Lewis Questions Ch 35

The nurse knows that discharge teaching about the management of a new permanent pacemaker has been most effective when the patient states

"I won't lift the arm on the pacemaker side until I see the health care provider."

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/min.

40 to 60

When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ____.

50

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first?

A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone (Cordarone) due

A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54 mm Hg, and the student denies any health problems. What action by the nurse is most appropriate?

Allow the student to participate on the soccer team.

A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which action should the nurse take next?

Apply the transcutaneous pacemaker (TCP) pads.

A 19-yr-old student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional unifocal premature ventricular contractions (PVCs). What action should the nurse take next?

Ask the patient about current stress level and caffeine use.

A patient's heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next?

Call the health care provider before giving scheduled metoprolol (Lopressor).

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg?

Give a sedative before cardioversion is implemented.

A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first?

Give supplemental O2 at 2 to 3 L/min via nasal cannula.

After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the drug has been effective?

Increase in the patient's heart rate

Which action by a new registered nurse (RN) who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias?

Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin?

Instruct the patient to call for assistance before getting out of bed.

A patient has ST segment changes that suggest an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient?

Lead II

Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as telemetry technicians on the cardiac care unit?

Observe heart rhythms for multiple patients who have telemetry monitoring.

A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action should the nurse take first?

Perform immediate defibrillation.

A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which action should the nurse take next?

Prepare to give IV amiodarone per agency dysrhythmia protocol.

To determine whether there is a delay in impulse conduction through the ventricles, the nurse will measure the duration of the patient's

QRS complex.

When analyzing the rhythm of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n)

QRS interval of 0.14 second.

Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?

Serum potassium of 2.9 mEq/L

A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic, and has no palpable pulses. What action should the nurse take next?

Start cardiopulmonary resuscitation (CPR).

Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more teaching about the care of patients with ICDs?

The nurse encourages the patient to do active range of motion exercises for all extremities.

Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter?

The procedure uses electrical energy to destroy areas of the conduction system.

When preparing to defibrillate a patient, in which order will the nurse perform the following steps?

Turn the defibrillator on. Select the appropriate energy level. Place the hands-free, multifunction defibrillator pads on the patient's chest. Check the location of other staff and call out "all clear." Deliver the electrical charge.

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use?

Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.

The nurse notes that a patient's heart monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm?

Ventricular bigeminy

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. Teaching for this patient would include information about

anticoagulant therapy.

A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval is 0.24 seconds. The most appropriate intervention by the nurse would be to

document the finding and monitor the patient.

A patient reports dizziness and shortness of breath for several days. During heart monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as

third-degree atrioventricular (AV) block.

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval regular, and QRS complex wide and distorted, and QRS duration of 0.18 second. The nurse interprets the patient's cardiac rhythm as

ventricular tachycardia.