agents decreases stimulation of the sympathetic nervous system and subsequently heart rate.
A client with a forceful, pounding heartbeat is diagnosed with mitral valve prolapse. Which client statement indicates to the nurse a need for additional teaching? a) "I can still drink coffee and tea." b) "I'll enroll in an aerobic exercise program." c) "I should increase my fluid intake." d) "I should eat foods rich in protein."
"I can still drink coffee and tea." The client requires more teaching if he states that he may drink coffee and tea. Caffeine is a stimulant, which can exacerbate palpitations, and should be avoided by a client with symptomatic mitral valve prolapse. High fluid intake helps maintain adequate preload and cardiac output. Aerobic exercise helps increase cardiac output and decrease heart rate. Protein-rich foods aren't restricted but high-calorie foods are.
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? a) "You may resume all normal activity in 1 week; if you are used to playing tennis, you may proceed with this activity." b) "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." c) "You should avoid tennis; basketball or football would be a good substitute." d) "Cancel your tennis tournament and wait until fall, then try hockey; skating is much easier on pacemakers."
"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (eg, basketball, football, hockey).
After taking an ECG on a 38-year-old woman, the nurse reports that the PR interval reflects normal sinus rhythm. The nurse has made this interpretation based on the PR interval of: a) 0.15 and 0.3 seconds. b) 0.05 and 0.1 seconds. c) 0.12 and 0.2 seconds. d) 0.25 and 0.4 seconds.
0.12 and 0.2 seconds. The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It measures the time needed for conduction through the AV node before ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds
Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds? a) 0.2 b) 0.1 c) 0.3 d) 0.4
0.2 Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second.
Which PR interval presents a first-degree heart block? a) 0.18 seconds b) 0.14 seconds c) 0.16 seconds d) 0.24 seconds
0.24 seconds In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block.
A patient is admitted to the emergency department (ED) with complaints of chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph (ECG) monitor. The nurse counts 9 RR intervals on the patient's 6-second rhythm tracing. The nurse correctly identifies the patient's heart rate as which of the following? a) 80 bpm b) 100 bpm c) 90 bpm d) 70 bpm
90 bpm An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90.
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 poor kidney perfusion b) A new myocardial infarction client c) A client with atrial dysrhythmias d) A client with third-degree heart block
A client with atrial dysrhythmias 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 nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication does the nurse anticpate administering to treat his bradycardia? a) Dobutamine (Dobutrex) b) Amiodarone (Cordarone) c) Atropine d) Lidocaine (Xylocaine)
A client with atrial dysrhythmias 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
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 affect the heart's ability to pump blood effectively. c) Altered patterns frequently produce neurological deficits. d) Altered patterns frequently cause a variety of home safety issues.
Altered patterns frequently affect the heart's ability to pump blood effectively. The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer
The nurse caring for a patient with a dysrhythmia understands that the P wave on an electrocardiogram (ECG) represents what phase of the cardiac cycle? a) Ventricular repolarization b) Ventricular depolarization c) Atrial depolarization d) Early ventricular repolarization
Atrial depolarization The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave.
Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker? a) Avoid sources of electrical interference b) Keep moving the arm on the side where the pacemaker is inserted c) Delay for at least 3 weeks activities such as swimming and bowling d) Keep the arm on the side of the pacemaker higher than the head
Avoid sources of electrical interference The nurse must instruct the patient with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the patient to avoid strenuous movement (especially of the arm on the side where the pacemaker is inserted), to keep the arm on the side of the pacemaker lower than the head except for brief moments when dressing or performing hygiene, and to delay for at least 8 weeks activities such as swimming, bowling, tennis, vacuum cleaning, carrying heavy objects, chopping wood, mowing, raking, and shoveling snow.
After having several Stokes-Adams attacks within 4 months, a client reluctantly agrees to implantation of a permanent pacemaker. Before discharge, the nurse reviews pacemaker care and safety guidelines with the client and his spouse. Which safety precaution is appropriate for a client who has a pacemaker? a) Avoid undergoing magnetic resonance imaging (MRI). b) Avoid going through airport metal detectors. c) Never engage in activities that require vigorous arm and shoulder movement. d) Stay at least 2? away from microwave ovens.
Avoid undergoing magnetic resonance imaging 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; nonetheless, the client should stay at least 5? away from microwaves, not 2?. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? a) Begin cardiopulmonary resuscitation (CPR) b) Administer atropine 0.5 mg c) Administer epinephrine d) Defibrillate with 360 joules (monophasic defibrillator)
Begin cardiopulmonary resuscitation (CPR) Commonly called flatline, ventricular asystole (Fig. 26-19) is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Ventricular asystole is treated the same as PEA, focusing on high-quality CPR with minimal interruptions and identifying underlying and contributing factors
A nurse is providing morning care for a patient in the ICU. Suddenly, the bedside monitor shows ventricular fibrillation and the patient becomes unresponsive. After calling for assistance, what action should the nurse take next? a) Begin cardiopulmonary resuscitation. b) Provide electrical cardioversion. c) Prepare for endotracheal intubation. d) Administer intravenous epinephrine.
Begin cardiopulmonary resuscitation. In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the patient as soon as possible. If defibrillation is not readily available, CPR is begun until the patient 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 patient in ventricular fibrillation.
You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what 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
Clients with recurrent life-threatening tachydysrhythmias The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect.
Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: a) occur during the QRS complex b) occur at a rate of more than six per minute c) are paired with a normal beat d) have the same shape
Correct response: occur at a rate of more than six per minute When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy
A patient is prescribed Quinidex for treatment of moderate depression of depolarization. The nurse knows to assess for the drugs' effectiveness, which can be evidenced by which of the following? a) Decrease in cardiac contractility b) Hypertension with IV administration. c) Decreased QRS duration of about 40% from baseline d) Shortened QT segment
Decrease in cardiac contractility Quinidex works by increasing the heart's resistance to activity and causes decreased cardiac contractility. The nurse needs to monitor the blood pressure for signs of hypotension and observe the patient for signs of heart failure, chest pain, and arrhythmias.
The nurse is working on a telemetry unit, caring for a client who has been in a sinus rhythm for the past 2 days with a heart rate of 88 to 96 beats per minute. The client puts on the call light in the bathroom and reports severe dizziness. The telemetry shows a heart rate of 46 beats per minute. What should the nurse be prepared to do? a) Give an IV bolus of atropine. b) Prepare the client for maze surgery. c) Assist with a temporary pacemaker. d) Send the client to the cardiac catheterization laboratory.
Give an IV bolus of atropine. Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia.
Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a: a) Heart rate of 42 beats per minute (bpm). b) P-to-QRS ratio of 1:1. c) QT interval of 0.37 seconds. d) PR interval of 0.18 seconds.
Heart rate of 42 beats per minute (bpm). All answers refer to a normal sinus rhythm (NSR) except for the heart rate. A rate of 42 bpm is slow but normal when it occurs in athletes without symptoms.
Which of the following is a potential cause of premature ventricular complexes (PVCs)? a) Hypokalemia b) Alkalosis c) Bradycardia d) Hypovolemia
Hypokalemia PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia.
While assessing a client, the nurse finds a heart rate of 120 beats per minute. The nurse recalls that causes of sinus tachycardia include which of the following? a) Hypothyroidism and athletic training b) Hypovolemia and fever c) Digoxin and vagal stimulation d) Vagal stimulation and sleep
Hypovolemia and fever Causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, sleep, hypothyroidism, athletic training, and Digoxin all will cause a slow heart rate
A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist? a) Cardiac catheterization b) Cardioversion or IV bolus of dopamine c) IV bolus of atropine or temporary pacing d) A maze procedure or IV bolus of furosemide
IV bolus of atropine or temporary pacing 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.
A 63-year-old client is in the cardiac step-down unit where you practice nursing. In your discussions about his condition, the client is puzzled as to what causes the heart to be an effective pump. Which of the following statements would you include in your response? a) Inherent electrons in muscle tissue b) Inherent rhythmicity of cardiac muscle tissue c) Sufficient blood pressure d) Inherent rhythmicity of all muscle tissue
Inherent rhythmicity of cardiac muscle tissue Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively.
The nurse is 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) Aortic stenosis b) Atherosclerotic heart disease c) Ischemic heart disease d) Peripheral vascular disease
Ischemic heart disease 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 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) Fracture of the lead wire b) Faulty generator c) Sensitivity is too low d) Lead wire dislodgement
Lead wire dislodgement Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation.
A nurse should obtain serum levels of which electrolytes in a client with frequent episodes of ventricular tachycardia? a) Potassium and calcium b) Magnesium and potassium c) Calcium and magnesium d) Potassium and sodium
Magnesium and potassium Hypomagnesemia as well as hypokalemia and hyperkalemia are common causes of ventricular tachycardia. Calcium imbalances cause changes in the QT interval and ST segment. Alterations in sodium level don't cause rhythm disturbances.
The nurse expects to see which of the following characteristics on an ECG strip for a patient who has third-degree AV block? a) Atrial rate of 60 bpm or below b) More P waves than QRS complexes c) Shortened QRS duration. d) Extended PR interval
More P waves than QRS complexes There is no PR interval because there isn't any relationship between the P and R wave. No atrial impulse is conducted through the AV node; atrial and ventricular contractions are independent. With third-degree AV block, two separate impulses stimulate the heart; there is no synchrony or relationship.
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? a) Model number b) Date and time of insertion c) Location of the generator d) Pacer rate
Pacer rate After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.
A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding? a) Prolonged QT interval b) Flattened P waves c) Occasional U waves d) Peaked T waves
Peaked T waves The patient'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 patient'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 patient'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 patient'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 patient's serum potassium level.
A 28-year-old female patient presents to the emergency department (ED) stating severe restlessness and anxiety. Upon assessment, the patient's heart rate is 118 bpm and regular, the patient's pupils are dilated, and the patient appears excitable. Which action should the nurse take next? a) Instruct the patient to hold her breath and bear down. b) Question the patient about alcohol and illicit drug use. c) Prepare to administer a calcium channel blocker. d) Place the patient on supplemental oxygen.
Question the patient about alcohol and illicit drug use. The patient is experiencing sinus tachycardia. Since the patient's findings of tachycardia, dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the patient about alcohol and illicit drug use. This information will direct the patient'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 patient comes to the emergency department with complaints 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) Ventricular tachycardia d) Sinus tachycardia
Sinus tachycardia 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)
A 26-year-old male patient, who has been diagnosed with paroxysmal supraventricular tachycardia (PSVT), is being treated in the emergency department. The patient is experiencing occasional runs of PSVT lasting up to several minutes at a time. During these episodes, the patient becomes lightheaded but does not lose consciousness. Which of the following maneuvers may be used to interrupt the patient's atrioventricular nodal reentry tachycardia (AVNRT)? Select all that apply. a) Performing carotid massage b) Stimulating the patient's gag reflex c) Instructing the patient to breathe deeply d) Placing the patient's face in cold water e) Instructing the patient to vigorously exercise
Stimulating the patient's gag reflex Placing the patient's face in cold water Performing carotid massage The following vagal maneuvers can be used to interrupt AVNRT: stimulating the patient's gag reflex, having the patient hold his breath, cough, bear down, placing his 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 patients with carotid bruits. If the vagal maneuvers are ineffective, the patient 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 SVT
The nurse is preparing to administer adenosine (Adenocard) for a patient diagnosed with atrial flutter. Which of the following should be completed when giving this medication? a) The dose is administered slow IV push. b) The medication is followed by a rapid lactated Ringer's (LR) flush c) The medication is followed by a slow saline flush. d) The dose is administered rapid IV push.
The dose is administered rapid IV push. The dose is administered by rapid IV push (1 to 2 seconds), followed with a rapid saline flush. LR is not used during administration of this medication.
The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? a) The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute b) The registered nurse stating to administer Lanoxin (digoxin) c) The registered nurse administering atropine sulfate intravenously d) The registered nurse stating to administer all medications accept those which are cardiotonics
The registered nurse administering atropine sulfate intravenously The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed
Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes: a) Administration of amiodarone b) Treating the underlying cause c) Immediate defibrillation d) Electrical cardioversion
Treating the underlying cause Sinus tachycardia occurs in response to an underlying condition and will usually resolve once that condition is corrected.
Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? a) Lanoxin b) Vasotec c) Atropine d) Valium
Valium Prior to cardioversion, cardiac medications are held, and the client is sedated with a medication such as Valium.
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? a) Adenosine (Adenocard) b) Atropine c) Amiodarone (Pacerone) d) Warfarin (Coumadin)
Warfarin (Coumadin) Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone (Cordarone), flecainide (Tambocor), ibutilide (Corvert), propafenone (Rythmol), or sotalol (Betapace) prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation (Fuster, Rydén et al., 2011).
The nurse is proving discharge instruction for a patient with a new arrhythmia. Which of the following should the nurse include? a) Your family and friends may want to take a CPR class. b) It is not necessary to learn how to take your own pulse. c) Do not be concerned if you experience symptoms of lightheadedness and dizziness. d) If you miss a dose of your antiarrhythmia medication, double up on the next dose.
Your family and friends may want to take a CPR class. Having friends and family learn to take a pulse and perform CPR will help patients to manage their condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness are symptoms which should be reported to the provider.
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 have an appointment for magnetic resonance imaging of my knee scheduled for next week." b) "I need to stay at least 10? away from the microwave." c) "I'll keep a log of each time my ICD discharges." d) "I can't wait to get back to my football league."
"I'll keep a log of each time my ICD discharges." The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD
Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? a) "It shows the time it takes the AV node impulse to depolarize the septum and travel through the Purkinje fibers." b) "It shows the time it takes the AV node impulse to depolarize the atria and travel through the SA node." c) "It shows the time it takes the AV node impulse to depolarize the ventricles and travel through the SA node." d) "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."
"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers.
A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between sinus rhythm and sinus bradycardia when I look at the EKG strip" The best reply by the nurse is which of the following? a) "The only difference is the rate, which will be below 60 bpm in sinus bradycardia." b) "The QRS complex will be smaller in sinus bradycardia." c) "The P-R interval will be prolonged in sinus bradycardia, and you will have to measure carefully to note the width." d) "The P waves will be shaped differently."
"The only difference is the rate, which will be below 60 bpm in sinus bradycardia." All characterestics 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 nurse is caring for a client with a diagnosis of atrial fibrillation. The onset was approximately 2 to 3 days ago. The client is scheduled for a transesophageal echocardiogram this morning. The client's spouse asks what this test is for. The best response by the nurse is which of the following? a) "This test will let the doctor know if the client is at risk for hypotension." b) "This test will show any blood clots in the heart and if it is safe to do a cardioversion." c) "This test will show if the client needs a cardiac catheterzation." d) "This test will show the specific area causing the atrial fibrillation and what can be done to stop it."
"This test will show any blood clots in the heart and if it is safe to do a cardioversion." When contemplating cardioversion for the client with atrial fibrillation, the absence of a thrombus in the atria can be confirmed by transesophageal echocardiogram.
A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the nurse how excited he is because he's planning to go rifle hunting with his grandson. How should the nurse respond? a) "You'll need to take an extra dose of your antiarrhythmic before you shoot." b) "Enjoy your time with your grandson." c) "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." d) "Being that close to a rifle might make your ICD fire."
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with his left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of his antiarrhythmic.
The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following? a) "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." b) "There is a long list of clients in line to be cardioverted." c) "The doctor wants to see if your heart will switch back to its normal rhythm by itself." d) "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion."
"Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion
An 83-year-old resident in the long-term care facility where you practice nursing has an irregular heart rate of around 100 beats/minute. He also has a significant pulse deficit. What component of his history would produce such symptoms? a) Atrial flutter b) Atrial fibrillation c) Heart block d) Bundle branch block
Atrial fibrillation In atrial fibrillation, several areas in the right atrium initiate impulses resulting in disorganized, rapid activity. The atria quiver rather than contract, producing a pulse deficit due to irregular impulse conduction to the AV node. The ventricles respond to the atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not atrial flutter. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not heart block. Atrial fibrillation generally causes disorganized activity, irregular heart rates, and pulse deficits. It is not bundle branch block.
A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? a) Atrial flutter b) Ventricular fibrillation c) Premature ventricular contraction d) Asystole
Atrial flutter Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart.
A nurse is completing a shift assessment on a patient admitted to the telemetry unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The patient is also experiencing dizziness and shortness of breath. Which of the following medications will the nurse anticipate administering to the patient based on these clinical findings? a) Atropine b) Cardizem c) Lidocaine d) Pronestyl
Atropine The patient is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias.
Cardioversion is used to terminate dysrhythmias. With cardioversion, the: a) Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time. b) Electrical impulse can be discharged during the T wave. c) Defibrillator should be set to deliver a shock during the QRS complex. d) Amount of voltage used should exceed 400 watts/second.
Defibrillator should be set to deliver a shock during the QRS complex. Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation
The nurse is assessing a patient with a probable diagnosis of first-degree AV block. He is aware that this dysrhythmia is evident on an ECG strip by which of the following? a) Irregular rhythm b) Delayed conduction, producing a prolonged PR interval c) P waves hidden within the QRS complex d) Variable heart rate, usually fewer than 90 bpm
Delayed conduction, producing a prolonged PR interval First-degree AV block may occur without an underlying pathophysiology, or it can result from medications or conditions that increase parasympathetic tone. It occurs when atrial conduction is delayed through the AV node, resulting in a prolonged PR interval.
The nurse is preparing a patient for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. Which of the following information should the nurse include? a) After the procedure, the arrhythmia will not recur. b) The procedure will occur in the operating room under general anesthesia. c) During the procedure, the arrhythmia will be reproduced under controlled conditions. d) The procedure takes less time than a cardiac catheterization.
During the procedure, the arrhythmia will be reproduced under controlled conditions. During EP studies, the patient is awake and may experience symptoms related to the arrhythmia. EP studies do not always include ablation of the arrhythmia.
The nurse is assessing a client with mitral regurgitation. The nurse expects to note which of the following findings in this client? a) Dizziness, syncope, and palpitations b) Orthopnea, angina, and pulmonary edema c) Dry cough, wheezing, and hemoptysis d) Dyspnea, fatigue, and weakness
Dyspnea, fatigue, and weakness Chronic mitral regurgitation is often asymptomatic, but acute mitral regurgitation can cause dyspnea, fatigue, and weakness. Dizziness, syncope, and palpitations are usually symptoms of mitral valve prolapse. Orthopnea, angina, and pulmonary edema are more likely with aortic stenosis. Dry cough, wheezing, and hemoptysis are more likely with mitral stenosis.
You are caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? a) Mace procedure b) Elective cardioversion c) Defibrillation d) Pacemaker implantation
Elective cardioversion Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Mace procedure is only a distractor for this question. Pacemakers are implanted for bradycardia.
A 65-year-old client has come to the emergency department reporting light-headedness, chest pain, and shortness of breath. As you finish your assessment, the physician enters and orders tests to ascertain what is causing the client's problems. In your client education, you explain the tests. Which test is used to identify cardiac rhythms? a) Electroencephalogram b) Electrocautery c) Echocardiogram d) Electrocardiogram
Electrocardiogram An electrocardiogram is used to identify normal and abnormal cardiac rhythms. An electrocardiogram is the device used to identify normal and abnormal cardiac rhythms.
Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for an elective electrical cardioversion? a) Monitor blood pressure every 4 hours b) Facilitate CPR until the patient is prepared for cardioversion c) Administer digitalis and diuretics 24 hours before cardioversion d) Instruct the patient to restrict food and oral intake
Instruct the patient to restrict food and oral intake The nurse should instruct the patient 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 patient is in cardiopulmonary arrest, the nurse should facilitate CPR until the patient is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a patient with cardiac dysrhythmia
What nursing interventions could you institute with a client who has a suspected dysrhythmia that would help detect life-threatening dysrhythmias and would manage and minimize any that occur? a) Monitor cardiac rhythm continuously. b) Provide supplemental oxygen. c) Palpate the client's pulse and observe the client's response. d) Monitor blood pressure continuously.
Monitor cardiac rhythm continuously. The nurse should monitor cardiac rhythm continuously. Cardiac monitors display real-time heart rate and rhythm and alert the nurse to potentially life-threatening dysrhythmias. Monitoring blood pressure continuously and palpating the client's pulse do not help detect life-threatening dysrhythmias. Providing supplemental oxygen helps maintain adequate cardiac output and does not help detect life-threatening dysrhythmias.
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) TP interval d) QT interval
RR interval 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.
Your client has just been diagnosed with a dysrhythmia. The client asks you to explain normal sinus rhythm. What would you explain are the characteristics of normal sinus rhythm? a) The sinoatrial (SA) node initiates the impulse. b) Heart rate between 60 and 150 beats per minute. c) Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 seconds. d) The ventricles depolarize in 0.5 seconds or less.
The sinoatrial (SA) node initiates the impulse. The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats per minute; the SA node initiates the impulse; the impulse travels to the AV node in 0.12 to 0.2 seconds; the ventricles depolarize in 0.12 seconds or less; and each impulse occurs regularly
The nurse explains to the patient with PACs that there are many causes, some of which are modifiable. Select all the possible causes. a) Alcohol b) Atrial ischemia c) Hypovolemia d) Anxiety e) Hypoxemia f) Hyperkalemia
• Hypoxemia • Atrial ischemia • Alcohol • Anxiety All of these causes stimulate or increase electrical impulses in the heart except for hyperkalemia. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems,
