Dysrhythmia Study Questions

A with a HR of 45 beats/minute complains of dizziness and has a BP of 82/60 mmHg. Which action should the nurse take? a) Defibrillate the client b) Administer digoxin c) Continue to monitor the client d) Prepare for transcutaneous pacing

D) Prepare for transcutaneous pacing RATIONALE: Bradycardia: May give IV atropine, do transcutaneous pacing (or permanent pacing) - may also use epinephrine or dopamine if other meds not effective. This patient IS symptomatic, needs treatment - pacing is the only appropriate choice (remember that on NCLEX "continuing to monitor" means you're not taking other actions)

The nurse is administering adenosine (Adenocard) to a client with supraventricular tachycardia. What is the expected therapeutic response? a) A short period of asystole b) A brief episode of ventricular tachycardia c) An increase in blood pressure d) Brief feeling of numbness and tingling of extremities

a) A short period of asystole RATIONALE: Expected response to this medication is a moment of asystole! We don't expect V tach, increases in BP, or numbness/tingling in the extremities.

A client is admitted to the telemetry unit with atrial fibrillation. What is the appropriate action of the nurse? Select all that apply. a) Administer warfarin b) Application of sequential compression device c) Continuous cardiac monitoring d) Monitor for decreased deep tendon reflexes e) Assess for changes in level of consciousness

a) Administer warfarin b) Application of sequential compression device c) Continuous cardiac monitoring e) Assess for changes in level of consciousness RATIONALE: All are appropriate for an admitted patient with a dysrhythmia, except for monitoring Deep Tendon Reflexes. Not indicated as part of monitoring/assessment with a fib.

The nurse caring for a client on the cardiac unit notices that the client's cardiac monitor shows ventricular fibrillation. What is the priority action by the nurse? a) Administration of digoxin (Lanoxin) b) Insertion of an IV line c) Immediate defibrillation d) Scheduling a pacemaker insertion

c) Immediate defibrillation RATIONALE: V fib is disorganized electric activity of the heart; v fib requires immediate debrillation Digoxin, IV meds, pacemaker are not indicated ("scheduling a pacemaker" in the future does nothing to fix the patient now!)

A nurse is caring for a client who is experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. What is the nurse's priority action? a) Administer lidocaine 100 mg IV push as ordered. b) Administer a 500 ml IV bolus of normal saline solution (0.9% NaCl). c) Notify the attending physician. d) Administer atropine 0.5 mg IV push as ordered.

d) Administer atropine 0.5 mg IV push as ordered RATIONALE: Patient is symptomatic! Priority is to fix this problem, which can be done with IV atropine (decreases PNS, to allow more SNS influence on the HR) Sodium channel blockers are not used for sinus brady; fluid bolus not indicated; physician can be notified after.

A client is admitted to the telemetry unit following a ST segment-elevation myocardial infarction (STEMI). The electrocardiogram (EKG) tracing shows a run of sustained ventricular tachycardia. What is the first action that the nurse should take? a) Apply the external pacemaker. b) Begin cardiopulmonary resuscitation (CPR). c) Defibrillate the client. d) Assess the client's airway, breathing, pulses, and level of conciseness.

d) Assess the client's airway, breathing, pulses, and level of consciousness RATIONALE: First action is to assess! Remember with V tach we need to determine if the patient has a pulse or does not have a pulse. If pulse -> Cardiovert If no pulse -> Start CPR so -> Defibrillate

A client wearing a continuous cardiac monitor suddenly sets off an alarm. A nurse sees no electrocardiograph complexes on the screen. Which is the priority action of the nurse? a) Call a code b) Call the healthcare provider c) Check the client's status and lead placement d) Press the recorder button on the electrocardiogram console

C) Check the client's status and lead placement RATIONALE: Check the patient before you treat the strip!

Following a myocardial infarction, a client develops an arrhythmia and requires a continuous infusion of lidocaine (Xylocaine). To monitor the effectiveness of the intervention, the nurse should focus primarily on the client's: a) electrocardiogram (ECG). b) lidocaine level. c) troponin level. d) blood pressure.

a) Electrocardiogram (ECG) RATIONALE: If lidocaine is given for a dysrhythmia the best indicator that it is effective is an improvement in the rhythm! This will be detected with the ECG Remember that drug levels will increase, but this doesn't mean the drug is having the desired effect Troponin is an important cardiac marker, but will tell is damage to the heart is occurring and not if the dysrhythmia is improving.

The monitor technician informs the nurse that the client has started having premature ventricular contractions every other beat. Which is the priority nursing action? a) Activate the rapid response team. b) Assess the client's orientation and vital signs c) Call the physician. d) Administer a bolus of lidocaine.

b) Assess the client's orientation and vital signs RATIONALE: Check the patient before you treat the strip! PVCs every other beat do not require a rapid response; prior to administering medications you should assess the patient to see if they are symptomatic (patient can have his dysrhythmia and not be symptomatic); calling the physician can come later

The nurse interprets the rhythm strip from a client's bedside monitor (as shown) as which of the following? a) Normal sinus rhythm. b) Supraventricular tachycardia. c) Atrial fibrillation. d) Ventricular tachycardia.

b) Supraventricular tachycardia RATIONALE: This is a difficult strip to interpret, and not looking from Lead II! Here's how I walk through the choices: 1.Definitely not a normal sinus rhythm! 2.Does not look anything like a fib either - no sign of the "flutter" waves 3.SVT vs V tach? Hard to identify other features; QRS looks wide and distorted, but the waveform is not just "up and down" like we see with V tach, so we're possibly seeing a T wave 4.Makes this more likely SVT

A client is given amiodarone in the emergency department for a dysrhythmia. Which of the following indicates the drug is having the desired effect? a) The ventricular rate is increasing. b) The number of premature ventricular contractions is decreasing. c) The absent pulse is now palpable. d) The fine ventricular fibrillation changes to coarse ventricular fibrillation.

b) The number of premature ventricular contractions is decreasing RATIONALE: Amiodarone is a K+ channel blocker, helps extend the refractory period, given with PVCs A)No - Would expect slowing if we're decreasing premature beats and extending refractory period B)Yes! We're giving it to decrease PVCs C)No - this is not given for a dysrhythmia where there is no pulse D)No - not given for this dysrhythmia! (fine vs course v fib refers to size of the waves - fine will result in smaller waves (less electric activity), coarse v fib results in more prominent waves.)

A client with chest pain, dyspnea, and an irregular heartbeat comes to the emergency department. An electrocardiogram shows a heart rate of 110 beats/minute (sinus tachycardia) with frequent premature ventricular contractions. Shortly after admission, the client has ventricular tachycardia and becomes unresponsive. After successful resuscitation, the client is taken to the intensive care unit (ICU). Which nursing diagnosis is the priority at this time? a) Fear related to threat of death b) Activity Intolerance related to decreased cardiac output c) Social isolation related to restricted visiting hours in the ICU d) Ineffective tissue perfusion (cardiopulmonary) related to arrhythmia

d) Ineffective tissue perfusion (cardiopulmonary) related to arrhythmia RATIONALE: Highest priority should be given to "Ineffective Tissue Perfusion" although all can be appropriate for this patient. Irregular beats, sinus tachycardia frequent PVCs --> V tach indicates a worsening of the patients condition. While in the ICU ensuring that the rhythm remains stable and perfusion is effective is the top concern.