Chapter 26: Caring for Clients with Cardiac Dysrhythmias
The nurse is speaking with a client admitted with a dysrhythmia. The client asks the nurse to explain the "F waves" on the electrocardiogram. What is the nurse's best response?
"The F waves are flutter waves representing atrial activity."
A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response?
"To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia."
The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response?
"Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes."
A monitor technician on the telemetry unit asks a charge nurse why every client whose monitor shows atrial fibrillation is receiving warfarin. Which response by the charge nurse is best?
"Warfarin prevents clot formation in the atria of clients with atrial fibrillation."
A client is diagnosed with sinus bradycardia. The nurse knows that the client's atrial rate is at or below what number?
60
The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention?
Administer an IV bolus of atropine.
The nurse is caring for a client who has been resistant to past antidysrhythmic therapy. Which cardiac dysrhythmic medication is administered for ventricular dysrhythmias when other mediations have failed?
Amiodarone
A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as
Atrial flutter
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
The nurse is planning discharge teaching for a client with a newly inserted permanent pacemaker. What is the priority teaching point for this client?
Avoid exposure to strong electromagnetic fields
A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker?
Avoid sources of electrical interference.
The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?
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
The nurse is caring for a client who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment?
Cardiac monitoring
A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for?
Catheter ablation therapy
The nurse is caring for a client who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output?
Changes in level of consciousness
A nurse is caring for a client who is exhibiting ventricular tachycardia (VT). Because the client is pulseless, the nurse should prepare for what intervention?
Defibrillation
The nurse recognizes which as being true of cardioversion?
Defibrillator should be set to deliver a shock during the QRS complex.
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 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.
The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During the client's most recent follow-up appointment, the nurse identifies data that suggest the client may be socially isolated and depressed. What nursing diagnosis is suggested by these data?
Ineffective coping related to pacemaker implantation
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
Monitor vital signs and cardiac rhythm
A client is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurse's responsibility in the care of the client's pacemaker?
Monitoring for pacemaker malfunction or battery failure
The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker?
Pacer rate
Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle?
QRS complex
The nurse is caring for a client with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the client's most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best interpret this finding?
Recognize this as a therapeutic goal of the procedure.
During a client's care conference, the team is discussing whether the client is a candidate for surgery maze procedure. What would be the most important criterion for a client to have this surgery?
Refractory atrial fibrillation
The nurse is assisting with the monitoring of a client with a dysrhythmia that shows the pattern in the accompanying image. What dysrhythmia does the client have?
Sinus bradycardia
A patient comes to the emergency department with reports 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 nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the client's heart?
T wave
A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response?
The medication increases the force of the myocardial contraction.
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client?
The need to have regular blood levels drawn
A patient has been admitted to the unit for an electrophysiology (EP) study. For what is an electrophysiology study primarily performed?
To diagnose the dysrhythmia
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
The nurse is caring for a client who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment?
Vigilant monitoring of the client's ECG
The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client?
alerting the healthcare provider of the third-degree heart block
Which is not a likely origination point for cardiac arrhythmias?
bundle of His
The nurse witnesses a client experiencing ventricular fibrillation. What is the nurse's priority action?
defibrillation
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 assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?
hypovolemia
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.
A client arrived at the hospital with symptoms of chest and jaw pain. After stabilizing the client's condition, the nurse discusses the client's symptoms, indicating that the most common cause of cardiac arrhythmias is:
ischemic heart disease.
A client's electrocardiogram reveals an irregular rhythm of 75 bpm with a normal QRS and P wave. The nurse who is caring for the client should anticipate:
no immediate treatment.
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.
When the nurse observes that the client's heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating
sinus arrhythmia.
The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document?
ventricular tachycardia
