Wagner Chapter 9

A patient has been diagnosed with premature ventricular contractions. The nurse realizes that this dysrhythmia can result from a weaker than normal stimulus during which action potential period? 1. Absolute refractory period 2. Relative refractory period 3. Supranormal period 4. Subnormal period

3 During the supranormal period a weaker than normal stimulus can produce depolarization and can result in premature ventricular contractions.

A patient has a new onset of a left bundle branch block (LBBB) seen on a 12-lead ECG. What is the nurse's primary intervention? 1. Increase oxygen. 2. Elevate the head of the bed to a 30-degree angle. 3. Ask the patient if he is having chest pain. 4. Reposition the chest leads and assess for any changes.

3 New onset LBBB may indicate a myocardial infarction (MI) is occurring. The priority intervention is to assess for chest pain or other findings associated with MI.

The nurse has determined that the patient has a bundle branch block. Which condition likely exists? 1. A PR interval longer than 0.20 seconds 2. An elevated ST segment 3. A QRS segment longer than 0.12 seconds 4. A PR interval that lengthens with each beat

3 The QRS complex should be 0.12 seconds or less in length unless there is a delay in the impulse reaching the ventricles. A widened QRS complex means delayed conduction through the bundle branches or a bundle branch block, abnormal conduction within the ventricles, or early activation of the ventricles through a bypass route.

A patient's admission vital signs were blood pressure 128/64 mmHg; heart rate 86 beats per minute, respirations 16, and temperature 98.6°F. The patient has spiked a temperature of 101.6°F. Which change in heart rate would the nurse anticipate? 1. Increase to 116 beats per minute 2. Increase to 100 beats per minute 3. Decrease to 76 beats per minute 4. Increase or decrease of no more than 5 beats per minute

1 Hyperthermia increases electrical activity of the heart. Heart rate increases about 10 beats per minute for each degree Fahrenheit. This patient's temperature has elevated by 3 degrees F, so a 30 beats per minute increase to 116 would be expected.

A patient's electrocardiogram ST segment tracing is deflected from baseline. The nurse would conduct assessment for which condition? 1. Ventricular muscle injury 2. Atrial muscle injury 3. Respiratory acidosis 4. Hypocalcemia

1 The ST segment represents the completion of ventricular depolarization and the beginning of ventricular repolarization. The segment should be isoelectric, or consistent with the baseline. There should be no deflections present because positive and negative charges are balanced. Deflections in the ST segment usually indicate ventricular muscle injury.

A patient's cardiac monitor reveals heart rate of 40 beats per minute with an irregular rate. The PR intervals are constant and there are P waves with no QRS to follow. The QRS complexes are wider than normal. The patient complains of severe dizziness and nausea. Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer atropine. 2. Prepare to cardiovert the patient. 3. Prepare for placement of a temporary pacemaker. 4. Administer epinephrine. 5. Ask the patient to cough forcefully.

1,3,4 This rhythm represents Mobitz type II second-degree atrioventricular (AV) block and the patient is symptomatic. Atropine is indicated. This rhythm is a Mobitz type II second-degree block and the patient is symptomatic. Type II second-degree blocks are generally treated by inserting a pacemaker. Dopamine or epinephrine is used in severe symptomatic bradycardia like the patient is experiencing.

A patient is diagnosed with hypermagnesemia. The nurse would assess for which changes on the patient's cardiac rhythm strip? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Prolonged QT interval 2. Tachycardia 3. Narrow, upright QRS 4. Atrioventricular (AV) block 5. Prolonged PR interval

1,4,5 Hypermagnesemia can prolong the QT interval. AV block can result from high magnesium levels. Hypermagnesemia can result in lengthening of the PR interval.

A patient is having multifocal premature ventricular contractions (PVCs). What nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer oxygen. 2. Withhold the next digoxin dose. 3. Administer atropine. 4. Monitor the patient closely for other dysrhythmias. 5. Consult with the healthcare provider.

1,4,5 Hypoxemia can cause PVCs. The nurse should implement emergency orders for oxygen therapy. Multifocal PVCs may herald additional dysrhythmias such as ventricular tachycardia or ventricular fibrillation. Presence of multifocal PVCs indicates increased ventricular irritability. The nurse should contact the healthcare provider and discuss treatment options, such as adding medications.

A patient's atrial fibrillation has been refractory to treatment. The nurse would prioritize which discharge instructions? 1. Avoiding stressful situations 2. Anticoagulant therapy precautions 3. The importance of daily weights 4. How to check blood pressure at home

2 Patients in atrial fibrillation require anticoagulation such as warfarin therapy. The nurse must provide instructions regarding precautions that are made necessary by this therapy.

A patient in the emergency department has a heart rate of 140 beats per minute. Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assess the patient's temperature. 2. Administer atropine. 3. Present a calm demeanor. 4. Assess the patient for pain. 5. Prepare for intubation.

1,3,4 Increased temperature can result in tachycardia. Anxiety can result in tachycardia. The nurse should present a calm and confident demeanor. Pain can result in tachycardia. If pain is present it should be treated promptly.

A patient has a normal QRS complex on an electrocardiogram, which is followed by the P wave. Heart rate is 80 beats per minute and regular and the patient has no complaints. What nursing action is indicated? 1. Document presence of atrial escape rhythm. 2. Review the patient's medication history. 3. STAT page the patient's healthcare provider. 4. Notify the nurse manager that it may become necessary to call the rapid response team.

2 Junctional rhythm may be caused by several medications. The nurse should review the medication list for possible causative drugs.

A patient presents to the emergency department and says, "I am so dizzy that it is scaring me." Monitoring reveals the patient's blood pressure is 78/52 mmHg and heart rate is 44 beats per minutes. Which nursing intervention is indicated? 1. Administer antianxiety medication. 2. Administer atropine. 3. Instruct the patient to cough forcefully. 4. Monitor the patient while contacting the primary care provider.

2 Sinus bradycardia is not treated unless the person experiences symptoms of decreased cardiac output, such as syncope, hypotension, and angina. Symptomatic sinus bradycardia is treated by administering atropine because it blocks the parasympathetic innervation to the sinoatrial (SA) node, allowing normal sympathetic innervation to gain control and increase SA node firing. The patient is symptomatic so atropine is indicated.

The nurse interpreting a patient's electrocardiogram has just examined the P waves. What is the nurse's next step? 1. Determine if each P wave is followed by a QRS complex. 2. Measure the PR interval. 3. Diagnose the rhythm. 4. Examine and measure the QRS complex.

2 The next structure of importance in the rhythm is the PR interval. The nurse should measure its length.

A patient's cardiac monitor frequently sounds false rate alarms. Which nursing intervention is indicated? 1. Ask the patient to lie still. 2. Adjust the high and low rates on the alarm. 3. Shut the room door so the alarm will not disturb other patients. 4. Set the alarms on silent.

2 The nurse should adjust the alarms to save levels slightly above and slightly below the patient's average heart rate.

A patient in the emergency department has a cardiac rhythm strip that reveals a junctional rhythm with rate of 128, PR interval of 0.08 seconds, a normally configured QRS, and an upright T wave. The patient is awake and alert with warm, dry skin. Which nursing intervention is indicated? 1. Prepare for immediate cardioversion 2. Immediate notification of the rapid response team 3. Continued monitoring and assessment 4. Administration of potassium by slow intravenous infusion

3 As long as this patient is stable, no immediate interventions are indicated. The nurse should continue to monitor the patient.

A patient has been prescribed flecainide (Tambocor) for treatment of ventricular dysrhythmia. Which finding should the nurse discuss with the prescriber prior to initiating this therapy? 1. The patient has lost 6 pounds since hospital admission. 2. The patient experienced nausea while taking digoxin (Lanoxin) many years ago. 3. The patient's urine output was 20 mL over the last hour. 4. The patient's potassium level is 4.8 mEq/dL this morning.

4 Flecainide is a class 1C sodium channel blocker and may increase plasma level of potassium. This patient's potassium is already high normal. There is no strict contraindication to the use of flecainide, but the nurse and prescriber must carefully monitor potassium levels.

A patient develops ventricular tachycardia on the cardiac monitor. The patient says, "My heart is racing" as the nurse determines a rapid pulse is present. What is the nurse's priority intervention? 1. Call respiratory therapy to prepare a mechanical ventilator. 2. Draw blood for arterial blood gases. 3. Prepare for a change in intravenous fluid being administered. 4. Monitor the patient for loss of consciousness.

4 Patients can be alert while experiencing ventricular tachycardia; however, as cardiac output falls, a loss of consciousness may occur. When this occurs, cardioversion may be necessary. The nurse's priority is to assess the patient.

A patient's cardiac monitor reveals a regular rhythm with a rate of 240 beats per minute. No P waves are distinguishable. The patient is alert and says, "My heart is racing." What nursing intervention is indicated? 1. Gather equipment to begin anticoagulant therapy. 2. Defibrillate the patient. 3. Prepare the patient for immediate cardioversion. 4. Ask the patient to bear down as if moving the bowels.

4 This patient has supraventricular tachycardia. This rhythm can be treated with Valsalva's maneuver, which is elicited by having the patient bear down as if moving the bowels.