MED SURG II CHP 26 PREPU

Question 1 See full question16sReport this Question Which postimplantation instruction must a nurse provide to a client with a permanent pacemaker? You Selected: Avoid sources of electrical interference Correct response: Avoid sources of electrical interference Explanation: The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference. The nurse should also instruct the client to avoid strenuous movement (especially of the arm on the side where the pacemaker is inserted), to keep the arm on the side of the pacemaker lower than the head except for brief moments when dressing or performing hygiene, and to delay for at least 8 weeks activities such as swimming, bowling, tennis, vacuum cleaning, carrying heavy objects, chopping wood, mowing, raking, and shoveling snow. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Chart 26-9, p. 747. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 747 Add a Note Question 2 See full question11sReport this Question Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? You Selected: QRS complex Correct response: QRS complex Explanation: The QRS complex represents ventricular depolarization. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria. The PR interval is a component of an ECG tracing reflecting conduction of an electrical impulse through the AV node. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 716. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 716 Add a Note Question 3 See full question14sReport this Question The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect? You Selected: pacemaker site infection Correct response: pacemaker site infection Explanation: Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These symptoms include swelling, unusual tenderness, drainage, and increased warmth. When the site is healing normally, there will be no tenderness and throbbing. A hematoma forms a lump at the pacemaker insertion site. Mild bleeding will be drainage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Nursing Management, p. 746. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 746 Add a Note Question 4 See full question11sReport this Question The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record? You Selected: Bigeminy Correct response: Bigeminy Explanation: The nurse is correct to note bigeminy on the permanent record when every other beat is a PVC. Couplets are two PVCs in a row. Multifocal PVCs originate from more than one location. R-on-T phenomenon occurs when the R wave falls on the T wave. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729 Add a Note Question 5 See full question15sReport this Question A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? You Selected: internal cardioverter defibrillator insertion Correct response: internal cardioverter defibrillator insertion Explanation: The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Implantable Cardioverter Defibrillator, p. 744. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744 Add a Note Question 6 See full question12sReport this Question A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient? You Selected: Lead wire dislodgement Correct response: Lead wire dislodgement Explanation: Phrenic nerve, diaphragmatic (hiccuping may be a sign), or skeletal muscle stimulation may occur if the lead is dislocated or if the delivered energy (mA) is set high. The occurrence of this complication is avoided by testing during device implantation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Chart 26-8, p. 743. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 743 Add a Note Question 7 See full question11sReport this Question A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? You Selected: Ventricular fibrillation Correct response: Ventricular fibrillation Explanation: The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Ventricular Fibrillation, p. 730. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 730 Add a Note Question 8 See full question15sReport this Question A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response? You Selected: Atrial flutter Correct response: Premature atrial complex Explanation: A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Atrial Complex, p. 720. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 720 Add a Note Question 9 See full question13sReport this Question Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? You Selected: Atrial flutter Correct response: Atrial flutter Explanation: Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in shape. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 727. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 727 Add a Note Question 10 See full question51sReport this Question A client with heart failure asks the nurse how dobutamine affects the body's circulation. What is the nurse's best response? You Selected: The medication helps the kidneys produce more urine. Correct response: The medication increases the force of the myocardial contraction. Explanation: A positive inotropic medication increases the force of the myocardial contraction. The inotropic medication decreases heart rate; it does not cause the kidneys to retain fluid or produce more urine.

Question 1 See full question14sReport this Question When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be You Selected: captured. Correct response: captured. Explanation: Capture is a term used to denote that the appropriate electrocardiogram (ECG) complex followed by the pacing spike. Triggered response means that the pacemaker will respond when it senses intrinsic heart activity. Inhibited response means that the response of the pacemaker is controlled by the activity of the client's heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 741. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 741 Add a Note Question 2 See full question14sReport this Question The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? You Selected: "I should ask for a handheld device search when I go through airport security." Correct response: "I should ask for a handheld device search when I go through airport security." Explanation: At security gates at airports, government buildings, or other secured areas, the client with a permanent pacemaker should show a pacemaker ID card and request a hand (not handheld device) search. The client should obtain and carry a physician's letter about this requirement. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 744. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744 Add a Note Question 3 See full question14sReport this Question The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in 1 week. What is the best advice the nurse can give related to this activity? You Selected: "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." Correct response: "You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks." Explanation: It is important to restrict movement of the arm until the incision heals. The client should not raise the arm above the head for 2 weeks afterward to avoid dislodging the leads. The client must avoid contact sports (eg, basketball, football, hockey). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 742. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 742 Add a Note Question 4 See full question13sReport this Question The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response? You Selected: "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." Correct response: "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." Explanation: A client experiencing pacemaker malfunctioning may develop bradycardia as well as signs and symptoms of decreased cardiac output. The client should check the pulse daily and report immediately any sudden slowing or increasing of the pulse rate, which may indicate pacemaker malfunction. The client needs to be evaluated to avoid cardiac output problems. Walking will not keep the heart rate at a safe level. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Surveillance, p. 744. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744 Add a Note Question 5 See full question23sReport this Question A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? You Selected: Elective electrical cardioversion Correct response: Elective electrical cardioversion Explanation: Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion for Atrial Fibrillation, p. 725. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 725 Add a Note Question 6 See full question19sReport this Question The nurse is working on a telemetry unit. When the nurse is interpreting a client's heart rhythm, the nurse counts each large block on graph paper as how many seconds? You Selected: 0.4 Correct response: 0.2 Explanation: Each small block on the graph paper equals 0.04 second, and five small blocks form a large block, which equals 0.2 second. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 715. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 715 Add a Note Question 7 See full question12sReport this Question A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? You Selected: supraventricular tachycardia Correct response: supraventricular tachycardia Explanation: Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (over 150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill. These symptoms do not suggest sinus tachycardia, heart block, or atrial flutter. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 729. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729 Add a Note Question 8 See full question14sReport this Question The nurse is caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia? You Selected: Elective cardioversion Correct response: Elective cardioversion Explanation: Atrial fibrillation also is treated with elective cardioversion or digitalis if the ventricular rate is not too slow. Defibrillation is used for a ventricular problem. A Maze procedure is only a distractor for this question. Pacemakers are implanted for bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion for Atrial Fibrillation, p. 725. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 725 Add a Note Question 9 See full question13sReport this Question A 1-minute electrocardiogram (ECG) tracing of a client with a regular heart rate reveals 25 small, square boxes within an RR interval. The nurse correctly identifies the client heart rate as You Selected: 60 bpm. Correct response: 60 bpm. Explanation: A client's HR can be obtained from the electrocardiogram (ECG) tracing by several methods. A 1-minute strip contains 300 large boxes and 1500 small boxes. Therefore, an easy and accurate method of determining heart rate with a regular rhythm is to count the number of small boxes within an RR interval and divide by 1,500. In this instance, 1,500/25 = 60. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 717. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 717 Add a Note Question 10 See full question20sReport this Question The nurse recognizes which as being true of cardioversion? You Selected: Defibrillator should be set to deliver a shock during the QRS complex. Correct response: Defibrillator should be set to deliver a shock during the QRS complex. Explanation: Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation

Question 1 See full question4m 36sReport this Question A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond? You Selected: "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." Correct response: "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." Explanation: The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with the left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of an antiarrhythmic. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 744. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744 Add a Note Question 2 See full question36sReport this Question Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? You Selected: Monitor vital signs and cardiac rhythm Correct response: Monitor vital signs and cardiac rhythm Explanation: The nurse should monitor the client's vital signs and cardiac rhythm for effectiveness of the medication and for side effects and should always have emergency life support equipment available when caring for an acutely ill client. The side effects of vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not necessary to place a client flat during or after vasopressor administration. When administering cholinergic antagonists, documentation of the heart rate is necessary. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 26: Table 26-1. Summary of Antiarrhythmic Medications Add a Note Question 3 See full question1m 25sReport this Question A client has a medical diagnosis of an advanced atrioventricular block, Mobitz Type II, and is symptomatic. What initial treatment will the nurse be prepared to complete? You Selected: prepare client for a cardiac catheterization Correct response: administer an IV bolus of atropine Explanation: The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists. Cardioversion is done with a fast heart rate. Furosemide will be given for fluid overload. Cardiac catheterization is administered for chest pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management of Conduction Abnormalities, p. 734. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 734 Add a Note Question 4 See full question1m 8sReport this Question A client's Holter monitor strip reveals a heart rate with normal conduction but with a rate consistently above 105 beats/minute. What other conditions can cause this response in a healthy heart? You Selected: All options are correct. Correct response: All options are correct. Explanation: There are a variety of causes that can create an elevated heart rate in an otherwise healthy heart, including fever, shock, and strenuous exercise. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 719. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 719 Add a Note Question 5 See full question34sReport this Question The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart? You Selected: Altered patterns frequently affect the heart's ability to pump blood effectively. Correct response: Altered patterns frequently affect the heart's ability to pump blood effectively. Explanation: The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 6 See full question15sReport this Question A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? You Selected: Atrial flutter Correct response: Atrial flutter Explanation: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Flutter, p. 726. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 726 Add a Note Question 7 See full question15sReport this Question A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client's heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings? You Selected: Atropine Correct response: Atropine Explanation: The client is demonstrating signs and symptoms of symptomatic sinus bradycardia. Atropine is the medication of choice in treating symptomatic sinus bradycardia. Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial dysrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 718. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718 Add a Note Question 8 See full question27sReport this Question The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? You Selected: Begin cardiopulmonary resuscitation (CPR) Correct response: Begin cardiopulmonary resuscitation (CPR) Explanation: Commonly called flatline, ventricular asystole (Fig. 26-19) is characterized by absent QRS complexes confirmed in two different leads, although P waves may be apparent for a short duration. There is no heartbeat, no palpable pulse, and no respiration. Without immediate treatment, ventricular asystole is fatal. Ventricular asystole is treated the same as PEA, focusing on high-quality CPR with minimal interruptions and identifying underlying and contributing factors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 731. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 731 Add a Note Question 9 See full question22sReport this Question The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? You Selected: Delayed conduction, producing a prolonged PR interval Correct response: Delayed conduction, producing a prolonged PR interval Explanation: Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, First-Degree Atrioventricular Block, p. 732. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 732 Add a Note Question 10 See full question32sReport this Question A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardigram as an indicator of sinus tachycardia? You Selected: heart rate of 118 bpm Correct response: heart rate of 118 bpm Explanation: The sinus node creates an impulse at a faster-than-normal rate. The PR interval of 0.1 seconds, QRS duration of 0.16 seconds and Q wave of 0.04 seconds are consistent with a normal sinus rhythm. Sinus tachycardia occurs when the heart rate is over 100 bpm.

Question 1 See full question16sReport this Question The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? You Selected: Avoid going through airport metal detectors. Correct response: Avoid undergoing magnetic resonance imaging (MRI). Explanation: A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave ovens. The client must avoid vigorous arm and shoulder movement only for the first 6 weeks after pacemaker implantation. Airport metal detectors don't harm pacemakers; however, the client should notify airport security guards that he has a pacemaker because its metal casing and programming magnet could trigger the metal detector. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 743. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 743 Add a Note Question 2 See full question12sReport this Question Which rhythm is also termed a ventricular escape rhythm? You Selected: Idioventricular rhythm Correct response: Idioventricular rhythm Explanation: Idioventricular rhythm is also called a ventricular escape rhythm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 731. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 731 Add a Note Question 3 See full question37sReport this Question The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect? You Selected: pacemaker site infection Correct response: pacemaker site infection Explanation: Postoperative care for a pacemaker insertion includes observing for symptoms of infection. These symptoms include swelling, unusual tenderness, drainage, and increased warmth. When the site is healing normally, there will be no tenderness and throbbing. A hematoma forms a lump at the pacemaker insertion site. Mild bleeding will be drainage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Nursing Management, p. 746. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 746 Add a Note Question 4 See full question34sReport this Question The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? You Selected: "We will be getting rid of our microwave oven so it will not affect my pacemaker." Correct response: "We will be getting rid of our microwave oven so it will not affect my pacemaker." Explanation: Permanent pacemaker generators have filters that protect them from electrical interference from most household devices, motors, and appliances, so the client can keep the microwave oven. Clients are taught to check pulses daily, avoid large magnets, and report any incisional redness or swelling. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Complications of Pacemaker Use, p. 744. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744 Add a Note Question 5 See full question20sReport this Question Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? You Selected: "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Correct response: "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 716. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 716 Add a Note Question 6 See full question30sReport this Question The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: You Selected: occur at a rate of more than six per minute Correct response: occur at a rate of more than six per minute Explanation: When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729 Add a Note Question 7 See full question15sReport this Question A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? You Selected: electrocardiogram Correct response: electrocardiogram Explanation: An electrocardiogram is used to identify normal and abnormal cardiac rhythms. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 8 See full question16sReport this Question The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as You Selected: normal sinus rhythm. Correct response: normal sinus rhythm. Explanation: The electrocardiogram (ECG) tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 718. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718 Add a Note Question 9 See full question49sReport this Question A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response? You Selected: Assess the client and monitor leads. Correct response: Assess the client and monitor leads. Explanation: The nurse should assess the client and monitor leads first. It is important that the nurse "treat the client, not the monitor." Ventricular asystole may often appear on the monitor when leads are displaced. The other interventions are not necessary. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 729. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729 Add a Note Question 10 See full question9sReport this Question A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client's vital signs, the client states, "Occasionally, my heart skips a beat. Is this normal?" What is the nurse's best response? You Selected: Atrial flutter Correct response: Premature atrial complex Explanation: A premature atrial complex (PAC) is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.

Question 1 See full question36sReport this Question After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? You Selected: Decreased cardiac output and decreased systolic and diastolic blood pressure Correct response: Decreased cardiac output and decreased systolic and diastolic blood pressure Explanation: As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac output and systolic and diastolic blood pressure; however, like other beta-adrenergic blockers, it increases peripheral vascular resistance at rest and with exercise. Atenolol may cause bradycardia, not tachycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-1, p. 721. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 721 Add a Note Question 2 See full question26sReport this Question The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe? You Selected: Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers Correct response: Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers Explanation: The correct sequence of conduction through the normal heart is the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Normal Electrical Conduction, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 3 See full question26sReport this Question A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? You Selected: "I will drink coffee with only two of my meals." Correct response: "I will drink coffee with only two of my meals." Explanation: Stimulation of the sympathetic nervous system with caffeinated beverages, smoking, and drinking alcohol increases heart rate.The client is still drinking caffeine with two meals, increasing the risk for a fast heart rate. Taking medications such as metoprolol and levothyroxine will help the client maintain a normal heart rate by decreasing stimulation of the sympathetic nervous system. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Influences on Heart Rate and Contractility, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 4 See full question16sReport this Question A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: You Selected: inherent rhythmicity of cardiac muscle tissue. Correct response: inherent rhythmicity of cardiac muscle tissue. Explanation: Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 5 See full question16sReport this Question The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching? You Selected: During the procedure, the dysrhythmia will be reproduced under controlled conditions. Correct response: During the procedure, the dysrhythmia will be reproduced under controlled conditions. Explanation: During EP studies, the patient is awake and may experience symptoms related to the dysrhythmia.The client does not receive general anesthesia. The EP procedure time is not easy to determine. EP studies do not always include ablation of the dysrhythmia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrophysiology Studies, p. 739. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 739 Add a Note Question 6 See full question14sReport this Question A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? You Selected: Double-check the monitoring equipment. Correct response: Double-check the monitoring equipment. Explanation: One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 743. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 743 Add a Note Question 7 See full question14sReport this Question The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment? You Selected: A defibrillator Correct response: A defibrillator Explanation: The nurse is most correct to place a defibrillator close to the client room if not in the room. The nurse realizes that clients with ventricular dysrhythmias are at a high risk for fatal heart dysrhythmia and death. A suction machine is used to remove respiratory secretions. Cardioversion is used in a planned setting for atrial dysrhythmias. An ECG machine records tracings of the heart for diagnostic purposes. Most clients with history of cardiac disorders have an ECG completed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Defibrillation, p. 738. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 738 Add a Note Question 8 See full question14sReport this Question A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? You Selected: "Spike" on the rhythm strip Correct response: "Spike" on the rhythm strip Explanation: Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Generator Functions, p. 741. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 741 Add a Note Question 9 See full question12sReport this Question A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as You Selected: 90 bpm. Correct response: 90 bpm. Explanation: An alternative but less accurate method for estimating heart rate, which is usually used when the rhythm is irregular, is to count the number of RR intervals in 6 seconds and multiply that number by 10. The RR intervals are counted, rather than QRS complexes, because a computed heart rate based on the latter might be inaccurately high. The same methods may be used for determining atrial rate, using the PP interval instead of the RR interval. In this instance, 9 × 10 = 90. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 717. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 717 Add a Note Question 10 See full question57sReport this Question A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client's heart rate is 118 bpm and regular, the client's pupils are dilated, and the client appears excitable. Which action should the nurse take next? You Selected: Instruct the client to hold the breath and bear down. Correct response: Question the client about alcohol and illicit drug use. Explanation: The client is experiencing sinus tachycardia. Since the client's findings of tachycardia, dilated pupils, restlessness, anxiety, and excitability can indicate illicit drug use (cocaine), the nurse should question the client about alcohol and illicit drug use. This information will direct the client's plan of care. Causes of tachycardia include medications that stimulate the sympathetic response, stimulants, and illicit drugs. The treatment goals for sinus tachycardia is usually determined by the severity of symptoms and directed at identifying and abolishing its cause. The other interventions may be implemented, but determining the cause of the tachycardia is essential.

Question 1 See full question19sReport this Question Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion? You Selected: Instruct the client to restrict food and oral intake Correct response: Instruct the client to restrict food and oral intake Explanation: The nurse should instruct the client to restrict food and oral intake before the cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion. When the client is in cardiopulmonary arrest, the nurse should facilitate CPR until the client is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a client with cardiac dysrhythmia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018. Add a Note Question 2 See full question23sReport this Question A client has a medical diagnosis of an advanced atrioventricular block, Mobitz Type II, and is symptomatic. What initial treatment will the nurse be prepared to complete? You Selected: administer an IV bolus of atropine Correct response: administer an IV bolus of atropine Explanation: The initial treatment of choice is an IV bolus of atropine. If the client does not respond to atropine, has advanced AV block, or has had an acute MI, temporary pacing may be started. A permanent pacemaker my be necessary if the block persists. Cardioversion is done with a fast heart rate. Furosemide will be given for fluid overload. Cardiac catheterization is administered for chest pain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management of Conduction Abnormalities, p. 734. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 734 Add a Note Question 3 See full question51sReport this Question The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? You Selected: tachycardia Correct response: feeling tired Explanation: The side effects of procainamide hydrochloride can include hypotension, GI upset, and feelings of tiredness. Procainamide does not cause hypertension, tachycardia, or a change in mental status. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Table 26-1, p. 721. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 721 Add a Note Question 4 See full question13sReport this Question The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1? You Selected: Right side of sternum, fourth intercostal space Correct response: Right side of sternum, fourth intercostal space Explanation: view V1, the electrodes would be placed on the right side of the sternum, fourth intercostal space. V2 is the left side of the sternum, fourth intercostal space. V3 is midway between V2 and V4. V4 is at the mid-clavicular line, fifth intercostal space. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Figure 26-2, p. 715. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 715 Add a Note Question 5 See full question14sReport this Question A client has had a pacemaker implanted and the nurse will begin client education upon the client becoming alert. Which postimplantation instructions must be provided to the client with a permanent pacemaker? You Selected: Avoid sources of electrical interference. Correct response: Avoid sources of electrical interference. Explanation: The nurse must instruct the client with a permanent pacemaker to avoid sources of electrical interference, such as MRI devices, large industrial motors, peripheral nerve stimulators, etc. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 740. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 740 Add a Note Question 6 See full question15sReport this Question The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? You Selected: A client with atrial dysrhythmias Correct response: A client with atrial dysrhythmias Explanation: The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 737 Add a Note Question 7 See full question13sReport this Question A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding? You Selected: Peaked T waves Correct response: Peaked T waves Explanation: The client's serum potassium level is high. The T wave is an ECG characteristic reflecting repolarization of the ventricles. It may become tall or "peaked" if a client's serum potassium level is high. The U wave is an ECG waveform characteristic that may reflect Purkinje fiber repolarization. It is usually seen when a client's serum potassium level is low. The P wave is an ECG characteristic reflecting conduction of an electrical impulse through the atria and is not affected by a client's serum potassium level. The QT interval is an ECG characteristic reflecting the time from ventricular depolarization to repolarization, and is not affected by a client's serum potassium level. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018. Add a Note Question 8 See full question13sReport this Question The nurse analyzes the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The client's ECG strip demonstrates PR intervals that measure 0.24 seconds. What is the nurse's most appropriate action? You Selected: Document the findings and continue to monitor the patient Correct response: Document the findings and continue to monitor the patient Explanation: The client's electrocardiogram (ECG) tracing indicates a first-degree atrioventricular (AV) block. First-degree AV block rarely causes any hemodynamic effect; the other blocks may result in decreased heart rate, causing a decrease in perfusion to vital organs, such as the brain, heart, kidneys, lungs, and skin. The most appropriate action by the nurse is to document the findings and continue to monitor the client. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018. Add a Note Question 9 See full question26sReport this Question The nurse participates in the care of a client requiring emergent defibrillation. The nurse determines the steps should be completed in which order? You Selected: Apply the multifunction conductor pads to the client's chest. Turn on the defibrillator and place it in "not sync" mode. Call "clear" three times ensuring client and environmental safety. Charge the defibrillator to the prescribed voltage. Deliver the prescribed electrical charge. Correct response: Turn on the defibrillator and place it in "not sync" mode. Charge the defibrillator to the prescribed voltage. Apply the multifunction conductor pads to the client's chest. Call "clear" three times ensuring client and environmental safety. Deliver the prescribed electrical charge. Explanation: This is the sequence of events the nurse should implement when delivering emergent defibrillation. If not followed correctly, the client and health care team may be placed in danger. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018. Add a Note Question 10 See full question15sReport this Question The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? You Selected: Atrial flutter Correct response: Atrial flutter Explanation: Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects (Fuster, Walsh et al., 2011).

Question 1 See full question13sReport this Question To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? You Selected: P wave Correct response: P wave Explanation: The P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The T wave depicts the relative refractory period, representing ventricular repolarization. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 715. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 715 Add a Note Question 2 See full question55sReport this Question A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? You Selected: "The box is recording the heart's electrical activity, and a physician will review the tracing later." Correct response: "The small box will transmit the heart rhythm to the central monitor all the time." Explanation: In telemetry, a small box transmits the client's heart rhythm to the central unit for constant monitoring. Telemetry has nothing to do with the client needing help. A holter monitor is a device that records the heart's electrical activity and for later review by a physician. The telemetry transmits the heart rhythm regardless of the client's heart rate. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 3 See full question19sReport this Question The nurse is caring for a client scheduled for a transesophageal echocardiogram with a diagnosis of atrial fibrillation. The client's spouse asks the nurse to explain the purpose of the test. What is the nurse's best response? You Selected: "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." Correct response: "This test will show any blood clots in the heart, and help us determine if it is safe to do a cardioversion." Explanation: The transesophageal echocardiogram will show if the client has blood clots and help determine if it is safe to use cardioversion. The transesophageal echocardiogram does not indicate which area is causing the atrial fibrillation or the need to evaluate coronary arteries, as with a cardiac catheterization. Hypotension is diagnosed with blood pressure readings. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Quality and Safety Nursing Alert, p. 725. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 725 Add a Note Question 4 See full question13sReport this Question A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? You Selected: Clients with recurrent life-threatening bradycardias Correct response: Clients with recurrent life-threatening tachydysrhythmias Explanation: The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Implantable Cardioverter Defibrillator, pp. 744-745. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744-745 Add a Note Question 5 See full question20sReport this Question The nurse knows that what PR interval presents a first-degree heart block? You Selected: 0.24 seconds Correct response: 0.24 seconds Explanation: In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, First-Degree Atrioventricular Block, p. 732. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 732 Add a Note Question 6 See full question12sReport this Question The nurse knows that electrocardiogram (ECG) characteristics of atrial fibrillation include what? You Selected: Atrial rate of 300 to 400 Correct response: Atrial rate of 300 to 400 Explanation: Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Fibrillation, p. 722. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 722 Add a Note Question 7 See full question2m 6sReport this Question The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up? You Selected: QT interval that is 0. 46 seconds long Correct response: QT interval that is 0. 46 seconds long Explanation: The QT interval that is 0.46 seconds long needs to be investigated. The QT interval is usually 0.32 to 0.40 seconds in duration if the heart rate is 65 to 95 bpm. If the QT interval becomes prolonged, the client may be at risk for a lethal ventricular dysrhythmia, called torsades de pointes. The other findings are normal. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 716. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 716 Add a Note Question 8 See full question43sReport this Question A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing? You Selected: Sinus tachycardia Correct response: Sinus tachycardia Explanation: Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate. Causes include medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, Ecstasy). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Sinus Tachycardia, p. 719. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 719 Add a Note Question 9 See full question28sReport this Question A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? You Selected: internal cardioverter defibrillator insertion Correct response: internal cardioverter defibrillator insertion Explanation: The implantable cardioverter defibrillator (ICD) is an electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation, especially those that are ventricular in origin. Patients at high risk of ventricular tachycardia (VT) or ventricular fibrillation who would benefit from an ICD are those who have survived sudden cardiac death syndrome, which usually is caused by ventricular fibrillation, or who have experienced spontaneous, symptomatic VT (syncope secondary to VT) not due to a reversible cause (called a secondary prevention intervention). Radiofrequency ablation destroys a small area of heart tissue that is causing rapid and irregular heartbeats, and is used to reduce pain. A cardiac electrophysiology study is an invasive procedure that tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Implantable Cardioverter Defibrillator, p. 744. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 744 Add a Note Question 10 See full question24sReport this Question The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? You Selected: atropine sulfate Correct response: atropine sulfate Explanation: Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation. The client will be treated with an anticholinergic that blocks the effects of the vagal nerve. Atenolol and nadolol are beta blockers that are used for chest pain, myocardial infarction, and hypertension. Diltazem is a calcium channel blocker used to treat angina or slow the heart rate.

Question 1 See full question20sReport this Question Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? You Selected: "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Correct response: "It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." Explanation: The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarization, and conduction through the AV node before ventricular depolarization. In a normal heart the impulses do not travel backward. The PR interval does not include the time it take to travel through the Purkinje fibers. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Waves, Complexes, and Intervals, p. 716. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 716 Add a Note Question 2 See full question13sReport this Question A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? You Selected: Elective electrical defibrillation Correct response: Elective electrical cardioversion Explanation: Elective electrical cardioversion is a nonemergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias. Chemical cardioversion is not a procedure; it is drug therapy. A Mace procedure is a distractor for this question. Defibrillation is not an elective procedure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Electrical Cardioversion for Atrial Fibrillation, p. 725. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 725 Add a Note Question 3 See full question23sReport this Question A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms? You Selected: electrocardiogram Correct response: electrocardiogram Explanation: An electrocardiogram is used to identify normal and abnormal cardiac rhythms. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 4 See full question16sReport this Question The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? You Selected: Fluttering Correct response: Fluttering Explanation: Premature ventricular contractions usually cause a flip-flop sensation in the chest, sometimes described as "fluttering." Associated signs and symptoms include pallor, nervousness, sweating, and faintness. Symptoms of premature ventricular contractions are not nausea, hypotension, and fever. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018. Add a Note Question 5 See full question13sReport this Question A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? You Selected: Atrial flutter Correct response: Atrial flutter Explanation: Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Flutter, p. 726. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 726 Add a Note Question 6 See full question11sReport this Question A client's electrocardiogram (ECG) tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as You Selected: Atrial flutter Correct response: Atrial flutter Explanation: The nurse correctly identifies the electrocardiogram (ECG) tracing as atrial flutter. Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate between 250 and 400 times per minute. The P waves are saw-toothed in appearance. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. The atrial rate is 300 to 600, and the ventricular rate is usually 120 to 200 in untreated atrial fibrillation. There are no discernible P waves. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. The ventricular rate is greater than 300 per minute and extremely irregular, without a specific pattern. The QRS shape and duration is irregular, undulating waves without recognizable QRS complexes. Ventricular tachycardia is defined as three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 727. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 727 Add a Note Question 7 See full question14sReport this Question The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? You Selected: Delayed conduction, producing a prolonged PR interval Correct response: Delayed conduction, producing a prolonged PR interval Explanation: First-degree AV block occurs when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal. Thus the PR interval is prolonged (>0.20 seconds). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, First-Degree Atrioventricular Block, p. 732. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 732 Add a Note Question 8 See full question27sReport this Question A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? You Selected: Atrial fibrillation Correct response: Ventricular fibrillation Explanation: The most common dysrhythmia in patients with cardiac arrest is ventricular fibrillation, which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles. No atrial activity is seen on the ECG. The most common cause of ventricular fibrillation is coronary artery disease and resulting acute myocardial infarction. Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a palpable pulse, and respirations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Ventricular Fibrillation, p. 730. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 730 Add a Note Question 9 See full question2m 50sReport this Question The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? You Selected: "The heart rate is between 150 to 250 bpm." Correct response: "The rhythm has a normal beat, then a premature beat pattern." Explanation: Bigeminy is a rhythm in which every other complex is a premature ventricular contraction (PVC). In trigeminy, every third complex is a PVC. The rhythm is not regular and the rate should not be 150-250 bpm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729 Add a Note Question 10 See full question1m 42sReport this Question The nurse recognizes which as being true of cardioversion? You Selected: Defibrillator should be set to deliver a shock during the QRS complex. Correct response: Defibrillator should be set to deliver a shock during the QRS complex. Explanation: Cardioversion involves the delivery of a "timed" electrical current. The defibrillator is set to synchronize with the ECG and deliver the impulse during the QRS complex. The synchronization prevents the discharge from occurring during the vulnerable period of repolarization (T wave), which could result in VT or ventricular fibrillation.

Question 1 See full question48sReport this Question A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client's blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia? You Selected: Atropine Correct response: Atropine Explanation: I.V. push atropine is used to treat symptomatic bradycardia. Dobutamine is used to treat heart failure and low cardiac output. Amiodarone is used to treat ventricular fibrillation and unstable ventricular tachycardia. Lidocaine is used to treat ventricular ectopy, ventricular tachycardia, and ventricular fibrillation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 718. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718 Add a Note Question 2 See full question40sReport this Question The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention? You Selected: Send the client to the cardiac catheterization laboratory. Correct response: Administer an IV bolus of atropine. Explanation: Atropine 0.5 mg given rapidly as an intravenous bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic second-degree heart block. The client may need to be sent to the cardiac catheterization lab for a temporary pacemaker, but atropine should be tried first. Cardioversion is used to treat a fast heart rate. Reviewing the medication record will not help the client initially. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 718. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718 Add a Note Question 3 See full question1m 10sReport this Question A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? You Selected: "I will drink coffee with only two of my meals." Correct response: "I will drink coffee with only two of my meals." Explanation: Stimulation of the sympathetic nervous system with caffeinated beverages, smoking, and drinking alcohol increases heart rate.The client is still drinking caffeine with two meals, increasing the risk for a fast heart rate. Taking medications such as metoprolol and levothyroxine will help the client maintain a normal heart rate by decreasing stimulation of the sympathetic nervous system. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Influences on Heart Rate and Contractility, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 4 See full question20sReport this Question A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: You Selected: inherent rhythmicity of cardiac muscle tissue. Correct response: inherent rhythmicity of cardiac muscle tissue. Explanation: Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The conduction system of the heart and the inherent rhythmicity of cardiac muscle produce a rhythm pattern, which greatly influences the heart's ability to pump blood effectively. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 713. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 713 Add a Note Question 5 See full question12sReport this Question A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves cannot be identified. What condition would the nurse expect the physician to diagnose? You Selected: supraventricular tachycardia Correct response: supraventricular tachycardia Explanation: Supraventricular tachycardia (SVT) is a dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (over 150 beats/minute). P waves cannot be identified on the ECG. Diastole is shortened and the heart does not have sufficient time to fill. These symptoms do not suggest sinus tachycardia, heart block, or atrial flutter. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 729. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729 Add a Note Question 6 See full question12sReport this Question A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? You Selected: Double-check the monitoring equipment. Correct response: Double-check the monitoring equipment. Explanation: One of the reasons for lack of pacemaker spikes is faulty monitoring equipment. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems, p. 743. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 743 Add a Note Question 7 See full question23sReport this Question A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? You Selected: "Spike" on the rhythm strip Correct response: "Spike" on the rhythm strip Explanation: Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pacemaker Generator Functions, p. 741. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 741 Add a Note Question 8 See full question16sReport this Question A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? You Selected: Begin cardiopulmonary resuscitation Correct response: Begin cardiopulmonary resuscitation Explanation: In the acute care setting, when ventricular fibrillation is noted, the nurse should call for assistance and defibrillate the client as soon as possible. If defibrillation is not readily available, CPR is begun until the client can be defibrillated, followed by advanced cardiovascular life support (ACLS) intervention, which includes endotracheal intubation and administration of epinephrine. Electrical cardioversion is not indicated for a client in ventricular fibrillation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 731. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 731 Add a Note Question 9 See full question29sReport this Question The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and "sawtooth" P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? You Selected: Atrial flutter Correct response: Atrial flutter Explanation: Atrial flutter occurs because of a conduction defect in the atrium and causes a rapid, regular atrial rate, usually between 250 and 400 bpm and results in P waves that are saw-toothed. Because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricle, causing a therapeutic block at the AV node. This is an important feature of this dysrhythmia. If all atrial impulses were conducted to the ventricle, the ventricular rate would also be 250 to 400 bpm, which would result in ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often occurs in patients with chronic obstructive pulmonary disease, pulmonary hypertension, valvular disease, and thyrotoxicosis, as well as following open heart surgery and repair of congenital cardiac defects (Fuster, Walsh et al., 2011). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Atrial Flutter, p. 726. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 726 Add a Note Question 10 See full question41sReport this Question The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? You Selected: Pacer rate Correct response: Pacer rate Explanation: After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.

Question 1 See full question35sReport this Question The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse? You Selected: "The doctor wants to see if your heart will switch back to its normal rhythm by itself." Correct response: "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Explanation: Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion. The doctor will not wait for a change in rhythm. Resting the heart will not change the rhythm. There is no delay but safer for the clots to be dissolved with the anticoagulant. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medications That Convert the Heart Rhythm or Prevent Atrial Fibrillation, p. 724. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 724 Add a Note Question 2 See full question15sReport this Question The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? You Selected: It is used to eliminate ventricular dysrhythmias. Correct response: It is used to eliminate ventricular dysrhythmias. Explanation: The only treatment for a life-threatening ventricular dysrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 737 Add a Note Question 3 See full question17sReport this Question The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? You Selected: Hypokalemia Correct response: Hypokalemia Explanation: PVCs can be caused by cardiac ischemia or infarction, increased workload on the heart (eg, exercise, fever, hypervolemia, heart failure, tachycardia), digitalis toxicity, acidosis, or electrolyte imbalances, especially hypokalemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Premature Ventricular Complex, p. 729. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 729 Add a Note Question 4 See full question17sReport this Question The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? You Selected: The registered nurse administering atropine sulfate intravenously Correct response: The registered nurse administering atropine sulfate intravenously Explanation: The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases without nursing intervention or administering additional medications until the imminent concern is addressed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Medical Management, p. 718. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718 Add a Note Question 5 See full question14sReport this Question Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? You Selected: Anticoagulant Correct response: Anticoagulant Explanation: Clients with persistent atrial fibrillation are prescribed anticoagulation therapy to reduce the risk of emboli formation associated with ineffective circulation. The other options may be prescribed but not expected in most situations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Pharmacologic Therapy, p. 724. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 724 Add a Note Question 6 See full question31sReport this Question The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? You Selected: A client with atrial dysrhythmias Correct response: A client with atrial dysrhythmias Explanation: The nurse is correct to identify a client with atrial dysrhythmias as a candidate for cardioversion. The goal of cardioversion is to restore the normal pacemaker of the heart, as well as, normal conduction. A client with a myocardial infarction has tissue damage. The client with poor perfusion has circulation problems. The client with heart block has an impairment in the conduction system and may require a pacemaker. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Cardioversion and Defibrillation, p. 737. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 737 Add a Note Question 7 See full question13sReport this Question A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? You Selected: Document the findings and continue to monitor the client Correct response: Document the findings and continue to monitor the client Explanation: Capture is a term used to denote that the appropriate complex is followed by the pacing spike. In this instance, the patient's temporary pacemaker is functioning appropriately; all Ps wave followed by an atrial pacing spike. The nurse should document the findings and continue to monitor the client. Repositioning the client, placing the client on the left side, checking the security of all connections, and increasing the milliamperage are nursing interventions used when the pacemaker has a loss of capture. Obtaining a 12-lead ECG and chest x-ray are indicated when there is a loss of pacing-total absence of pacing spikes or when there is a change in pacing QRS shape. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 741. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 741 Add a Note Question 8 See full question15sReport this Question A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client's heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of You Selected: embolic stroke. Correct response: embolic stroke. Explanation: Intervention is implemented to prevent the development of an embolic event/stroke. Clients with a history of previous stroke, transient ischemic attack (TIA), embolic event, mitral stenosis, or prosthetic heart valve and who develop atrial fibrillation are at significant risk of developing an embolic stroke. Antithrombotic therapy is indicated for all clients with atrial fibrillation, especially those at risk of an embolic event, such as a stroke, and it is the only therapy that decreases cardiovascular mortality. These client are often placed on warfarin, in contrast to clients who have no risk factors, and who are often prescribed 81 to 325 mg of aspirin daily. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, p. 722. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 722 Add a Note Question 9 See full question46sReport this Question The nurse reads an athletic client's electrocardigram. What finding will be consistent with a sinus bradycardia? You Selected: PR interval of 0.24 seconds. Correct response: Heart rate of 42 beats per minute (bpm). Explanation: The heart rate of 42 bpm is slow but normal when it occurs in athletes with a sinus bradycardia. The PR interval is prolonged at 0.24 seconds, indicating a heart block. The QR interval is prolonged and indicates ventricular delay.The ratio of P to QR should be 1:1 in sinus bradycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems, Normal Sinus Rhythm, p. 718. Chapter 26: Management of Patients with Dysrhythmias and Conduction Problems - Page 718 Add a Note Question 10 See full question29sReport this Question The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm below. What dysthymia should the nurse document? You Selected: idioventricular rhythm Correct response: ventricular fibrillation Explanation: The dysrhythmia is ventricular fibrillation because it is a rapid rhythm with no organization. This dysrhythmia causes ventricles to quiver and there is no atrial activity on the ECG. Atrial flutter will have atrial rate ranges between 250 and 400 bpm, ventricular rate between 75 and 150 bpm. The QRS shape and duration are usually normal, but may be abnormal or absent. The P-wave will be saw-toothed in shape. The PR-interval may be difficult to determine. Sinus Bradycardia will have a ventricular and atrial rate of less than 60 bpm. The ventricular and atrial rhythm will be regular. The QRS shape and duration is usually normal, but may be regularly abnormal. The P-wave will be normal and consistent in shape. The PR interval will have an interval between 0.12 and 0.20 seconds. Idioventricular rhythm will have a ventricular rate between 20 and 40 bpm. The ventricular rhythm will be regular. The QRS shape and duration will be abnormal shape, bizarre, and will have a duration of 0.12 seconds or more. Sinus rhythm with third-degree atrioventricular block will have a ventricular and atrial rhythm with a PP interval that is regular and the RR interval that is regular. The PP interval is not equal to the RR interval. The QRS shape and duration will depend on the escape rhythm. With junctional rhythm, the QRS shape and duration are usually normal; with an idioventricular rhythm, the QRS shape and duration are usually abnormal. The P-wave will depend on the underlying rhythm. The PR interval is very irregular. The P:QRS ratio will show more P-waves than QRS complexes.