Patient Care Dysrhythmias Study Guide

How does the nurse interpret a client's telemetry ECG strip that shows four successive premature ventricular contractions ( PVCs ) ?

The client had an episode of non-sustained ventricular tachycardia ( NSVT )

How would the nurse best interpret the electro- cardiogram ( ECG ) of a younger athletic client which shows sinus bradycardia with a rate of 54 beats / min ?

The sinus bradycardia provides an adequate stroke volume that is associated with cardiac conditioning

Which condition is indicated when the nurse notes ST segment elevation or one to two small blocks on a client's ECG ?

Myocardial injury or ischemia

What does the nurse determine is the client's heart rate when assessing a 6 - second telemetry ECG strip with five QRS complexes ?

50 beats / min , bradycardia

Which ECG strip pattern is evidence to the nurse that a client's temporary transvenous pacemaker has successfully depolarized the ventricles ?

A pacer spike followed by a QRS complex

Where will the nurse place the leads on a client for a five - lead continuous monitoring system ? Select all that apply. A. Right arm electrode just below the right clavicle B. Left arm electrode just below the left clavicle C. Right leg electrode on the highest palpable rib , on the right midclavicular line D. Left leg electrode on the lowest palpable rib , on the left midclavicular line. E. Fifth electrode placed to obtain one of the six chest leads F. Left arm electrode just above the left clavicle

ABDE

Which ECG waveforms and intervals are the normal measurements or positions ? Select all that apply . A. PR interval 0.12-0.20 second B. QRS complex 0.06-0.10 second C. PR segment isoelectric line D. QT interval less than half of the R to R interval E. U wave follows T wave if present F. TP segment one block above isoelectric line

ABCDE

Which signs and symptoms would the nurse expect to assess in a client with sinus tachycardia ? Select all that apply . A. Fatigue B. Shortness of breath C. Decreased oxygen saturation D. Decreased blood pressure E. Anginal pain F. Widened QRS complexes

ABCDE

Which causes would the nurse recognize as leading to increased atrial irritability and pre- mature atrial contractions ( PACS ) in a client's myocardium ? Select all that apply . A. Caffeine intake B. Anxiety C. Syncope D. Stress in life E. Infection F. Pulmonary hypotension

ABDE

Which important teaching points would the nurse discuss with a client who receives a new permanent pacemaker ? Select all that apply . A. Report any pulse rate that is lower than the rate set on the pacemaker . B. Avoid sources of strong electromagnetic fields such as magnets . C. If the surgical incision is near the shoulder , be sure to perform daily range of motion . D. Carry a pacemaker identification card and wear a medical alert bracelet . E. Avoid tight clothing to prevent pressure over the pacemaker generator . F. It is safe to go through airport security because the pacemaker will not set off the alarms .

ABDE

Which actions are essential nursing care for a client immediately after elective cardioversion ? Select all that apply . A. Administer oxygen . B. Assess vital signs and level of consciousness C. Provide sips of water or ice chips D. Monitor for dysrhythmias . E. Maintain an open airway. F. Document the results of the cardioversion

ABDEF

Which actions would the nurse take when the monitor technician states that a client's telemetry ECG signal transmission is not very clear ? Select all that apply . A. Ensure that the gel on each electrode is moist and fresh . B. Clean the skin and clip hairs if necessary . C. Abrade the skin by rubbing briskly with a rough washcloth . D. Make sure that the skin is free of lotion or any other substance . E. Clean the skin with povidone - iodine before applying electrodes F. Check to be sure that electrodes are not placed over scar tissue .

ABDF

Which questions would the nurse use to assess a client's P wave on an ECG rhythm strip ? Select all that apply . A. Do all P waves look similar ? B. Are P waves present ? C. Does one P wave follow each QRS complex ? D. Are P waves occurring regularly ? E. Are the P waves greater than 0.20 second ? F. Are P waves smooth , rounded , and upright ?

ABDF

Which actions are responsibilities of the monitor technician ? Select all that apply . A. Report client rhythm and significant changes to the nurse . B. Notify the health care provider of any pertinent changes . C. Print routine ECG strips for each monitored client . D. Apply battery - operated transmitter leads to clients . E. Watch the bank of cardiac monitors on a client care unit . F. Interpret rhythm strips for each monitored client .

ACEF

Which are nursing responsibilities for the care of a client with a newly implanted permanent pacemaker ? Select all that apply . A. Assess the implantation site for bleeding , swelling , redness , tenderness , or infection . B. Administer short - acting sedatives as needed and prescribed . C. Monitor the ECG rhythm strip to ensure that the pacemaker is working correctly . D. Observe for overstimulation of the chest wall , which might cause pneumothorax . E. Assess that the implantation site dressing is clean and dry . F. Teach the client about initial activity restrictions .

ACEF

Which conditions would the nurse suspect when a client's telemetry ECG rhythm strip shows ST elevation of 1.5 mm ( 1.5 small blocks ) ? Select all that apply . A. Pericarditis B. Hypokalemia C. Myocardial infarction D. Ventricular hypertrophy E. Endocarditis F. Hyperkalemia

ACF

What is the priority action for the nurse when the monitor technician states that a client's telemetry monitor shows a rhythm that appears as a wandering or fuzzy baseline ?

Assess the client to differentiate artifact from an actual lethal rhythm

To determine if a client has a pulse deficit , what procedure would the nurse follow ?

Assess the apical and radial pulses for a full minute and calculate the difference

Which would be the best method for the nurse to confirm a report from the monitor technician about a change in a monitored client's heart rate ?

Assess the client's heart rate directly by checking the apical pulse

Which normal heart rates does the nurse expect to be initiated by the primary pacemaker of the heart ( SA Node ) in clients when the heart rate is regular ? Select all that apply . A. 55 beats / min B. 62 beats / min C. 74 beats / min D. 86 beats / min E. 98 beats / min F. 110 beats / min

BCDE

Which statements about permanent pacemakers are accurate ? Select all that apply A. Permanent pacemakers are powered by lithium batteries that last over 20 years . B. Permanent pacemakers are available as pacemaker / defibrillator devices . C. Biventricular pacemakers allow up synchronized depolarization of the ventricles . D. Permanent pacemakers are used to treat disorders such as complete heart block. E. A client with a new pacemaker should avoid lifting his or her arm over the head for at least 6 months . F. The pulse generator for a permanent pacemaker is usually implanted in the left subclavian area .

BCDF

Which risk factors for atrial fibrillation would the nurse monitor for in client ? Select all that apply . A. Peripheral vascular disease B. Hypertension C. Chronic obstructive pulmonary disease D. Diabetes mellitus E. Excessive alcohol intake F. Mitral valve disease

BDEF

Which descriptions are characteristics of Class III antidysrhythmic drugs ? Select all that apply . A. Increase force of contraction B. Lengthen absolute refractory period C. Include hypertension as a side effect for some drugs D. Include bradycardia as a side effect for some drugs E. Prolong QT interval F. Prolong repolarization

BDF

After calling for help , when the nurse finds a client in his or her room without a pulse , apneic and unconscious , which action should be taken next ?

Begin cardiac compressions

For which cardiac dysrhythmia ( s ) would an automatic external defibrillator ( AED ) instruct the nurse to immediately defibrillate an unconscious client at an outpatient clinic ? Select all that apply . A. Paroxysmal supraventricular tachycardia B. Pulseless electrical activity C. Ventricular fibrillation D. Pulseless ventricular tachycardia E. Non-sustained ventricular tachycardia F. Atrial fibrillation with rapid ventricular response

CD

Which nursing actions have priority when a client with acute supraventricular tachycardia ( SVT ) is to be administered adenosine by the health care provider ? Select all that apply . A. Have injectable beta - blocker drugs at the bedside . B. Give the drug slowly over 1-2 minutes . C. Ensure that emergency equipment is at the bedside . D. Follow the drug injection with a normal saline bolus . E. Monitor the client for bradycardia , nausea , and vomiting . F. Prepare for synchronized cardioversion after giving the adenosine

CDE

Which criteria support the nurse's assessment that a client's ECG rhythm strip shows a nor- mal sinus rhythm ( NSR ) ? A. PR interval is 0.24 second . B. Atrial and ventricular rates are 58 beats / min . C. Atrial and ventricular rates are regular . D. P waves are present before every QRS complex . E. QRS duration is consistent at 0.08 second F. Atrial and ventricular rates are 82 beats / min .

CDEF

When would the telemetry unit nurse use temporary transcutaneous pacing for a client ? Select all that apply . A. Only when a client's ECG shows a brady dysrhythmia and the client is asymptomatic B. When a client's ECG strip shows atrial fibrillation with a rapid ventricular response C. Only as a temporary emergency measure until invasive pacing method can be started D. When a client is experiencing syncope , dizziness and fainting E. Only until the client's heart rhythm returns to normal F. When invasive pacing is not immediately available

CEF

Which client assessment takes priority when the nurse begins his or her shift ?

Client with atrial fibrillation and sustained rapid ventricular response

Which safety precaution must be taken before defibrillating a client with ventricular fibrillation ( VF ) ?

Command all health care team members to stand clear of the client's bed

What is the first step when the e nurse analyzes a client's ECG rhythm strip ?

Determine the heart rate

Caffeine To best perform a 12 - lead ECG on a client , how does the nurse place the leads on the client ?

Four leads are placed on the limbs and six are placed on the chest

Which procedure would the nurse provide teaching about to a client who has chronic atrial fibrillation and is at increased risk for a stroke , but is not a candidate for anticoagulation ?

Left atrial appendage ( LAA ) occlusion

Which drug does the nurse prepare to administer to a client diagnosed with the dysrhythmia torsade's de pointes ?

Magnesium sulfate

Which waveform does the nurse recognize as atrial depolarization when a client is placed on a cardiac monitor ?

P wave

Which priority concept does the nurse focus on when a client is diagnosed with a dysrhythmia ?

Perfusion

Which serum electrolyte would the nurse check after noting tall and peaked T waves on a client's ECG ?

Potassium

What does the nurse suspect when assessing a client's telemetry ECG strip and noting a wide distorted QRS complex of 0.14 second followed by a P wave ?

Premature ventricular complex followed by atrial contraction

Which definition best describes the electro- physiologic property called automaticity of myocardial pacemaker cells ?

The ability of cardiac cells to generate an electrical impulse spontaneously and repetitively

What effect does the nurse expect a Class IV drug to have on a client's cardiac conduction system ?

Slow the flow of calcium into the cell during depolarization to depress automaticity

Which beta - blocker drug approved for treating dysrhythmias is also a Class III antidysrhythmic drug ?

Sotalol

Which dysrhythmia does the nurse consider life threatening because it causes the ventricles to quiver and results in the absence of cardiac output for a client ?

Ventricular fibrillation

When a client has been in atrial fibrillation for 3 days and is scheduled for an elective cardio- version , what priority teaching does the nurse provide to the client ?

Watch for any sign of bleeding and report this to your health care provider