LEWIS Ch.39 - Dysrhythmias
B- chest pain and palpitations Rationale: Manifestations of decreased cardiac output in the patient with supraventricular tachycardia include hypotension, angina, palpitations, and dyspnea.
3. In the patient with supraventricular tachycardia, which assessment indicated decreased cardiac output? A. hypertension and dyspnea B. chest pain and palpitatins C. abdominal distention and tachypnea D. bounding pulses and systolic murmur
C- Observe for symptoms of hypotension and angina Rationale: The rhythm is a second-degree atrioventricular (AV) block, type I (i.e., Mobitz I or Wenckebach heart block). It is characterized by a gradual lengthening of the PR interval. Type I AV block is usually a result of myocardial ischemia or infarction. It is typically transient and well tolerated. The nurse should assess for bradycardia, hypotension, and angina. The symptomatic patient may need atropine or a temporary pacemaker.
1. A patient with syncope has continuous ECG monitoring. The rhythm strip shows: Atrial rate 74 BPM and regular; ventricular rate 62 BPM and irregular; P wave normal shape; PR interval lengths progressively until a P wave is not conducted; QRS normal shape. Which intervention would the nurse prioritize? A. administer epinephrine 1 mg IV push B. Prepare the patient for synchronized cardioversion C. Observe for symptoms of hypotension and angina D. Apply a transcutaneous pacemaker pad on the patient
D- Assess the pt response to dysrhythmia A premature ventricular contraction- in an ectopic focus in the ventricles. Every other beat is a PVC, the rhythm is called ventricular bigeminy. PVCs are usually a benign finding in pt with a normal heart. In pt with heart disease, PVCs may reduce the cardiac output and precipitate angina and heart failure, depending on the frequency. bc PVCs in (CAD) or acute mi indicate ventricular irritability, the pts physiologic response to PVCs must be monitored.
2. The ECG monitor of a patient in the cardiac care unit after an MI shows ventricular bigeminy with a rate of 50 beats/min. The nurse would a. perform defibrillation. b. administer IV amiodarone. c. prepare for temporary pacemaker insertion. d. assess the patient's response to the dysrhythmia.
D- Cardioversion is painful for an awake patient Rationale: Synchronized cardioversion is for pts with hemodynamically unstable ventricular or supraventricular tachydysrhythmias. If synchronized cardioversion is done on a nonemergency basis, the patient is sedated before the procedure, and the initial energy needed for synchronized cardioversion is less than the energy needed for defibrillation.
4. The nurse prepares a patient for elective synchronized cardioversion. Which information would the nurse consider in planning for the procedure? A. Defibrillation delivers a lower dose of electrical energy. B. Cardioversion is a treatment for atrial bradydysrhythmias C. Defibrillation delivers a shock during the QRS complex. D. Cardioversion is painful for an awake patient.
B, C, D Rationale: Air travel is not restricted, should tell airport security of the presence of a pacemaker because it may set off the metal detector. A hand-held screening wand should not pass directly over the pacemaker. The pt should monitor the pulse and tell the HCP if it drops below a predetermined rate. The pt should have and wear a Medic Alert ID device at all times. The pt must avoid lifting the arm on the pacemaker side above the shoulder until approved by the HCP.
5. Which patient teaching points would the nurse include when providing discharge instructions to a patient with a new permanent pacemaker? (select all that apply) A. avoid or limit air travel B. take and record a daily pulse rate C. obtain and wear a medic alert id device at all times D. avoid lifting arm on the side of the pacemaker above shoulder E. Do not use a microwave oven because it interferes with pacemaker function
C- the procedure will destroy areas of the conduction system that are causing rapid heart rhythms. Rationale: Radiofrequency catheter ablation therapy involves the use of electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias.
6. Which information would the nurse teach the patient scheduled for a radiofrequency catheter ablation procedure? A. ventricular bradycardia may be induced and treated during the procedure B. a catheter will be placed in both femoral arteries to allow double catheter intervention. C. The procedure will destroy areas of the conduction system that are causing rapid heart rhythms. D. general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences.
C Because this patient has dyspnea and chest pain in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by starting with O2 administration. The other actions are also important and should be implemented rapidly
A patient on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action in the agency dysrhythmia protocol would the nurse take first? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the patient's blood pressure and discomfort level
C The patient has sinus tachycardia, which may have multiple causes, such as pain, dehydration, anxiety, and myocardial ischemia. Further assessment is needed before determining the treatment. Vagal stimulation, pain management, or Beta-blockade may be used after further assessment of the patient.
A patient who reports a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. (little space in the QRS complex) Which action would the nurse take next? a. Administer morphine 4 mg IV. b. Have the patient perform the Valsalva maneuver. c. Obtain the patient's vital signs including O2 saturation. d. Prepare to give a -blocker medication to slow the heart rate.
D The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The nurse should notify the health care provider after the medication is started. Cardioversion is not indicated given that the patient has returned to a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.
A patient who was admitted with a myocardial infarction has a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which action would the nurse take next? a. Immediately notify the health care provider. b. Document the rhythm and continue to monitor the patient. c. Prepare for synchronized cardioversion per agency protocol. d. Prepare to give IV amiodarone per agency dysrhythmia protocol.
A Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria. Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information does not indicate that the patient has a slow heart rate.
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for four days. Which topic would the nurse plan to include in patient teaching? a. Anticoagulant therapy b. Permanent pacemakers c. Emergency cardioversion d. IV adenosine (Adenocard)
B When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned "on" for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this alert patient.
A patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg is being prepared for cardioversion. Which action should the nurse expect to take? a. Turn the synchronizer switch to the "off" position. b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device
B The patient's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, begin chest compressions. The other actions may also be appropriate but should not be done first.
A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action would the nurse take first? a. Give epinephrine (Adrenalin) IV. b. Perform immediate defibrillation. c. Prepare for endotracheal intubation. d. Ventilate with a bag-valve-mask device
C The patient has progressive first-degree atrioventricular (AV) block, and the -blocker should be held until discussing the drug with the health care provider. Documentation is appropriate later. The patient with first-degree AV block usually is asymptomatic; if the patient became symptomatic, a pacemaker or atropine may be used.
A patient's heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action would the nurse take first? a. Place the transcutaneous pacemaker pads on the patient. b. Give atropine sulfate 1 mg IV per agency dysrhythmia protocol. c. Hold the scheduled metoprolol (Lopressor) and call the health care provider. d. Document the patient's rhythm and PR measurements in the medical record
D The frequent firing of the ICD indicates that the patient's ventricles are very irritable. The priority is to assess the patient and give the amiodarone. The other patients can be seen after the amiodarone is given.
The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient would the nurse see first? a. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin (Coumadin) due b. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating c. A patient who is in a sinus rhythm, rate 98 and regular, recovering from an elective cardioversion 2 hours ago d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due
B The accurate way to measure the heart rate from an EKG of a patient with an irregular rhythm is to count the number of QRS complexes in 1 minute. The other methods are accurate for regular heart rhythms
The nurse needs to measure the heart rate for a patient with an irregular heart rhythm. Which method will be accurate? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes. c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next and divide into 1500.
Clinical manifestations: *Hypotension *Pale, cool skin *Weakness *Angina *Dizziness or syncope *Confusion or disorientation *SOB Treatment: Stop offending drugs, IV atropine, Pacemaker, Dopamine or epinephrine infusion
What are the clinical manifestations and treatment of sinus bradycardia?
*Dizziness *Dyspnea *Hypotension *Angina in patients with CAD Treatment: *Guided by cause, Vagal maneuvers, Beta-blockers, adenosine, or calcium channel blockers, or Synchronized cardioversion
What are the clinical manifestations and treatments of sinus tachycardia?
*Contraction starting from an ectopic focus in atrium other than SA node *Creates distorted p-wave Causes: Emotional stress, Fatigue, Caffeine, Tobacco, Alcohol, Hypoxia, Electrolyte imbalances, or Disease states. Clinical manifestations: Palpitations (Heart "skips a beat") Treatment: Monitor for more serious dysrhythmias, Withhold sources of stimulation, Beta blockers
What is a premature atrial contraction? Causes Clinical manifestations Treatment
*Reentrant phenomenon: PAC triggers a run of repeated premature beats *Paroxysmal refers to an abrupt onset and ending *May occur with overexertion, stress, deep inspiration, stimulants, disease, digitalis toxicity Clinical Manifestations: HR 151-220 beats/min *HR greater than 180 leads to decreased cardiac output and stroke volume *Hypotension *Palpitations *Dyspnea *Angina
What is paroxysmal supraventricular tachycardia (PSVT)? Clinical manifestations
D The QRS complex represents ventricular depolarization. The P wave represents the depolarization of the atria. The PR interval represents depolarization of the atria, atrioventricular node, bundle of His, bundle branches, and the Purkinje fibers. The Q wave is the first negative deflection following the P wave and would be narrow and short.
What would the nurse measure to determine whether there is a delay in electrical impulse conduction through the patient's ventricles? a. P wave b. Q wave c. PR interval d. QRS complex
PNS *Decreases firing of the SA node *Slows impulse conduction of the AV node SNS *Increases SA node firing *Increases impulse conduction of the AV node *Increases cardiac contractility
When it comes to controlling the heart, what is the role played by the PNS and SNS?
B Adenosine must be given over 1 to 2 seconds to be effective. The other actions indicate a need for more teaching about treatment of heart dysrhythmias. The RN should hold the diltiazem until discussing it with the health care provider. The treatment for asystole is immediate CPR. The synchronizer switch should be "off" when defibrillating
Which action by a registered nurse (RN) who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias? a. Prepares defibrillator settings at 360 joules for a patient whose monitor shows asystole. b. Injects IV adenosine over 2 seconds for a patient with supraventricular tachycardia. c. Turns the synchronizer switch to the "on"position before defibrillating a patient with ventricular fibrillation. d. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second-degree AV block.
D Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values are also abnormal, they are not likely to be the cause of the patient's PVCs and do not require immediate correction
Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose of 243 mg/dL b. Serum chloride of 92 mEq/L c. Serum sodium of 134 mEq/L d. Serum potassium of 2.9 mEq/L
B AP serving as telemetry technicians can monitor heart rhythms for individuals or groups of patients. Nursing actions such as assessment and choice of the most appropriate lead based on ST segment elevation location require RN-level education and scope of practice
Which nursing action can the registered nurse (RN) delegate to experienced assistive personnel (AP) working as telemetry technicians on the cardiac care unit? a. Decide whether a patient's heart rate of 116 requires urgent treatment. b. Observe heart rhythms for multiple patients who have telemetry monitoring. c. Monitor a patient's level of consciousness during synchronized cardioversion. d. Select the best lead for monitoring a patient admitted with acute coronary syndrome.
D The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period
Which patient statement indicates that discharge teaching about the management of a new permanent pacemaker was effective? a. "It will be several weeks before I can return to my usual activities." b. "I will avoid cooking with a microwave oven or being near one in use." c. "I will notify the airlines when I make a reservation that I have a pacemaker." d. "I won't lift the arm on the incision side until I see the health care provider."
