Test 2 Cardiac
A patient the nurse is caring for has a permanent pacemaker implanted with the identification code beginning with VVI. What does this indicate? A)Ventricular paced, ventricular sensed, inhibited B)Variable paced, ventricular sensed, inhibited C)Ventricular sensed, ventricular situated, implanted D)Variable sensed, variable paced, inhibited
A Feedback: The identification of VVI indicates ventricular paced, ventricular sensed, inhibited.
The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do? A)Maintain firm contact between paddles and patient skin. B)Apply a layer of water as a conducting agent. C)Call "all clear" once before discharging the defibrillator. D)Ensure the defibrillator is in the sync mode.
A Feedback: When defibrillating an adult patient, the nurse should maintain good contact between the paddles and the patient's skin to prevent arcing, apply an appropriate conducting agent (not water) between the skin and the paddles, and ensure the defibrillator is in the nonsync mode. "Clear" should be called three times before discharging the paddles.
When preparing to defibrillate a patient. In which order will the nurse perform the following steps? (Put a comma and a space between each answer choice [A, B, C, D, E].) a. Turn the defibrillator on. b. Deliver the electrical charge. c. Select the appropriate energy level. d. Place the paddles on the patient's chest. e. Check the location of other staff and call out "all clear."
A, C, D, E, B This order will result in rapid defibrillation without endangering hospital staff.
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac rhythm as a.atrial flutter. b.sinus tachycardia. c.ventricular fibrillation. d.ventricular tachycardia.
ANS: D The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.
A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a.notify the health care provider immediately. b.give atropine per agency dysrhythmia protocol. c.prepare the patient for temporary pacemaker insertion. d.document the finding and continue to monitor the patient.
ANS: D First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? A)P wave B)T wave C)QRS complex D)U wave
C Feedback:the QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.
A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take? a.Perform synchronized cardioversion. b.Start cardiopulmonary resuscitation (CPR). c.Administer atropine per agency dysrhythmia protocol. d.Provide supplemental oxygen via non-rebreather mask.
ANS: B The patient's clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.
Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as a telemetry technician on the cardiac care unit? a.Decide whether a patient's heart rate of 116 requires urgent treatment. b.Monitor a patient's level of consciousness during synchronized cardioversion. c.Observe cardiac rhythms for multiple patients who have telemetry monitoring. d.Select the best lead for monitoring a patient admitted with acute coronary syndrome.
ANS: C UAP serving as telemetry technicians can monitor cardiac rhythms for individuals or groups of patients. Nursing actions such as assessment and choice of the most appropriate lead based on ST segment elevation location require RN-level education and scope of practice.
A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine? A)Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. B)Administer atropine as a continuous infusion until symptoms resolve. C)Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours. D)Administer atropine 1.0 mg sublingually.
A Feedback: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate.
The nurse is caring for a patient who has had an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. How should the nurse best respond? A)Recognize that the view of the electrical current changes in relation to the lead placement. B)Recognize that the electrophysiological conduction of the heart differs with lead placement. C)Inform the technician that the ECG equipment has malfunctioned. D)Inform the physician that the patient is experiencing a new onset of dysrhythmia.
A Feedback: Each lead offers a different reference point to view the electrical activity of the heart. The lead displays the configuration of electrical activity of the heart. Differences between leads are not necessarily attributable to equipment malfunction or dysrhythmias.
The nurse and the other members of the team are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated unsuccessfully and the patient remains in VF. According to national standards, the nurse should anticipate the administration of what medication? A)Epinephrine 1 mg IV push B)Lidocaine 100 mg IV push C)Amiodarone 300 mg IV push D)Sodium bicarbonate 1 amp IV push
A Feedback: Epinephrine should be administered as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and licocaine are given if ventricular dysrhythmia persists.
A patient is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurse's responsibility in the care of the patient's pacemaker? A)Monitoring for pacemaker malfunction or battery failure B)Determining when it is appropriate to remove the pacemaker C)Making necessary changes to the pacemaker settings D)Selecting alternatives to future pacemaker use
A Feedback: Monitoring for pacemaker malfunctioning and battery failure is a nursing responsibility. The other listed actions are physician responsibilities.
A patient who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response? A)"To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia" B)"To detect and treat bradycardia, which is an excessively slow heart rate" C)"To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently" D)"To shock your heart if you have a heart attack at home"
A Feedback: The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia.
A nurse is caring for a patient who is exhibiting ventricular tachycardia (VT). Because the patient is pulseless, the nurse should prepare for what intervention? A)Defibrillation B)ECG monitoring C)Implantation of a cardioverter defibrillator D)Angioplasty
A Feedback:Any type of VT in a patient who is unconscious and without a pulse is treated in the same manner as ventricular fibrillation: Immediate defibrillation is the action of choice. ECG monitoring is appropriate, but this is an assessment, not an intervention, and will not resolve the problem. An ICD and angioplasty do not address the dysrhythmia.
The nurse is caring for a patient who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment? A)Cardiac monitoring B)Monitoring the implanted device signal C)Pain assessment D)Monitoring the patient's level of consciousness (LOC)
A Feedback:Following catheter ablation therapy, the patient is closely monitored to ensure the dysrhythmia does not reemerge. This is a priority over monitoring of LOC and pain, although these are valid and important assessments. Ablation does not involve the implantation of a device.
Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin? a.Instruct the patient to call for assistance before getting out of bed. b.Explain the association between various dysrhythmias and syncope. c.Educate the patient about the need to avoid caffeine and other stimulants. d.Tell the patient about the benefits of implantable cardioverter-defibrillators.
ANS: A A patient with fainting episodes is at risk for falls. The nurse will plan to minimize the risk by having assistance whenever the patient up. The other actions may be needed if dysrhythmias are found to be the cause of the patient's syncope, but are not appropriate for syncope of unknown origin.
Which action by a new registered nurse (RN) who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias? a.Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia b.Obtains the defibrillator and quickly brings it to the bedside of a patient whose monitor shows asystole c.Turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation d.Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second degree AV block
ANS: A Adenosine must be given over 1 to 2 seconds to be effective. The other actions indicate a need for more education about treatment of cardiac dysrhythmias. The RN should hold the diltiazem until talking to the health care provider. The treatment for asystole is immediate CPR. The synchronizer switch should be "off" when defibrillating.
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. The priority teaching needed for this patient would include information about a.anticoagulant therapy. b.permanent pacemakers. c.electrical cardioversion. d.IV adenosine (Adenocard).
ANS: A Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria. Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information does not indicate that the patient has a slow heart rate.
Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs? a.The nurse assists the patient to do active range of motion exercises for all extremities. b.The nurse assists the patient to fill out the application for obtaining a Medic Alert ID. c.The nurse gives amiodarone (Cordarone) to the patient without first consulting with the health care provider. d.The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.
ANS: A The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.
A 19-year-old student comes to the student health center at the end of the semester complaining that, "My heart is skipping beats." An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take next? a.Start supplemental O2 at 2 to 3 L/min via nasal cannula. b.Ask the patient about current stress level and caffeine use. c.Ask the patient about any history of coronary artery disease. d.Have the patient taken to the hospital emergency department (ED).
ANS: B In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.
Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg? a.Turn the synchronizer switch to the "off" position. b.Give a sedative before cardioversion is implemented. c.Set the defibrillator/cardioverter energy to 360 joules. d.Provide assisted ventilations with a bag-valve-mask device
ANS: B When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned "on" for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this patient.
A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a.Obtain a 12-lead electrocardiogram (ECG). b.Notify the health care provider of the change in rhythm. c.Give supplemental O2 at 2 to 3 L/min via nasal cannula. d.Assess the patient's vital signs including oxygen saturation.
ANS: C Because this patient has dyspnea and chest pain in association with the new rhythm, the nurse's initial actions should be to address the patient's airway, breathing, and circulation (ABC) by starting with oxygen administration. The other actions also are important and should be implemented rapidly.
Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a.Blood glucose 243 mg/dL b.Serum chloride 92 mEq/L c.Serum sodium 134 mEq/L d.Serum potassium 2.9 mEq/L
ANS: D Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the patient's PVCs and do not require immediate correction.
A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next? a.Immediately notify the health care provider. b.Document the rhythm and continue to monitor the patient. c.Perform synchronized cardioversion per agency dysrhythmia protocol. d.Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.
ANS: D The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The nurse should notify the health care provider after the medication is started. Defibrillation is not indicated given that the patient is currently in a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.
The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first? a.A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago b.A patient with new onset atrial fibrillation, rate 88, who has a first dose of warfarin (Coumadin) due c.A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating d.A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due
ANS: D The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.
A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which actions should the nurse take next? a.Recheck the heart rhythm and BP in 5 minutes b.Have the patient perform the Valsalva maneuver. c.Give the scheduled dose of diltiazem (Cardizem). d.Apply the transcutaneous pacemaker (TCP) pads.
ANS: D The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva maneuver will further decrease the rate.
After providing a patient with discharge instructions on the management of a new permanent pacemaker, the nurse knows that teaching has been effective when the patient states a."I will avoid cooking with a microwave oven or being near one in use." b."It will be 1 month before I can take a bath or return to my usual activities." c."I will notify the airlines when I make a reservation that I have a pacemaker." d."I won't lift the arm on the pacemaker side up very high until I see the doctor."
ANS: D The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period.
A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the main goal of treatment is what? A)Decrease SA node conduction B)Control ventricular heart rate C)Improve oxygenation D)Maintain anticoagulation
B Feedback: Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. This is a priority because it directly affects cardiac output. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice, followed by anticoagulation with heparin and then Coumadin.
A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient? A)Chest pain B)Bleeding at the implantation site C)Malignant hyperthermia D)Bradycardia
B Feedback:Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.
The nurse caring for a patient whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this patient? A)Implanted pacemaker B)Trancutaneous pacemaker C)ICD D)Asynchronous defibrillator
B Feedback: If a patient suddenly develops a bradycardia, is symptomatic but has a pulse, and is unresponsive to atropine, emergency pacing may be started with transcutaneous pacing, which most defibrillators are now equipped to perform. An implanted pacemaker is not a time-appropriate option. An asynchronous defibrillator or ICD would not provide relief.
The ED nurse is caring for a patient who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform? A)Place gel pads over the apex and posterior chest for better conduction. B)Ensure no one is touching the patient at the time shock is delivered. C)Continue to ventilate the patient via endotracheal tube during the procedure. D)Allow at least 3 minutes between shocks.
B Feedback: In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads, or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patient's skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation.
The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patient's heart? A)P wave B)T wave C)U wave D)QRS complex
B Feedback:The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show? A)PP interval and RR interval are irregular. B)PP interval is equal to RR interval. C)Fewer QRS complexes than P waves D)PR interval is constant.
C Feedback:In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis.
The nurse is caring for a patient who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output? A)Increased blood pressure B)Bounding peripheral pulses C)Changes in level of consciousness D)Skin flushing
C Feedback: The nurse conducts a physical assessment to confirm the data obtained from the history and to observe for signs of diminished cardiac output (CO) during the dysrhythmic event, especially changes in level of consciousness. Blood pressure tends to decrease with lowered CO and bounding peripheral pulses are inconsistent with this problem. Pallor, not skin flushing, is expected.
The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient? A)Maintain a resting heart rate below 70 bpm. B)Maintain adequate control of chest pain. C)Maintain adequate cardiac output. D)Maintain normal cardiac structure.
C Feedback:For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient? A)Start lifting the arm above the shoulder right away to prevent chest wall adhesion. B)Avoid cooking with a microwave oven. C)Avoid exposure to high-voltage electrical generators. D)Avoid walking through store and library antitheft devices.
C Feedback:High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function.
The nurse is caring for a patient on telemetry. The patient's ECG shows a shortened PR interval, slurring of the initial QRS deflection, and prolonged QRS duration. What does this ECG show? A)Sinus bradycardia B)Myocardial infarction C)Lupus-like syndrome D)Wolf-Parkinson-White (WPW) syndrome
D Feedback: In WPW syndrome there is a shortened PR interval, slurring (called a delta wave) of the initial QRS deflection, and prolonged QRS duration. These characteristics are not typical of the other listed cardiac anomalies.
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement? A)Clean the skin with providone-iodine solution. B)Ensure that the area for electrode placement is dry. C)Apply tincture of benzoin to the electrode sites and wait for it to become "tacky." D)Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
D Feedback: An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. Disinfecting the skin is unnecessary and conduction gel is used.
A nurse is providing health education to a patient scheduled for cryoablation therapy. The nurse should describe what aspect of this treatment? A)Peeling away the area of endocardium responsible for the dysrhythmia B)Using electrical shocks directly to the endocarduim to eliminate the source of dysrhythmia C)Using high-frequency sound waves to eliminate the source of dysrhythmia D)Using a cooled probe to eliminate the source of dysrhythmia
D Feedback: Cryoablation therapy involves using a cooled probe to create a small scar on the endocardium to eliminate the source of the dysrhythmias. Endocardium resection involves peeling away a specified area of the endocardium. Electrical ablation involves using shocks to eliminate the area causing the dysrhythmias. Radio frequency ablation uses high-frequency sound waves to destroy the area causing the dysrhythmias.
Following cardiac resuscitation, a patient has been placed in a state of mild hypothermia before being transferred to the cardiac intensive care unit. The nurse's assessment reveals that the patient is experiencing neuromuscular paralysis. How should the nurse best respond? A)Administer hypertonic IV solution. B)Administer a bolus of warned normal saline. C)Reassess the patient in 15 minutes. D)Document this as an expected assessment finding.
D Feedback: The nurse caring for a patient with hypothermia (passive or induced) needs to monitor for appropriate level of cooling, sedation, and neuromuscular paralysis to prevent seizures; myoclonus; and shivering. Neuromuscular paralysis is an expected finding and does not necessitate further interventions.
