Ignatavicius CH 34 Dysrhythmias
A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation?
A 50-year-old who is post coronary artery bypass graft surgery
A nurse on a cardiac unit is caring for a group of clients. The nurse should recognize which of the following clients as being at risk for the development of a dysrhythmia?
A client who has metabolic alkalosis, COPD, underwent stent placement in a coronary artery
A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the clients electrocardiogram. Which action should the nurse take next?
Assess vital signs and level of consciousness.
A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?
Avoid straining while having a bowel movement.
A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring. Which statement should the nurse provide to the UAP related to this procedure?
Clean the skin and clip hairs if needed.
The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, Why do you want to know if I use cocaine? How should the nurse respond?
Clients who use cocaine are at risk for fatal dysrhythmias.
A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations should the nurse assess?
Decrease in cardiac output, increase in blood pressure, decrease of urine output
A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client?
Ensure that everyone is clear of contact with the client and the bed.
A nurse is caring for a client who experienced defibrillation. Which of the following should be included in the documentation of this procedure?
Follow up ECG, Energy settings used, skin condition under electrodes
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching?
I will avoid sources of strong electromagnetic fields.
A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment should the nurse complete next?
Level of consciousness
A nurse is reviewing the medical record of a client who is to undergo a scheduled electrical cardioversion. For which of the following findings should the nurse notify the provider? MAR: Ferrous Sulfate 200mg PO 0800 & 2000 Diazepam 2mg PO 0800 & 2000 Isosorbide 2.5mg PO 4 times daily AC & HS VS: 0800 T 99F BP 142/86 HR 88/min & irregular RR 20/min History & Physical: Bariatric Surg 10 yrs ago, dyspnea with exertion for three years, atrial fibrillation began three years ago, client reports the following medications for the last six weeks: iron supplement, multivitamin, antilipemic, and nitroglycerin
Medical history.
A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services. Which priority information should be communicated to the home health nurse upon discharge?
Medication reconciliation
A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse?
Mid-sternal chest pain
A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement should the nurse include in this clients teaching?
Minimize or abstain from caffeine.
A nurse on the cardiac unit is caring for a client who is on telemetry. The nurse recognizes the clients heart rate is 46/min and notifies the provider. Which of the following prescriptions might be appropriate for this client?
Pacemaker insertion
A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions should the nurse implement to address this clients concerns?
Schedule periods of exercise and rest during the day.
A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response?
Short period of asystole
After assessing a client who is receiving an amiodarone intravenous infusion for unstable ventricular tachycardia, the nurse documents the findings and compares these with the previous assessment findings: Vital Signs Nursing Assessment Time: 0800 Temperature: 98 F Heart rate: 68 beats/min Blood pressure: 135/60 mm Hg Respiratory rate: 14 breaths/min Oxygen saturation: 96% Oxygen therapy: 2 L nasal cannula Client alert and oriented. Cardiac rhythm: normal sinus rhythm. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Time: 1000 Temperature: 98.2 F Heart rate: 50 beats/min Blood pressure: 132/57 mm Hg Respiratory rate: 16 breaths/min Oxygen saturation: 95% Oxygen therapy: 2 L nasal cannula Client alert and oriented. Cardiac rhythm: sinus bradycardia. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Client voids 420 mL of clear yellow urine. Based on the assessments, which action should the nurse take?
Slow the amiodarone infusion rate.
A nurse is teaching a client with premature ectopic beats. Which education should the nurse include in this clients teaching?
Smoking cessation Stress reduction and management Adverse effects of medications
A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition?
Speech alterations
A newly licensed nurse is observing a cardioversion procedure and hears the team leader call out, open "stand clear." This statement indicates which of the following events is occurring?
Team members cannot be in contact with equipment connected to the client.
A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action should the nurse take prior to the initiation of cardioversion?
Turn off oxygen therapy.
A nurse teaches a client with a new permanent pacemaker. Which instructions should the nurse include in this clients teaching?
Until your incision is healed, do not submerge your pacemaker. Only take showers. Report any pulse rates lower than your pacemaker settings. Do not lift your left arm above the level of your shoulder for 8 weeks. The client should be advised of restrictions on physical activity for 8 weeks to allow the pacemaker to settle in place. Never apply pressure over the generator and avoid tight clothing. No MRI!
A nurse assesses a clients electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation?
Ventricular and atrial depolarizations are initiated from different sites.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this clients medication administration record to prevent a common complication of this condition?
Warfarin (Coumadin)
