CH. 37 Dysrhythmias

To best perform a 12-lead ECG on a client, how does the nurse place the leads on the client?

4 leads are placed on the limbs and 6 are placed on the chest

what does the nurse determine in the client's HR when assessing a 6 second tele ECG strip with 5 QRS complexes?

50 bpm, bradycardia

which normal heart rate does the nurse expect to be initiated by the primary pacemaker of the heart (SA node) in clients when the heart rate is regular? SATA

62 bpm, 74bpm, 86bpm, 98 bpm (anything 60-100bpm)

which waveform does the nurse recognize as atrial depolarization when a client is placed on a cardiac monitor?

P wave

which ECG waveforms and intervals are the normal measurements or positions? SATA

PR 0.12-0.20 QRS 0.06-0.10 PR segment isoelectric line QT <1/2R-R U wave follows T wave if present

which BB drug approved for treating dysrhythmias is also a class III antidysrhythmic drug?

Sotalol

why dysrhythmia does the nurse consider life threatening because it causes the ventricles to quiver and results in the absence of cardiac output for a client?

V FIB

for which cardiac dysrhythmias would an automatic external defibrillator (AED) instruct the nurse to immediately defibrillate an unconscious client at an outpatient clinic? SATA

V Fib pulseless ventricular tachycardia

which ECG strip pattern is evidence to the nurse that a client's temporary transvenous pacemaker has successfully depolarized the ventricles?

a pacer spike followed by a QRS complex

to determine if a client has a pulse deficit, what procedure would the nurse follow?

assess the apical and radial pulses for a full minute and calculate the difference

which actions are essential nursing care for a client immediately after elective cardioversion? SATA

administer oxygen assess VS and LOC monitor for dysrhythmias maintain an open airway document the results of the cardioversion

which questions would the nurse use to assess a client's P wave on an ECG rhythm strip? SATA

are P waves present? do all P waves look similar? are P waves occurring regularly? are P waves smooth, rounded, and upright?

what is the priority action for the nurse when the monitor tech states that a client's tele monitor shows a rhythm that appears as a wandering or fuzzy baseline?

assess the client to differentiate artifact from an actual lethal rhythm

which would be the best method for a nurse to confirm a report from the monitor tech about a change in a monitored client's HR?

assess the clients HR directly by checking the apical pulse

which are nursing responsibilities for the care of a client with a newly implanted permanent pacemaker? SATA

assess the implantation site for bleeding, swelling, redness, tenderness, or infection monitor the ECG rhythm strip to ensure that the pacemaker is working correctly assess that the implantation site dressing is clean and dry teach the client about initial activity restrictions

which criteria support the nurse's assessment that a client's ECG rhythm strip shows a normal sinus rhythm?

atrial and ventricular rates are regular atrial and ventricular rates are 82 bpm P waves are present before every QRS complex QRS duration is consistent at 0.08 second

after calling for help, when the nurse finds a client in his/her room without a pulse, apneic and unconscious, which action should be taken next?

begin cardiac compressions

which causes would the nurse recognize as leading to increased atrial irritability and premature atrial contractions (PACs) in a client's myocardium? SATA

caffeine intake anxiety stress in life infection

which client assessment takes priority when the nurse begins his/her shift?

client with atrial fibrillation and sustained rapid ventricular response

which safety precaution must be taken before defibrillating a client with ventricular fibrillation (VF)?

command all health care team members to stand clear of the client's bed

what is the first step when the nurse analyzes a client's ECG rhythm strip?

determine the heart rate

which nursing actions have priority when a client with acute supraventricular tachycardia (SVT) is to be administered adenosine by the HCP? SATA

ensure that emergency equipment is at the bedside follow the drug injection with a normal saline bolus monitor the client for bradycardia, nausea, and vomiting

which actions would the nurse take when the monitor tech states that a client's tele ECG signal transmission is not very clear? SATA

ensure that the gel on each electrode is moist & fresh clean the skin & clip hairs id necessary make sure that the skin is free of lotion or any other substance check to be sure that electrodes are not placed over a scar

which s/s would the nurse expect to assess in a client with sinus tachycardia? SATA

fatigue SOB decreased O2 saturation decreased BP anginal pain

which risk factors for atrial fibrillation would the nurse monitor for in a client? SATA

hypertension diabetes mellitus excessive alcohol intake mitral valve diseasewatch f

which procedure would the nurse provide teaching about to a client who has chronic A FIB and is at increased risk for a stroke, but is not a candidate for anticoagulation?

left atrial appendage (LAA) occlusion

which descriptions are characteristics of Class III antidysrhythmic drugs? SATA

lengthen absolute refractory period include bradycardia as a side effect for some drugs prolong repolarization

which drug does the nurse prepare to administer to a client diagnosed with the dysrhythmia torsades de pointes?

magnesium sulfate

which condition is indicated when the nurse notes ST segment elevation or one to two small blocks on the client's ECG?

myocardial injury or ischemia

When would the telemetry unit nurse use temporary transcutaneous pacing for a client? SATA

only as a temporary emergency measure until invasive pacing method ca be started only until the clients heart rhythm returns to normal when invasive pacing is not immediately available

which priority concept does the nurse focus on when a client is diagnosed with a dysrhythmia?

perfusion

which conditions would the nurse suspect when a client's tele ECG rhythm strip shows ST elevation of 1.5 mm ( 1.5 small blocks)? SATA

pericarditis MI hyperkalemia

which statements about permanent pacemakers are accurate? SATA

permanent pacemakers are available as pacemaker/defibrillator devices permanent pacemakers are used to treat disorders such as complete heart block biventricular pacemakers allow synchronized depolarization of the ventricles the pulse generator for a permanent pacemaker is usually implanted in the left subclavian area

which serum electrolyte will the nurse check after noting tall and peaked T waves on a client's ECG?

potassium

what does the nurse suspect when assessing a client's tele ECG strip and noting a wide distorted QRS complex of 0.14 second followed by a P wave?

premature ventricular complex followed by atrial contraction

which important teaching points would the nurse discuss with a client who receives a new permanent pacemaker? SATA

report any pulse that is lower than the rate set on the pacemaker avoid sources of strong electromagnetic fields such as magnets carry a pacemaker id card and wear a medical alert bracelet avoid tight clothing to prevent pressure over the pacemaker generator

which actions are responsibilities of the monitor tech? SATA

report client rhythm and significant changes to the nurse print routine ECG strips for each monitored client watch the bank of cardiac monitors on a client care unit interpret rhythm strips for each monitored client

where will the nurse place the leads on a client for a 5-lead continuous monitoring system? SATA

right arm electrode just below the right clavicle left arm electrode just below the left clavicle left leg electrode on the lowest palpable rib, on the left midclavicular line fifth electrode placed to obtain one of the six chest leads

what effect does the nurse expect a Class IV drug to have on a client's cardiac conduction system?

slow the flow of calcium into the cell during depolarization to depress automaticity

which definition best describes the electrophysiologic property called automaticity of myocardial pacemaker cells?

the ability of cardiac cells to generate an electrical impulse spontaneously and repetitively

how does a nurse interpret a clients tele ECG strip that shows four successive premature ventricular contractions (PVCs)?

the client had an episode of non-sustained ventricular tachycardia (NSVT)

how would the nurse best interpret the ECG of a younger athletic client which shows sinus bradycardia with a rate of 54 bpm?

the sinus bradycardia provides an adequate stroke volume that is associated with cardiac conditioning

when a client has been in arial fibrillation for 3 days and is scheduled for an elective cardioversion, what priority teaching does the nurse provide to the client?

watch for any sign of bleeding and report this to your HCP