EQA 4 Dysrhymias
A patient's has the following electrocardiogram (ECG) tracing. What should a nurse do? 1 No intervention is necessary. Continue monitoring. 2 Call the primary health care provider recommending a blood sample be drawn to evaluate electrolyte status. 3 Notify the primary health care provider that the ECG tracing is showing second degree atrioventricular (AV) Block Type 1. 4 Call a Code Blue.
Answer: 1 The patient is in a first degree AV Block, a benign rhythm. It is not necessary to evaluate electrolytes. The patient is not in a lethal rhythm, so do not call a Code Blue. No interventions are necessary. Text Reference - p. 798
A nurse is performing an initial assessment on a patient. The electrocardiogram (ECG) tracing is as follows. The nurse recognizes that this type of tracing may result from an electrolyte imbalance or a medication. What is another cause for the abnormality? 1 Myocardial infarction 2 Myocardial ischemia 3 Fluid overload 4 Dehydration
Answer: 2 Decreased blood and oxygen to the heart muscle (myocardial ischemia) results in ST segment depression. Myocardial infarction causes ST elevation. Fluid overload and dehydration often affect the heart rate, but not ST segment position on the ECG tracing. Text Reference - p. 806
When computing a heart rate from the ECG tracing, the nurse counts 15 of the small blocks between the R waves of a patient whose rhythm is regular. From this data, the nurse calculates the patient's heart rate to be: 1 60 beats/min 2 75 beats/min 3 100 beats/min 4 150 beats/min Because each small block on the ECG
Answer: 3 paper represents 0.04 seconds, 1500 of these blocks represent one minute. By dividing the number of small blocks (15 in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100). Sixty beats per minute, 75 beats/min, and 150 beats/min are incorrect answers.
The patient has atrial fibrillation with a rapid ventricular response. The nurse knows to prepare for which treatment if an electrical treatment is planned for this patient? 1 Defibrillation 2 Synchronized cardioversion 3 Automatic external defibrillator (AED) 4 Implantable cardioverter-defibrillator (ICD)
Aswer: 2 Synchronized cardioversion is planned for a patient with supraventricular tachydysrhythmias (atrial fibrillation with a rapid ventricular response). Defibrillation or AEDs are the treatment of choice to end ventricular fibrillation and pulseless ventricular tachycardia (VT). An ICD is used with patients who have survived sudden cardiac death (SCD), have spontaneous sustained VT, and are at high risk for future life-threatening dysrhythmias. Text Reference - p. 802
A nurse works in a cardiac care unit. When attending to a patient on a cardiac monitor, what indicators should the nurse use to determine normal sinus rhythm? Select all that apply. 1 The R-R intervals are relatively consistent. 2 One P wave precedes each QRS complex. 3 4 to 8 complexes occur in a 6-second strip. 4 The ST segment is higher than PR interval. 5 The T wave is upright.
ANswer: 1, 2 , 5 The consistency of the R-R interval indicates regular rhythm. A normal P wave before each complex indicates the impulse originated in the SA node. The T wave is upright and represents ventricular repolarization. Disturbance in the T wave is usually caused by electrolyte imbalance, ischemia, or infarction. The number of complexes in a 6-second strip is multiplied by 10 to approximate the heart rate; normal sinus rhythm is 60 to 100. An elevation of the ST segment is a sign of cardiac ischemia and is not related to the rhythm. Text Reference - p. 791
A patient has been advised to have a permanent pacemaker implanted. What are the correct indications for a permanent pacemaker? Select all that apply. 1 Cardiomyopathy 2 SA node dysfunction 3 Coronary angioplasty 4 Drug therapy that may cause bradycardia 5 Third-degree atrioventricular (AV) block
Answer: 1, 2, 5 A permanent pacemaker helps to maintain the normal cardiac pace and is implanted within the body. The power source of such a device is placed subcutaneously, usually over the pectoral muscle on the patient's nondominant side. The permanent pacemaker is used in cardiomyopathy, SA node dysfunction, and third-degree AV block when the dysfunction of the electrical pathways is assumed to be permanent or irreversible. A temporary pacemaker may be required during coronary angioplasty and during drug therapy that may cause bradycardia. To maintain adequate cardiac rhythms during postoperative recovery and as a prophylactic measure after open heart surgery, temporary pacemakers are used. Text Reference - p. 804
A patient who underwent a cardioverter-defibrillator implant (ICD) is being discharged from the health care facility. Which instructions should the nurse give the patient and caregiver? Select all that apply. 1 Keep the incision dry as instructed and report any signs and symptoms of infection. 2 Exercise the arm on the incision side as soon as the incision heals and discomfort decreases. 3 Avoid large magnets and strong electromagnetic fields. 4 Avoid air travel until the cardiologist provides official clearance. 5 Inform the cardiologist if the implanted ICD fires.
Answer: 1, 3, 5 he incision should be kept dry for as many days as instructed by the cardiologist. The patient should avoid metal detectors, large magnets, and strong electromagnetic fields. If the ICD fires, the patient should inform the cardiologist or contact emergency medical service. The patient should not lift the arm on the side of the ICD until approved by the cardiologist. Air travel is not restricted; however, the patient should not drive unless cleared by the cardiologist. Text Reference - p. 803
A nurse finds that a patient has an atrial rate of 450 beats per minute and a ventricular rate of 150 beats per minute. What condition is the patient likely experiencing? 1 Atrial flutter 2 Atrial fibrillation 3 Ventricular fibrillation 4 Premature ventricular contractions
Answer: 2 Atrial fibrillation is characterized by alterations in electrical conductivity of the atrium. The atrial rate is as high as 350 beats per minute to 600 beats per minute. Atrial fibrillation with controlled ventricular response is observed at a ventricular rate of 60 beats per minute to 100 beats per minute. A ventricular rate above 100 beats per minute is considered as atrial fibrillation with uncontrolled ventricular response. The atrial rate and ventricular rate in atrial flutter occur at the ratio of 2:1. The atrial rate is observed between 200 beats per minute to 350 beats per minute and the ventricular rate occurs at 150 beats per minute. Ventricular fibrillation elicits dysrhythmia and P wave and QRS complex cannot be predicted. Premature ventricular contractions elicit dysrhythmia with deflections in the heart rate. Text Reference - p. 796
The nurse is evaluating a patient's pacemaker for malfunction. Pacemaker malfunction involves a failure to sense or a failure to capture. Which condition results in failure to capture? 1 Failure to recognize spontaneous atrial activity 2 Inability to produce atrial or ventricular contraction 3 Firing during the excitable period of the cardiac cycle 4 Failure to recognize spontaneous ventricular activity
Answer: 2 Failure to capture occurs when the electrical charge to the myocardium is insufficient to produce atrial or ventricular contraction. Failure to sense occurs when the pacemaker fails to recognize spontaneous atrial or ventricular activity, and it fires inappropriately. This can result in the pacemaker firing during the excitable period of the cardiac cycle, resulting in ventricular tachycardia. Text Reference - p. 805
The nurse is doing discharge teaching with the patient and spouse of the patient who just received an implantable cardioverter-defibrillator (ICD) in the left side of the chest. Which statement by the patient indicates to the nurse that the patient needs more teaching? 1 "I will call the cardiologist if my ICD fires." 2 "I cannot fly because it will damage the ICD." 3 "I cannot move my left arm until it is approved." 4 "I cannot drive until my cardiologist says it is okay."
Answer: 2 The patient statement that flying will damage the ICD indicates misunderstanding about flying. The patient should be taught that the Transportation Security Administration should be informed about the ICD because it may set off the metal detector, and if a hand-held screening wand is used it should not be placed directly over the ICD. "I will call the cardiologist if my ICD fires," "I cannot move my left arm until it is approved," and "I cannot drive until my cardiologist says it is okay" indicate the patient understands the teaching. Text Reference - p. 802
A nurse is preparing to complete an electrocardiogram (ECG) for a patient. The nurse observes artifact on the monitor. What could be a cause of artifact? Select all that apply. 1 The patient has dry skin. 2 The patient is shivering. 3 The conductive gel is still moist. 4 Electrical interference is present. 5 The leads and electrodes are not secure.
Answer: 2, 4, 5 Muscle activity caused by shivering of the patient, electrical interference, or loose leads and electrodes can cause distorted baseline and waveforms called artifact on the electrocardiogram (ECG). Oily skin is wiped dry with alcohol to prepare the patient for ECG. Electrodes may have to be replaced if conductive gel has dried out. Text Reference - p. 790
The electrocardiogram of a patient indicates hidden P waves in preceding T waves and a normal QRS complex. The nurse recognizes that the patient is most likely experiencing what condition? 1 Ventricular fibrillation 2 Junctional dysrhythmia 3 Premature atrial contraction 4 Premature ventricular contraction
Answer: 3 A premature atrial contraction occurs at the atrium and occurs before the next sinus beat occurs. A premature atrial contraction occurs in either the left atrium or right atrium and travels along the atria. The electrocardiogram of a premature atrial contraction usually shows hidden P waves in preceding T waves with prolonged PR interval. The QRS complex remains normal. The electrocardiogram of ventricular fibrillation has absent P waves and an undetectable PR interval and QRS complex. The electrocardiogram of junctional dysrhythmia shows a distorted P wave and reduced PR interval. The QRS complex remains normal. The electrocardiogram of premature ventricular contractions shows a rare occurrence of P waves. The PR interval cannot be measured with a disturbed and elongated QRS complex and T wave. Text Reference - p. 795
A patient comes to the emergency department complaining of dizziness and shortness of breath. The ECG tracing reveals the following. Which prescription should a nurse question? 1 12-Lead ECG 2 Transcutaneous pacing 3 Amiodarone (Cordarone) bolus 4 2 L oxygen vía nasal cannula
Answer: 3 Amiodarone is an antiarrhythmic medication that decreases ventricular irritability. Amiodarone is contraindicated in patients with third degree atrioventricular (AV) heart block. The nurse would expect to receive prescriptions for oxygen and a 12-lead ECG. Transcutaneous pacing is used to increase the heart rate until a transvenous or permanent pacemaker can be placed. Text Reference - p. 799
A health care provider is preparing the drug therapy for a patient with sinus tachycardia. The nurse recognizes that which drug will likely be included in the patient's treatment plan? 1 Atropine (AtroPen) 2 Dopamine (Intropin) 3 Adenosine (Adenocard) 4 Epinephrine (Adrenalin)
Answer: 3 Hypotension, dizziness, and dyspnea are symptoms of sinus tachycardia. Sinus tachycardia manifests as increased heart rate from 101 beats per minute to 200 beats per minute. Adenosine (Adenocard) is used in the treatment of sinus tachycardia. Adenosine decreases the heart rate caused by inhibition of the vagus nerve and myocardial oxygen consumption. Anticholinergic drugs like atropine (AtroPen), dopamine (Intropin), and epinephrine (Adrenalin) are the choice of drugs in the treatment of sinus bradycardia. Text Reference - p. 796
Which dysrhythmia is associated with a heart rate of 60 to 100 beats per minute and irregular cardiac rhythm? 1 Sinus tachycardia 2 Junctional dysrhythmias 3 Premature atrial contraction 4 Paroxysmal supraventricular tachycardia
Answer: 3 In premature atrial contraction, the heart rate is usually 60 to 100 beats per minute and has irregular rhythm. In sinus tachycardia, the patient's heart rate is 101 to 200 beats per minute, and the cardiac rhythm is regular. A heart rate of 40 to 180 beats per minute with regular cardiac rhythm is observed in patients with junctional dysrhythmias. A heart rate of 150 to 220 beats per minute with regular cardiac rhythm is observed in patients with paroxysmal supraventricular tachycardia. Text Reference - p. 794
While ambulating a patient, the ECG tracing changes from a normal sinus rhythm, with a ventricular rate of 90 impulses per minute, to the following tracing. Which action should the nurse take? 1 Notify the primary health care provider 2 Administer digoxin (Lanoxin) 3 Continue ambulating the patient 4
Answer: 3 Place the patient back into bed It is a normal phenomenon for the heart rate to increase slightly during ambulation because of an increased demand for oxygen. Therefore, the correct answer is to continue ambulating the patient. There is no need to notify the primary health care provider unless other symptoms occur. Digoxin does decrease the heart rate, but is not given if the heart rate only increases with exertion. Ambulation is to be encouraged to promote health. Placing the patient back into bed would not be appropriate in this situation. Text Reference - p. 793
While a nurse is administering Lasix via intravenous push (IVP), a patient becomes unresponsive. The electrocardiogram (ECG) tracing shows the following. Which of these actions should the nurse do first? 1 Cardiovert 2 Defibrillate 3 Feel for a pulse 4 Administer oxygen
Answer: 3 The ECG tracing is ventricular tachycardia (VT). Ventricular tachycardia can either be with a pulse or pulseless. The treatment algorithm depends on whether the patient has a pulse or not. Therefore, checking for a pulse is a priority. If the patient does not have a pulse, cardiopulmonary resuscitation (CPR) should be performed until a defibrillator is available. Oxygen may be administered, but it is not a priority. Text Reference - p. 800
What should a nurse advise a group of caregivers with regard to a patient with an implantable cardioverter-defibrillator (ICD)? Select all that apply. 1 Restrict air travel 2 Restrict driving 3 Report any signs of infection at incision site 4 Restrict magnetic resonance imaging (MRI) scan 5 Restrict the lifting of arm on ICD side unless approved
Answer: 3, 4, 5 The patient with ICD should immediately report any signs of infection such as redness, swelling, drainage, or fever. The patient should not undergo MRI scan unless the ICD is approved as MRI safe. Also, the arm on the ICD side should not be lifted above the shoulder unless approved by the cardiologist. Air travel is not restricted. However, while traveling, the patient should inform the airport security personnel about the presence of ICD because it may set off the metal detector. The patient should wear a Medic Alert ID or bracelet at all times. Text Reference - p. 803
A nurse is reviewing an electrocardiogram that was recorded for a patient with an electrolyte imbalance. Which wave is affected by alterations in the electrolyte levels? 1 P wave 2 Q wave 3 S wave 4 T wave
Answer: 4 The T wave represents ventricular repolarization in an electrocardiogram. It is always upright in a normal electrocardiogram. Disturbances in T waves can occur due to electrolyte imbalances, ischemia, and infarction. Disturbances in the P wave can be due to alterations in atrial conduction. Disturbances in the Q wave can occur due to myocardial infraction. Disturbances in the S wave do not affect the normal functioning of heart. Text Reference - p. 791
The nurse understands that a pacemaker is used most often for which type of dysrhythmia? Incorrect 1 Atrial fibrillation 2 Ventricular fibrillation 3 Ventricular tachycardia 4 Third-degree heart block
Answer: 4 Third-degree heart block The use of a pacemaker (temporary or permanent) is considered a lifesaving measure for patients who have experienced heart block, particularly third-degree or complete heart block. A temporary pacemaker may be used until the block is resolved through medical interventions or a permanent pacemaker is inserted. In special situations, a pacemaker may be used for ventricular fibrillation or ventricular tachycardia; however, this is more an exception rather than routine. Atrial fibrillation is treated with medication such as diltiazem (Cardizem) or synchronized electrical cardioversion. In special situations a ventricular pacemaker may be used for ventricular fibrillation or ventricular tachycardia; however, this is more an exception rather than routine. Text Reference - p. 804
A patient is admitted with an acute myocardial infarction. An ECG tracing changes from a sinus tachycardia to the following tracing. In which order should a nurse perform these interventions? Correct 1. Call for assistance Correct 2. Lower the head of the bed Correct 3. Begin cardiopulmonary resuscitation (CPR) Correct 4. Defibrillate when defibrillator arrives
Answer: Call for assistance, lower head of bed, CPR, defibrillate The ECG tracing is ventricular fibrillation, a lethal rhythm requiring a team of health care providers to provide interventions. Therefore, the priority is to call for assistance and then lower the head of the bed and start CPR until the defibrillator arrives. Once the defibrillator is available, CPR should be stopped and the patient defibrillated. Text Reference - p. 801
A nurse is teaching about the conduction system of the heart to a group of nursing students. Arrange the order in which the electrical impulses travel through the parts of the conduction system. Correct 1. Sinoatrial node Correct 2. Internodal pathways Correct 3. Atrioventricular node Correct 4. Bundle of His Correct 5. Purkinje fibers
Answer: SV node, internodal pathways, AV node, bundle of His, Perkinje fibers The conduction system of the heart consists of specialized neuromuscular tissue. The electrical impulse of the heart begins at the sinoatrial node in the upper right atrium. This impulse travels through the intermodal fibers and spreads over the atrial musculature. This causes atrial contraction. The impulse then reaches the atrioventricular (AV) node. From the AV node the impulse moves down through the bundle of His and ends at the Purkinje fibers. Impulses from the Purkinje fibers cause ventricular contractions. Text Reference - p. 787
A nurse completing an electrocardiogram (ECG) for a patient is aware that cardiac cells contain properties that enable the conduction system to start an electrical impulse. Which property of the heart enables the cardiac cells to respond mechanically to an impulse? 1 Automaticity 2 Excitability 3 Conductivity 4 Contractility
Answer: contractility Contractility enables the cardiac cells to respond mechanically to an impulse. Automaticity provides the ability to initiate an impulse spontaneously and continuously. Excitability enables the cardiac cells to be electrically stimulated. Conductivity allows transmission of an impulse along a membrane in an orderly manner. Text Reference - p. 2
