Evolve: Chapter 31 Exam 4
Which statement made by a patient who is taking propranolol for a dysrhythmia warrants further investigation by the nurse? (31) "I feel constipated since I've been in the hospital." "I got dizzy when walking to the bathroom earlier." "I have been more tired since I started taking this medicine." "My pulse seems to be slower and more regular than before."
"I got dizzy when walking to the bathroom earlier." Propranolol is a beta blocker that has been approved for the treatment of dysrhythmias. The nurse should monitor heart rate and blood pressure (BP); bradycardia and decreased BP are expected effects. The nurse should assess for insomnia, fatigue, and dizziness; side effects may require a decrease in dosage or discontinuation of the drug. Constipation and fatigue are possible side effects of metoprolol. An expected outcome with propranolol is a decreased heart rate.
How does the nurse respond when a patient with a stable cardiac rhythm asks when the continuous ECG monitoring can be discontinued? (31) "Monitoring can be discontinued at bedtime." "Monitoring cannot be discontinued for any reason." "You can determine when monitoring can be discontinued." "Monitoring can usually be suspended for showering and transport to other units."
"Monitoring can usually be suspended for showering and transport to other units." If a patient's rhythm is stable, monitoring can usually be suspended for showering and transport to other units for testing. Constant monitoring, precluding a shower or hygiene, is not necessary for a stable patient. The nurse does not discontinue monitoring at bedtime. The health care provider, not the patient, determines monitoring at certain times of the day or discontinuation.
Which instruction about taking a pulse does the nurse give to a family member who is caring for a patient with a permanent pacemaker? (31) "Take it for 1 full minute at the same time each day." "Take it for 2 full minutes at the same time each day." "Take it for 1 full minute at different times each day." "Take it for 2 full minutes at different times each day."
"Take it for 1 full minute at the same time each day." While educating a patient's family member about management of a permanent pacemaker, the nurse should instruct the caregiver to take the patient's pulse for 1 full minute at the same time each day and to record it in a pacemaker diary. The family member may take the patient's pulse any time he or she believes there are symptoms of pacemaker failure and report the patient's heart rate and symptoms to the physician. Taking the pulse for 2 full minutes at the same each day, or at different times of the day, is unnecessary for detecting pacemaker failure. Measuring the pulse for 1 full minute at a different time each day or recording 2 full minutes of the pulse reading at different times on the same day does not provide an accurate assessment of the pacemaker's functioning.
Which information does the nurse include when teaching patients who are at risk for bradydysrhythmias? (31) "Use a stool softener." "Stop smoking, and avoid caffeine." "Avoid potassium-containing foods." "Take nitroglycerin for a slow heartbeat."
"Use a stool softener." Patients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps prevent this. Patients with renal failure and hyperkalemia are instructed to avoid potassium-containing foods; if risk for hypokalemia exists, such as with diuretic therapy, the patient is instructed to eat foods high in potassium. Smoking and caffeine increase the heart rate; although all people should stop smoking, patients at risk for tachycardia, premature beats, and ectopic rhythms are instructed to stop smoking and avoid caffeine. Nitroglycerin is used to reduce oxygen demand in cardiac ischemia, not for bradycardia.
In electrocardiography, which is the normal time measurement of the PR interval? (31) 0.04 to 0.12 seconds 0.12 to 0.20 seconds 0.20 to 0.28 seconds 0.28 to 0.36 seconds
0.12 to 0.20 seconds The PR interval normally measures 0.12 to 0.20 seconds. The range of 0.04 to 0.12 seconds is too short. The ranges of 0.20 to 0.28 seconds and 0.28 to 0.36 seconds are longer than normal.
Which is an expected finding for a normal PR interval? (31) 0.04 seconds 0.10 seconds 0.16 seconds 0.22 seconds
0.16 seconds
Which will the nurse document as the heart rate of a patient with 12 QRS complexes in the 6-second strip? (31) 12 beats/min 100 beats/min 110 beats/min 120 beats/min
120 beats/min The answer is determined by multiplying 12 complexes by 10 to reach the heart rate per 60 seconds (1 minute): 120 beats/min.
Which number of large blocks represents a 6-second strip when analyzing an ECG? (31) 5 blocks 15 blocks 25 blocks 30 blocks
30 blocks Thirty large blocks represent a 6-second strip. A small block represents 0.04 seconds. Five small blocks make up one large block, defined by darker bold lines. These large blocks represent 0.20 seconds. Five of those blocks represent 1 second; thus 30 large blocks represent 6 seconds. Fifteen and twenty-five are incorrect answers.
What heart rate does the nurse document when calculating a patient's heart rate from a 6-second rhythm strip and noting eight QRS complexes on the strip? Record your answer using a whole number only; do not include label. ___ beats/min (31)
80 beats/min The most common method used is to count the number of QRS complexes in 6 seconds and multiply that number by 10 to calculate the rate for a full minute. This is called the 6-second strip method and is a quick method to determine the mean or average heart rate. The patient had 8 complexes in 6 seconds. 8 × 10 = 80.
Which waveform on the ECG indicates proper function of the sinoatrial (SA) node? (31) The ST segment is elevated. The QRS complex is present. The PR interval is 0.24 seconds. A P wave precedes every QRS complex.
A P wave precedes every QRS complex. A P wave is generated by the SA node and represents atrial depolarization. When the electrical impulse is consistently generated from the SA node, the P waves have a consistent shape in a given lead. Elevation of the ST segment indicates myocardial injury. The QRS complex represents ventricular depolarization. The PR interval represents time required for atrial depolarization and for the impulse delay in the atrioventricular node and travel time to the Purkinje fibers.
Which risk factor is known to contribute to atrial fibrillation (AF)? Select all that apply. One, some, or all responses may be correct. (31) Palpitations Advancing age High blood pressure Excessive alcohol use Use of beta-adrenergic blockers
Advancing age High blood pressure Excessive alcohol use The incidence of AF increases with age. Risk factors include hypertension, previous ischemic stroke, transient ischemic attack or other thromboembolic event, coronary heart disease, diabetes mellitus, heart failure and mitral valve disease, obesity, Caucasian race, and excessive alcohol. Beta-adrenergic blocking agents, which reduce heart rate, are used to treat AF. Palpitations are a symptom of atrial fibrillation rather than a risk or a cause.
The nurse anticipates a prescription for which medication for a patient who is experiencing episodes of ventricular tachycardia? (31) Digoxin Diltiazem Metoprolol Amiodarone
Amiodarone Amiodarone, a class III antidysrhythmic, is suggested for use in life-threatening ventricular dysrhythmias. Digoxin, a cardiac glycoside, is used for heart failure and atrial fibrillation. Metoprolol, a beta-adrenergic blocker, and diltiazem, a calcium channel blocker, are useful for atrial fibrillation.
Which action does the nurse take when a patient with asymptomatic sinus bradycardia experiences a decrease in heart rate from 56 beats/min to 46 beats/min? (31) Increase the IV fluid flow rate. Notify the Rapid Response Team. Administer atropine 0.5 mg IV push. Assess blood pressure, skin color, and moisture.
Assess blood pressure, skin color, and moisture. Intervention for sinus bradycardia should be based on assessment of the patient's condition. The patient may remain asymptomatic. If the patient is symptomatic, the nurse may choose to increase the IV flow rate, administer atropine, or notify the Rapid Response Team, depending on the severity of symptoms.
Which component of a patient's conduction system is identified by the circled part of the ECG waveform? (31) Atrial kick Atrial depolarization Ventricular contraction T-cell (transitional cell) impulse slowing
Atrial depolarization Atrial depolarization is represented by the P wave on the ECG. The "atrial kick" is when the atria contracts and the ventricles fill; this event occurs after the PR interval. Ventricular contraction occurs after ventricular depolarization (QRS complex). T cells slow the impulse during the PR interval.
Which dysrhythmia most likely contributed to a patient's acute pulmonary embolism? (31) Atrial fibrillation Sinus bradycardia Ventricular tachycardia Premature atrial contractions
Atrial fibrillation Because the atria are not fully contracting in atrial fibrillation, there is stagnation of blood flow resulting in formation of thrombi in the atria. A thrombus can be dislodged from the right atrium and travel to the lung, causing a pulmonary embolus. There is not a risk for thrombus formation with sinus bradycardia, premature atrial contractions, or ventricular tachycardia.
The nurse identifies that which medication will be given to a patient who presents to the emergency department with chest pain, shortness of breath, diaphoresis, hypotension, and a heart rate of 56 beats/min? (31) Digoxin Atropine Verapamil Propranolol
Atropine The administration of atropine along with IV fluids will increase intravascular volume and help to manage bradycardia. Beta blockers such as propranolol are not administered to patients with bradycardia. Cardiac glycoside (digoxin) and calcium channel blockers (verapamil) will further decrease the heart rate and worsen the symptoms.
Which is the ability of the cardiac cells to generate an electrical impulse spontaneously and repetitively called? (31) Excitability Conductivity Contractility Automaticity
Automaticity Automaticity is the ability of the cardiac cells to generate an electrical impulse spontaneously and repetitively. Excitability is the ability of the nonpacemaker heart cells to respond to an electrical impulse that begins in pacemaker cells. Conductivity is the ability to send an electrical stimulus from cell membrane to cell membrane. Contractility is the mechanical activity of the heart.
Which specialized function of myocardial cells gives them a pacing function? (31) Excitability Contractility Conductivity Automaticity
Automaticity Automaticity, also known as pacing function, is the ability of the myocardial cells to generate an impulse. The cells that generate the impulses are called primary pacemaker cells; they are mainly located in the sinoatrial node. Excitability is the ability of nonpacemaker heart cells to respond to an electrical impulse, which begins in pacemaker cells. Contractility is the mechanical activity of the heart. Conductivity is the ability to end impulses from cell membrane to cell membrane.
Which information does the nurse include in the discharge teaching for a patient with a newly placed implantable cardioverter-defibrillator (ICD)? Select all that apply. One, some, or all responses may be correct. (31) Avoid activity more vigorous than bowling or golf. Go to the emergency department if the device discharges. Use a cell phone on the opposite side from the ICD. Do not wear tight clothing over the ICD generator. Remove electrodes before showering or bathing, and replace them immediately afterwards. Avoid leaning directly over the alternator of a running motor of a car or boat.
Avoid activity more vigorous than bowling or golf. Use a cell phone on the opposite side from the ICD. Do not wear tight clothing over the ICD generator. Avoid leaning directly over the alternator of a running motor of a car or boat. The patient should avoid activities that involve rough contact with the ICD site. Activity more vigorous than bowling or golf should be avoided. Most modern wireless communication devices do not interfere with ICD function; however, cell phones should be used on the opposite side from the ICD. The patient should not wear tight clothing or belts that could cause irritation over the ICD generator. Caution should be used when in close proximity to a running alternator because it emits electromagnetic energy. The health care provider may want to be notified each time the device discharges; it does not necessarily mean that the patient should report to the emergency department. There are no external electrodes with an ICD.
Which teaching is essential for a patient who has had a permanent pacemaker inserted? (31) Avoid sexual activity. Do not take tub baths. Avoid talking on a cell phone. Avoid operating electrical appliances over the pacemaker.
Avoid operating electrical appliances over the pacemaker. The patient should avoid operating electrical appliances directly over the pacemaker site because this may cause the pacemaker to malfunction. No hazard exists with sexual activity. Bathing and showering are permitted. It is not necessary to avoid a telephone or a cell phone; radio transmitter towers, arc welding, and strong electromagnetic fields may pose a hazard.
Which food does the nurse recommend to a patient when the assessment findings include an ST depression on the ECG strip and a potassium level of 3.1 mEq/L? (31) Pretzels and beef broth Blueberries and cabbage Bananas and avocados Salted nuts and canned beans
Bananas and avocados An ST depression and a low potassium level indicate hypokalemia. The nurse should encourage the patient to eat foods high in potassium, such as tomatoes, beans, prunes, avocados, bananas, strawberries, and lettuce. Foods high in potassium increase the level and help correct the ST depression. Salted nuts, canned beans, pretzels, and beef broth are high in sodium, and blueberries and cabbage are low in potassium; none of these foods will have an impact on increasing potassium.
The nurse monitors for which significant effect when a patient is prescribed adenosine drug therapy to convert supraventricular tachycardia to normal sinus rhythm? (31) Bradycardia Rebound tachycardia Ventricular fibrillation Premature atrial complexes
Bradycardia Adenosine is mainly used to covert supraventricular tachycardia to a normal sinus rhythm. Adenosine terminates the acute episode and is followed by a normal saline bolus. The major side effect of this drug therapy is significant bradycardia. Rebound tachycardia, ventricular fibrillation, and premature atrial complexes are conditions that are not associated with adenosine drug therapy.
How does the nurse prepare for an immediate carotid sinus massage that is prescribed for a patient's new onset of supraventricular tachycardia? (31) Obtain a stat chemistry profile prior to the procedure. Remove the pillow and place a rolled towel behind the neck. Bring a defibrillator and resuscitative equipment to the bedside. Raise the side rails and place the bed in the reverse Trendelenburg position.
Bring a defibrillator and resuscitative equipment to the bedside. Serious dysrhythmias may occur as a result of carotid sinus massage. These include bradydysrhythmias, asystole, and ventricular fibrillation, which may result in brain injury. Because of this, a defibrillator and resuscitative equipment must be available during the procedure. Given the urgency of the situation, obtaining a blood specimen before the procedure is not reasonable. The nurse prepares the patient with instruction to turn the head slightly away from the side to be massaged. Preparation does not include hyperextending the neck or placing the patient in the reverse Trendelenburg position.
The nurse monitors for which adverse effect when administering acebutolol to a patient? (31) Tremors Insomnia Blurred vision Bronchospasm
Bronchospasm Acebutolol hydrochloride is a beta-blocking agent. It causes sudden constriction of the muscles in the walls of the bronchioles, which in turn causes bronchospasm. Flecainide acetate causes tremors. Propafenone hydrochloride affects the sleep cycle and causes insomnia. Mexiletine hydrochloride affects vision acuity and may cause blurred vision as a side effect.
When providing dietary teaching for a patient with premature atrial complexes (PACs), which item does the nurse instruct the patient to avoid? (31) Sodium Caffeine Citrus products Low-fiber foods
Caffeine A PAC (contraction) occurs when atrial tissue becomes irritable. The nurse should teach the patient measures to manage stress and substances to avoid, such as caffeine and alcohol, that are known to increase atrial irritability. Sodium is restricted in patients with hypertension and heart failure. Citrus products are often restricted with kidney failure or hyperkalemia, and low-fiber foods are used with diarrhea.
Which statement correctly differentiates cardioversion from defibrillation? (31) Defibrillation is a synchronized shock delivered to depolarize the myocardium simultaneously in atrial fibrillation. Cardioversion is an asynchronous shock to the patient to convert ventricular tachycardia or ventricular fibrillation. Defibrillation delivers an electrical shock to the heart; cardioversion involves use of a temporary pacemaker to deliver the shock. Cardioversion delivers a synchronized shock for ventricular tachycardia or supraventricular tachycardia.
Cardioversion delivers a synchronized shock for ventricular tachycardia or supraventricular tachycardia. Cardioversion involves the delivery of a synchronized electric shock to terminate unstable ventricular or supraventricular rhythms. It is not useful in ventricular fibrillation because all electrical activity is disorganized with no ability to synchronize. Defibrillation delivers an asynchronous countershock, depolarizing a critical mass of the myocardium to stop the re-entry circuit in ventricular fibrillation or pulseless ventricular tachycardia, allowing the sinus node to regain control of the heart.
Which is a function of T cells in the atrioventricular (AV) junction area? (31) Causes the ventricles to contract Helps to speed up impulses to the ventricles Generates impulses spontaneously and rhythmically Causes a delay in the conduction of impulses to the AV node
Causes a delay in the conduction of impulses to the AV node The T cells (transitional zone cells) cause a delay in the conduction of impulses to the AV node. This delay facilitates adequate time for atrial filling. The conduction through Purkinje fibers causes the ventricles to contract. The SA node generates impulses spontaneously and rhythmically in a normally functioning cardiac electrical conduction system. The AV node does not speed up impulses to the ventricles but rather acts as a relay station for electrical conduction and electrically connects atrial and ventricular chambers.
When caring for a patient with heart disease, the nurse recognizes that which activity should be avoided to prevent excessive vagal stimulation to the heart? Select all that apply. One, some, or all responses may be correct. (31) Hiccups Constipation Oropharyngeal suctioning Ocular pressure Hip flexion greater than 90 degrees
Constipation Oropharyngeal suctioning Ocular pressure Excessive vagal stimulation may result from carotid sinus massage, vomiting, suctioning, Valsalva maneuvers (e.g., bearing down for a bowel movement, gagging), ocular pressure, or pain. If constipated, the patient may strain or bear down to have a bowel movement. Oropharyngeal suctioning often causes the patient to gag and possibly vomit. Hiccups and hip flexion do not cause vagal stimulation.
Which property of the heart is related to mechanical activity? (31) Excitability Conductivity Automaticity Contractility
Contractility Contractility is the ability of the myocardial cells of atria and ventricles to shorten their fiber length in response to electrical stimulation. This causes sufficient pressure to push blood forward through the heart. Therefore contractility is known as the mechanical property of the heart. Excitability, conductivity, and automaticity are not the mechanical properties of the heart.
Which medication will the nurse document as an antidysrhythmic drug used to slow ventricular conduction? (31) Diltiazem Apixaban Atropine sulfate Magnesium sulfate
Diltiazem Diltiazem is a calcium channel blocker used to slow ventricular conduction. Apixaban is an anticoagulant. Atropine sulfate is used to treat bradycardia. Magnesium sulfate is an electrolyte used to treat a ventricular dysrhythmia.
Which information does the nurse include when providing education for a patient who is scheduled for a 12-lead ECG? (31) Electrodes will be placed on the chest and legs. Acetaminophen must be given an hour before the test. A contrast agent will be injected, but it will not cause pain. No food or liquids are permitted up to 4 hours before the test.
Electrodes will be placed on the chest and legs. The 12-lead ECG is a noninvasive test, and electrodes will be placed on the patient's chest and legs. Administration of acetaminophen and injection of a contrast agent are not components of an ECG test. The patient may eat and drink before the test.
Which medication information will be included in discharge instructions for a patient with a high risk for emboli? (31) Digoxin Diltiazem Metoprolol Enoxaparin
Enoxaparin Emboli are blood clots. Atrial fibrillation may increase the risk for emboli in the patient; therefore the patient is prescribed anticoagulant therapy to prevent embolus formation. Enoxaparin is an anticoagulant that prevents embolus formation. Digoxin treats heart failure and atrial fibrillation. Diltiazem is a calcium channel blocker that slows ventricular conduction. Metoprolol slows the ventricular response.
Which assessment finding does the nurse expect when caring for a patient who is hospitalized with sustained tachydysrhythmia? (31) Fainting Flushing Agitation Bounding pulse
Fainting Patients with tachydysrhythmia may experience syncope (blackout or fainting), palpitations, chest pressure/pain, pallor (not flushing), and restlessness/anxiety. Agitation is a sign of hypoxemia, and a bounding pulse is associated with increased cardiac output or increased intracranial pressure.
The nurse recognizes that which drug may be used in the treatment of a patient with atrial fibrillation? Select all that apply. One, some, or all responses may be correct. (31) Heparin Digoxin Warfarin Diltiazem Amiodarone Phytonadione (vitamin K)
Heparin Digoxin Warfarin Diltiazem Amiodarone Antidysrhythmic medications such as diltiazem, digoxin, and amiodarone are used to slow the heart rate or restore normal sinus rhythm. Anticoagulants such as heparin or warfarin are used to prevent emboli secondary to the loss of coordinated atrial contraction. Phytonadione is not used in atrial fibrillation because it can reverse the effects of warfarin and has no antidysrhythmic properties.
When caring for a patient with premature ventricular contractions (PVCs), the nurse monitors for which electrolyte imbalance that may contribute to the dysrhythmia? Select all that apply. One, some, or all responses may be correct. (31) Hypokalemia Hyponatremia Hypocalcemia Hypomagnesemia Hypophosphatemia
Hypokalemia Hypomagnesemia
Which class of antidysrhythmic drugs does the nurse anticipate being prescribed for the patient diagnosed with supraventricular tachycardia associated with excessive beta-adrenergic stimulation? (31) I II III IV
II Class II antidysrhythmics control dysrhythmias associated with excessive beta-adrenergic stimulation. Class I drugs are membrane stabilizing agents. Class III drugs lengthen the absolute refractory and prolong repolarization. Class IV drugs slow the flow of calcium into the cell during depolarization.
The nurse questions which item that is listed on discharge instructions for a patient with tachycardia? (31) Avoid alcohol intake. Develop strategies for stress management. Consult a mental health professional for increased anxiety. Include foods rich in caffeine to stimulate the central nervous system (CNS).
Include foods rich in caffeine to stimulate the central nervous system (CNS). The patient should be instructed to avoid taking substances that will increase the heart rate (such as caffeine). Alcohol should be avoided because it increases the heart rate. Patients are advised to develop strategies for stress management because stress can increase the heart rate. Consulting a mental health professional can help to alleviate anxiety, which will increase the heart rate.
Which will the nurse note in the patient if the sinoatrial (SA) node generates electrical impulses at a higher rate? (31) Increased heart rate Decreased blood pressure Delayed atrial depolarization Hindered ventricular depolarization
Increased heart rate The SA node generates impulses that are conducted through the heart. This generation of impulses happens at a specific rate, which can be measured as the heart rate. If the number of electrical impulses increases, the heart rate will increase, and the blood pressure will increase. If the SA node generates electrical impulses at a higher rate, atrial and ventricular depolarization will occur at a higher rate.
Which task is a responsibility of a monitor technician of an acute care facility who has been educated in in ECG rhythm interpretation? Select all that apply. One, some, or all responses may be correct. (31) Interpret rhythms. Assess monitored patients every 4 hours. Print ECG rhythm strips routinely and as needed. Have ongoing communication with health care providers (HCPs). Watch a bank of monitors on an acute care unit. Report the patient's rhythm and significant changes to the nurse.
Interpret rhythms. Print ECG rhythm strips routinely and as needed. Watch a bank of monitors on an acute care unit. Report the patient's rhythm and significant changes to the nurse. The responsibilities for monitor technicians include interpreting the rhythms, printing the ECG rhythm strips, continually watching the bank of monitors, and reporting any changes to the nurse. Monitor technicians do not assess patients, nor do they have continuous communication with the HCP in an acute care setting.
Which represents no electrical current flow in the heart on an ECG? (31) Cardiac axis Isoelectric line Positive deflections Negative deflections
Isoelectric line The baseline is the isoelectric line. It occurs when there is no current flow in the heart after complete depolarization and complete repolarization. The cardiac axis is the direction of electrical current flow in the heart. Positive deflections occur above this line, and negative deflections occur below it. Negative deflections represent depolarization and repolarization of cells.
Which is a characteristic of the ST segment? (31) It is normally a positive deflection. It represents ventricular depolarization. Its length is consistent in measurement. It occurs from the J point to the beginning of the T wave.
It occurs from the J point to the beginning of the T wave. The ST segment occurs from the J point to the beginning of the T wave. It is normally an isoelectric line and represents early ventricular repolarization. A positive deflection is when the direction of electrical current flow in the heart (cardiac axis) is toward the positive pole. The QRS complex represents ventricular depolarization. The ST segment length varies with changes in the heart rate, the administration of medications, and electrolyte disturbances.
When examining a sinus rhythm cardiac telemetry strip, which information about the rhythm's P waves does the nurse recall? (31) It precedes the QRS complex. It is always positively deflected. It is followed immediately by a T wave. It is a deflection representing atrial repolarization.
It precedes the QRS complex. The P wave precedes the QRS complex. The shape of the P wave may be a positive, negative, or biphasic (both positive and negative) deflection, depending on the lead selected. The P wave is followed by the QRS complex, not the T wave. The P wave is a deflection representing atrial depolarization, not repolarization.
Which statement is true about an atrial kick? (31) It results in cardiac arrest. It results in cardiac failure. It results in a decreased heart rate. It results in increased cardiac output.
It results in increased cardiac output. Atrial kick is the priming force caused by atrial contraction before ventricular systole. It contributes additional blood volume for a greater cardiac output. Cardiac arrest and cardiac failure are not associated with atrial kick. An atrial kick causes an increased heart rate.
Which step is involved in the ECG rhythm analysis of P waves? Select all that apply. One, some, or all responses may be correct. (31) Looking for the presence of P waves Analyzing the similarity in appearance of P waves Assessing whether P waves are greater than 0.20 seconds Assessing the consistent occurrence of one P wave for each QRS complex Placing one caliper point at the start of the P wave and the other at the end of the PR segment
Looking for the presence of P waves Analyzing the similarity in appearance of P waves Assessing the consistent occurrence of one P wave for each QRS complex Analysis of the ECG strip requires a systemic approach. P waves should be analyzed for their presence on the strip, their similarity in appearance, and the consistency of occurrence of one P wave for each QRS complex on the ECG strip. PR intervals, not P waves, are assessed for whether they are longer than 0.20 seconds. One caliper point is placed at the start of the P wave and the other at the end of the PR segment when analyzing the PR segment.
The nurse suspects which cause of artifact that is seen on a patient's cardiac monitor? Select all that apply. One, some, or all responses may be correct. (31) Loose electrodes Improper grounding Patient movement Faulty ECG equipment Paradoxical chest movements
Loose electrodes Improper grounding Patient movement Faulty ECG equipment Artifact is interference seen on the monitor or rhythm strip, which may look like a wandering or fuzzy baseline. It can be caused by patient movement, loose or defective electrodes, improper grounding, or faulty ECG equipment such as broken wires or cables. Paradoxical breathing does not cause artifact. Paradoxical breathing reverses the normal breathing pattern; it means that during inspiration, the chest contracts, and during expiration, it expands.
The nurse questions which item that is listed on the plan of care for a patient with an implantable cardioverter/defibrillator (ICD)? (31) Radiation therapy Radiographic imaging CT MRI
MRI Patients with an ICD should avoid sources of strong electromagnetic fields, such as large electrical generators and radio and television transmitters. MRI should not be used. Radiation therapy, microwave ovens, and CT scans are safe to use.
When caring for a patient after an acute myocardial infarction, which is the nursing priority? (31) Providing a low-fat, low-sodium diet Padding the oxygen tubing behind the ears Instructing the patient to wear sequential compression devices while in bed Monitoring for increased frequency of premature ventricular contractions
Monitoring for increased frequency of premature ventricular contractions Increasing frequency of premature ventricular contractions after an acute myocardial infarction can lead to life-threatening ventricular dysrhythmias. Prophylaxis of venous thromboembolism, cardiac diet, and prevention of skin breakdown are important, but the greatest priority is the risk for life-threatening dysrhythmias.
Which equipment is involved in monitoring cardiac electrical activity during electrocardiography? (31) A computer attached to the patient A clicker system held close to the chest Multiple electrodes attached to the body A global positioning system (GPS) transmitting the signal
Multiple electrodes attached to the body Cardiac electrical activity is transmitted via electrodes and through lead wires to the machine or monitor during electrocardiography. Multiple leads are usually placed on the patient's body for a comprehensive view of cardiac electrical activity. During monitoring, the patient does not hold a computer or use a clicker system. A GPS system does not transmit the electrical signal during cardiac monitoring.
Where does the nurse place the electrodes on the patient for continuous ECG monitoring? (31) On the extremities On the shoulder blades On the trunk of the body On the chest over the heart
On the trunk of the body For continuous ECG monitoring, the nurse should place the electrodes on the trunk, a more stable area, to minimize artifact and to obtain a clearer signal. The electrodes are not placed on the limbs because movement of the extremities causes artifact. Leads are not placed on the chest but below the clavicles and lowest palpable ribs. Leads are not placed on the shoulder blades.
What complex makes up a normal ECG? Select all that apply. One, some, or all responses may be correct. (31) S wave P wave T wave U wave QRS complex
P wave T wave QRS complex Complexes that make up a normal ECG consist of a P wave, a QRS complex, and a T wave. Sometimes a U wave may be present, but it is not typically seen in a normal ECG. There is no S wave.
The nurse expects which assessment finding when a patient with a pacemaker experiences loss of capture? The patient demonstrates hiccups. The pacemaker spike falls on the T wave. Pacemaker spikes are noted, but no P wave or QRS complex follows. The heart rate is 42 beats/min, and no pacemaker spikes are seen on the rhythm strip.
Pacemaker spikes are noted, but no P wave or QRS complex follows. Loss of capture occurs when the pacing stimulus (spike) is not followed by the appropriate response, either P wave or QRS complex, depending on placement of the pacing electrode. Pacemaker spikes falling on the T wave indicate improper sensing. A heart rate of 42 beats/min with no pacemaker spikes seen on the rhythm strip indicates failure to pace or sense properly; demand pacing should cause the pacemaker to intervene with electrical output when the heart rate falls below the set rate. Although the set rate is not given, this heart rate indicates profound bradycardia. Hiccups may indicate stimulation of the chest wall or diaphragm from wire perforation.
For a 12-lead ECG with standard bipolar limb leads, the nurse identifies that which patient extremity will be used for the fourth lead to act as a ground electrode? (31) Left leg Left arm Right leg Right arm
Right Leg
Which is the priority after a crash cart has been brought to a patient's room when the nurse is responding to a patient in ventricular fibrillation? (31) Perform defibrillation. Administer epinephrine. Provide rescue breathing. Perform cardiac compressions.
Perform defibrillation. In cases of ventricular fibrillation, the earlier that defibrillation (asynchronous countershock) is performed, the greater the chance of survival. Defibrillation depolarizes a critical mass of myocardium simultaneously with the goal of restoring spontaneous circulation. Cardiac compressions, rescue breathing, and the administration of epinephrine follow defibrillation.
The nurse questions which electrode placement when reviewing a suggested diagram for staff use for setting up a patient for continuous ECG monitoring? (31) Placing the left leg electrode on the lowest palpable rib Placing the left arm electrode just above the left clavicle Placing the right leg electrode on the lowest palpable rib Placing the right arm electrode just below the right clavicle
Placing the left arm electrode just above the left clavicle The nurse questions when the diagram depicts placing the left arm electrode just above the left clavicle. The proper position and placement for the left arm electrode is just below the left clavicle. The right arm, right leg, and left leg electrode placements are correct.
Which dysrhythmia is caused by atrial irritability? (31) Atrial fibrillation Premature atrial complexes Supraventricular tachycardia Premature ventricular complexes
Premature atrial complexes Premature atrial complexes will develop when the atrial tissue becomes irritated. The ectopic focus generates impulses before the next normal sinus impulse, which causes palpitations and a sense of the heart skipping a beat. Atrial fibrillation, supraventricular tachycardia, and premature ventricular complexes are not caused by atrial irritability.
Which action does the nurse take when, during a wellness physical examination, a patient's cardiac rhythm strip has all the characteristics of normal sinus rhythm, except that there is a pattern of irregularity that is associated with the patient's breathing? (31) Proceed with the examination as planned. Immediately notify the health care provider. Move the electrodes, and re-evaluate the rhythm strip. Suggest for the patient to follow up with a cardiologist.
Proceed with the examination as planned. Sinus arrhythmia is a variant of normal sinus rhythm. It results from changes in intrathoracic pressure during breathing. Instead, the heart rate increases slightly during inspiration and decreases slightly during exhalation. This irregular rhythm is frequently observed in healthy adults. In this context, the term arrhythmia does not mean an absence of rhythm, as the term suggests. Therefore no further action is needed. The health care provider does not need immediate notification. There is no need to re-evaluate the rhythm strip. There is no indication that follow-up with a cardiologist is needed.
Which part of the cardiac conduction system is responsible for ventricular depolarization? (31) Purkinje fibers Sinoatrial (SA) node Transitional cell zone Atrioventricular (AV) node
Purkinje fibers Purkinje fibers are responsible for the rapid conduction of electrical impulses throughout the ventricles, which leads to ventricular depolarization. The SA node causes atrial depolarization. The transitional cell zone area consists of the AV node and the bundle of His. This area causes impulses to slow down or to be delayed before proceeding to the ventricles but does not cause ventricular depolarization.
4.Which complex makes up a normal ECG? (31) QRS PQR RST STU
QRS An ECG is made up of complexes such as a P wave, a QRS complex, a T wave, and possibly a U wave. PQR, RST, and STU complexes are not seen in a normal ECG.
Which finding on a cardiac rhythm strip indicates there is a delay in conduction of the electrical impulse? (31) PR interval of 0.16 seconds PR interval of 0.08 seconds QRS duration of 0.10 seconds QRS duration of 0.24 seconds
QRS duration of 0.24 seconds Normal QRS duration is 0.04 to 0.10 seconds. A duration greater than 0.10 seconds represents a delay in conduction or a greater amount of time for the cardiac impulse to depolarize through the ventricles. A PR interval of 0.08 seconds is short, indicating faster conduction than normal. A PR interval of 0.16 seconds is within the normal range of 0.12 to 0.20 seconds.
When analyzing a cardiac rhythm strip, the nurse identifies that which component on the waveform varies with changes in heart rate? (31) PR interval ST segment QT interval QRS duration
QT interval The QT interval varies with change in heart rate, lengthening with slower heart rates and shortening with faster rates. The PR interval, QRS duration, and ST segment remain constant with changes in heart rate.
Which parameter is the nurse determining by analyzing the P waves on an ECG using the walking out technique? (31) The heart rate The measurement of the PR interval Regularity of the atrial rhythm Intensity of atrial depolarization
Regularity of the atrial rhythm The nurse should move the caliper from P wave to P wave along the entire strip ("walking out" the P waves) to determine the regularity of the rhythm. The walking out technique is used to determine atrial rhythm, not to determine the heart rate. The nurse measures the PR interval by placing one caliper point at the beginning of the P wave and the other point at the end of the PR segment. The intensity of atrial depolarization is not measured using the walking out technique.
Which lead acts as the ground electrode for a 12-lead ECG? (31) Chest Positive Right leg Precordial
Right leg The lead placed on the right leg acts as the ground electrode. Positive leads are placed on the left leg and sometimes the left arm. A chest lead is the same thing as a precordial lead.
In which direction does electrical activity travel through the heart? Place the steps in order. (31) Bundle of His, atrioventricular (AV) node, sinoatrial (SA) node, left bundle branch AV node, bundle of His, left bundle branch, SA node SA node, AV node, bundle of His, left bundle branch Left bundle branch, AV node, SA node, bundle of His
SA node, AV node, bundle of His, left bundle branch The answer option of SA node, AV node, bundle of His, left bundle branch is the direction of the electrical activity of the heart. Conduction begins with the SA node (also called the sinus node). Impulses from the sinus node move directly through atrial muscle and lead to atrial depolarization. Atrial muscle contraction follows. Within the atrial muscle are slow and fast conduction pathways leading to the AV node. The bundle of His connects with the distal portion of the AV node and continues through the interventricular septum. The bundle of His, on the left side, extends as a left bundle branch, which further divides. The SA node is the heart's primary pacemaker and generates electrical impulses. In the normal heart, contractility does not originate from the bundle of His, AV node, or left bundle branch.
On an ECG, which is an isoelectric line that represents early ventricular repolarization? (31) PR segment ST segment TP segment U wave
ST segment The ST segment is normally an isoelectric line and represents early ventricular repolarization. The PR segment is the isoelectric line from the end of the P wave to the beginning of the QRS complex, when the electrical impulse is traveling through the atrioventricular node, where it is delayed. The TP segment is the portion of the ECG from the end of the T wave to the beginning of the P wave. This segment should always be at baseline and is used as a reference to determine whether the ST segment is elevated or depressed as there are no specific disease conditions that elevate or depress the TP segment. The U wave is the deflection that may follow the T wave and may result from slow repolarization of ventricular Purkinje fibers.
Which component of a normal ECG represents early ventricular repolarization? (31) U wave QT interval ST segment QRS complex
ST segment The ST segment represents early ventricular repolarization. The U wave represents late ventricular repolarization. The QT interval represents the total time required for ventricular depolarization and repolarization. The QRS complex represents ventricular depolarization.
What is the primary pacemaker of the heart? (31) Bundle of His Purkinje fibers Sinoatrial (SA) node Atrioventricular (AV) node
Sinoatrial (SA) node The SA node is the primary pacemaker of the heart; it generates the heart's electrical impulses. The bundle of His and Purkinje fibers are responsible for rapid conduction of impulses through the ventricles; they are not the primary pacemakers of the heart. The AV node causes impulses to slow down or to be delayed before proceeding to the ventricles.
Which complication is associated with carotid sinus massage therapy? Select all that apply. One, some, or all responses may be correct. (31) Sinus bradycardia Cerebral damage Ventricular fibrillation Premature atrial complexes Premature ventricular complexes
Sinus bradycardia Cerebral damage Ventricular fibrillation Supraventricular tachydysrhythmias are treated temporarily by carotid sinus massage therapy. Complications of this therapy include bradycardia, cerebral damage, and ventricular fibrillation. Premature atrial complexes are caused by irritated atrial tissue, which is not associated with carotid sinus massage therapy. Premature ventricular complexes are caused by irritated ventricular tissue, which is also not associated with carotid sinus massage therapy.
Which information does the nurse include when teaching a patient who experiences palpitations and frequent premature atrial complexes? Select all that apply. One, some, or all responses may be correct. (31) Smoking cessation Limited physical exertion Decreased consumption of caffeinated beverages Improvement of hydration with increased water intake Techniques to reduce stress
Smoking cessation Decreased consumption of caffeinated beverages Techniques to reduce stress
Which medication will the nurse identify as a class II antidysrhythmic used to decrease heart rate and conduction velocity? Select all that apply. One, some, or all responses may be correct. (31) Sotalol Esmolol Tocainide Propranolol Amiodarone
Sotalol Esmolol Propranolol Sotalol hydrochloride, esmolol hydrochloride, and propranolol hydrochloride are beta blockers that compete for beta receptor sites, thereby decreasing heart rate and conduction. Tocainide hydrochloride is a class IB drug used to shorten repolarization. Amiodarone hydrochloride is a class III antidysrhythmic that lengthens the absolute refractory period and prolongs repolarization and action potential.
To decrease dysrhythmias, which food does the nurse suggest for a patient who is at risk for potassium imbalance? (31) Grapes Apples Turnips Strawberries
Strawberries Potassium-containing foods include citrus, tomatoes, beans, prunes, avocados, bananas, strawberries, and lettuce. Turnips, grapes, and apples are not foods high in potassium.
Which precaution does the nurse follow when providing cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) to a patient? (31) Protective isolation Standard Precautions Surgical asepsis with the defibrillator Airborne precautions during intubation
Standard Precautions Standard Precautions and personal protective equipment must be used when there is risk for contact with blood and body fluids. Protective isolation aims to protect an immunocompromised patient who is at high risk for acquiring microorganisms from either the environment or from other patients, staff, or visitors. Surgical asepsis involves ridding an item of all pathogens, such as in the operating room, with sterilization procedures. A defibrillator is a "clean," not sterile, item. Airborne precautions are used when germs, such as the kind that cause tuberculosis (TB) and chickenpox, can be spread through the air from one person to another. Instead, the nurse may choose to use protective eyewear or a face shield during intubation or suctioning of the airway to protect from spraying blood and body fluids.
Which action does the nurse take first when a patient suddenly becomes limp and unresponsive with no carotid pulse? (31) Maintain a patent airway. Start cardiac compressions. Contact the health care provider (HCP) immediately. Place a firm board under the patient.
Start cardiac compressions. With the new Basic Cardiac Life Support guidelines, cardiac compressions are initiated, followed by maintaining an airway and ventilating the patient. The HCP should be contacted after resuscitative efforts have begun. When help arrives, a firm board is placed under the patient to maximize efficiency of cardiac compressions.
Which is a cause of atrial irritability? Select all that apply. One, some, or all responses may be correct. Stress Fatigue Anemia Infection Muscle atrophy
Stress Fatigue Infection Stress, fatigue, and infection may cause atrial irritability. Anemia and muscle atrophy may lead to increased fatigue.
A patient with a tachydysrhythmia asks the nurse, "Why does my chest hurt?" Which information does the nurse use to base the explanation given to the patient? (31) A heart rate over 100 beats/min may cause palpitations. The diastole is shortened, and coronary perfusion is decreased. The aortic valve remains open, preventing coronary artery filling. The conduction is delayed at the atrioventricular (AV) node, causing heart block.
The diastole is shortened, and coronary perfusion is decreased. Coronary artery blood flow occurs mostly during diastole when the aortic valve is closed; shortened diastolic time shortens the coronary artery perfusion time, bringing less oxygenated blood to the myocardium. This results in chest pain. With palpitations, the patient perceives that he or she can feel the heart beating. Although tachycardia may result in palpitations, the sensation of one's heart beating may occur with chest pain, but it is not the cause. Conduction delays at the AV node are classified as heart blocks, which are by definition bradydysrhythmias.
How does the nurse interpret the result of a patient's 12-lead ECG that shows a positive deflection? (31) The cardiac axis is moving neither toward nor away from the axis. There is no current flow after complete depolarization and repolarization. The electrical current flow in the heart (cardiac axis) is toward the positive pole. The electrical current flow in the heart (cardiac axis) is toward the negative pole.
The electrical current flow in the heart (cardiac axis) is toward the positive pole. A positive deflection, or an ECG documented above the baseline, is seen when electrical current flow in the heart (cardiac axis) is toward the positive pole. The line will remain flat on the isoelectric line when there is no current flow in the heart after complete depolarization and also after complete repolarization. If the cardiac axis is moving neither toward nor away from the positive pole, the ECG will be documented both above and below the baseline. If the direction of electrical current flow in the heart (cardiac axis) is moving away from the positive pole toward the negative pole, documentation below the baseline is viewed.
Who is responsible for determining when continuous ECG monitoring can be suspended, such as during showering? (31) The nurse The patient The monitor technician The health care provider
The health care provider The health care provider is responsible for determining when monitoring can be suspended, such as during showering, and whether monitoring is needed during off-unit testing procedures and for transportation to other facilities. The nurse is responsible for accurate patient assessment management. The patient does not choose when monitoring can be suspended. The monitor tech watches, prints, interprets, and reports the patient rhythm to the nurse.
Which statement accurately describes the area of the heart that initiates the cardiac cycle? (31) The ventricles' Purkinje fibers are responsible for the initial cardiac impulse. The bundle of His acts to initiate cardiac contraction in the atria with a resulting QRS complex. The atrioventricular area acts as the primary pacemaker and produces the P wave on the ECG. The sinoatrial (SA) node is the primary pacemaker of the heart whose activity is reflected in the P wave on the ECG.
The sinoatrial (SA) node is the primary pacemaker of the heart whose activity is reflected in the P wave on the ECG. The SA node is the heart's primary pacemaker causing atrial depolarization, reflected in the P wave on the ECG. The Purkinje fibers cause rapid conduction of impulses throughout the ventricles, causing ventricular depolarization and contraction consistent with the QRS complex. The bundle of His extends down the interventricular septum to both ventricles. The atrial junction and atrioventricular node receive conduction from the SA node, delaying conduction before sending the impulse to the ventricles; this is reflected in the PR segment.
Which does the PR interval represent on an ECG? (31) An isoelectric line when the electrical impulse is traveling through the atrioventricular (AV) node, where it is delayed The time required for depolarization of both ventricles The time required for atrial depolarization, impulse delay in the AV node, and the travel time to the Purkinje fibers A deflection that represents atrial depolarization
The time required for atrial depolarization, impulse delay in the AV node, and the travel time to the Purkinje fibers The PR interval represents the time required for atrial depolarization, the impulse delay in the AV node, and the travel time to the Purkinje fibers. The PR segment is the isoelectric line from the end of the P wave to the beginning of the QRS complex, when the electrical impulse is traveling through the AV node, where it is delayed. The QRS duration represents the time required for depolarization of both ventricles. The P wave is a deflection that represents atrial depolarization.
Which description is characteristic of normal sinus rhythm? (31) The T wave is followed by a U wave. The PP intervals are essentially the same. The PR interval is greater than 0.20 seconds. There is a P wave for every QRS complex.
There is a P wave for every QRS complex. In normal sinus rhythm, a P wave precedes every QRS complex. A U wave is not always present in normal sinus rhythm. The PP intervals do have some minor variation, so they are not all the same. The normal PR interval is 0.12 to 0.20 seconds, not greater than 0.20 seconds.
Which information does the nurse include when providing education for a group of nurses about an ECG strip after it is printed? (31) Speed is measured on the vertical axis. Time is measured on the horizontal axis. Five small blocks make up five large blocks. Vertical lines at the top represent 2-second segments.
Time is measured on the horizontal axis. Time is measured on the horizontal axis of ECG strips. At this speed, each small block represents 0.04 seconds. Five small blocks make up one large block. Speed is the same as time, and it is measured on the horizontal axis. The vertical lines at the top margin of the graph paper are usually 15 large blocks apart and represent 3-second (not 2-second) segments.
Which cardiac dysrhythmia results from a prolonged QT interval? (31) Torsade de pointes Ventricular standstill Ventricular fibrillation Premature ventricular contractions
Torsade de pointes Torsade de pointes may result from a prolonged QT interval. Ventricular standstill, ventricular fibrillation, and premature ventricular contractions are not related to or caused by a prolonged QT interval.
Which cardiac rhythm typically deteriorates into ventricular fibrillation (VF)? (31) Atrial flutter Atrial fibrillation Ventricular tachycardia (VT) Third-degree heart block
Ventricular tachycardia (VT) VT may occur in patients with ischemic heart disease, myocardial infarction (MI), cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, heart failure, drug toxicity, hypotension, or ventricular aneurysm. In patients who go into cardiac arrest, VT is commonly the initial rhythm before deteriorating into VF as the terminal rhythm. Atrial fibrillation and flutter are not life-threatening rhythms. Third-degree heart block is related to ischemia or scarring in the atrioventricular node, which slows the rate, rather than making the heart irritable as in VT and fibrillation.