CH 26 PrepU
Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:
occur at a rate of more than six per minute
A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:
inherent rhythmicity of cardiac muscle tissue.
The nurse is instructing on home care after placement of an automatic implanted cardioverter defibrillator (AICD). Which statement, made by the client, needs clarification by the nurse?
"I need to stay away from microwaves."
The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the hear
Altered patterns frequently affect the heart's ability to pump blood effectively.
Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation?
Anticoagulant
The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle?
Atrial depolarization
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
"It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node."
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?
Atrial flutter
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:
0.12 and 0.2 seconds.
The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?
Atrial flutter
Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?
Atrial flutter
Which medication is the drug of choice for sinus bradycardia?
Atropine
The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed.
Atropine sulfate
A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do?
Double-check the monitoring equipment.
Which PR interval presents a first-degree heart block?
0.24 seconds
A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?
"I'll keep a log of each time my ICD discharges."
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?
"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)"
A patient is being examined for medical management of atrial flutter. The nurse reviews the ECG strip. He expects to see which of the following?
"Sawtooth" pattern to the waveform
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?
"Spike" on the rhythm strip
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?
"The only difference is the rate, which will be below 60 bpm in sinus bradycardia."
The nurse is caring for a 32-year-old client admitted with a medical diagnosis of atrial fibrillation, related to "holiday heart" syndrome. A nursing student working with the nurse asks for information about "holiday heart" syndrome. The best response by the nurse is which of the following?
"This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking."
A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between ventricular tachycardia and ventricular fibrillation when I look at the EKG strip?" The best reply by the nurse is which of the following?
"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast with wide QRS complexes."
The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education.
"We will be getting rid of our microwave oven so it will not affect my pacemaker."
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?
"You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks."
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?
During the procedure, the arrhythmia will be reproduced under controlled conditions.
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 client with atrial dysrhythmias
A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart?
All options are correct.
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?
Avoid undergoing magnetic resonance imaging (MRI).
A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next?
Begin cardiopulmonary resuscitation
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
Clients with recurrent life-threatening tachydysrhythmias
After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have?
Decreased cardiac output and decreased systolic and diastolic blood pressure
After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following?
Defibrillation
Cardioversion is used to terminate dysrhythmias. With cardioversion, the
Defibrillator should be set to deliver a shock during the QRS complex.
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?
Delayed conduction, producing a prolonged PR interval
The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?
Delayed conduction, producing a prolonged PR interval
A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response
Document the findings and continue to monitor the client
Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client?
Elective electrical cardioversion
The nurse is asked to explain ventricular bigeminy to a patient. The nurse explains that it is a conduction defect in which:
Every other complex is a PVC.
A client receives a pacemaker to treat a recurring arrhythmia. When monitoring the cardiac rhythm strip, the nurse observes extra pacemaker spikes that don't precede a beat. Which condition should the nurse suspect?
Failure to capture
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?
Fluttering
A patient experiences a faster-than-normal heart rate when she drinks more than two cups of coffee in the morning. The nurse knows that an indicator of sinus tachycardia on an ECG would be which of the following?
Heart rate of 118 bpm
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:
Heart rate of 42 beats per minute (bpm).
Which of the following is a potential cause of premature ventricular complexes (PVCs)?
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?
Hypovolemia and fever
The nurse understands that asystole can be caused by several conditions. Select all that apply.
Hypoxia Hypovolemia Hypothermia Acidosis
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?
IV bolus of atropine or temporary pacing
Which rhythm is also termed a ventricular escape rhythm?
Idioventricular rhythm
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
Monitor vital signs and cardiac rhythm
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?
Pacer rate
The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up?
QT interval that is 0. 46 seconds long
The nurse reviews the ECG strip, which indicates extended time between ventricular depolarization and repolarization. He checked the ventricular rate and rhythm again. To do that, the nurse would have to check which of the following?
RR interval
The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following?
Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers
Which dysrhythmia is common in older clients?
Sinus bradycardia
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?
Sinus tachycardia
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?
The registered nurse administering atropine sulfate intravenousl
Your patient is experiencing asymptomatic sinus tachycardia with a rate of 118. The nurse understands that the treatment of this condition includes:
Treating the underlying cause
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be?
Ventricular fibrillation
A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi?
Warfarin (Coumadin)
A client tells the nurse "my heart is skipping beats again; I'm having palpitations." After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to
avoid caffeinated beverages.
A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms?
electrocardiogram
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as
normal sinus rhythm.
A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have?
sinus bradycardia
A client's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as
Atrial flutter
You enter your client's room and find them pulseless and unresponsive. What would be the treatment of choice for this client
Immediate defibrillation
A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following?
It increases the force of the myocardial contraction.
The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation?
It is used to eliminate ventricular dysrhythmias.
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?
Lead wire dislodgement
To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform?
P wave
The nurse participates in the care of a client requiring emergent defibrillation. The nurse determines the steps should be completed in which order?
Turn on the defibrillator and place it in "not sync" mode. Charge the defibrillator to the prescribed voltage. Apply the multifunction conductor pads to the client's chest. Call "clear" three times ensuring client and environmental safety. Deliver the prescribed electrical charge.
