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Unit 8: CH 35 Dysrthymias Medsure 2

Terms in this set (31)

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patient
a.
P wave.
b.
Q wave.
c.
P-R interval.
d.
QRS complex.
a.
P wave.
SN: The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers. The QRS represents ventricular depolarization. The Q wave is the first negative deflection following the P wave and should be narrow and short.
The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use?
a.
Count the number of large squares in the R-R interval and divide by 300.
b.
Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes.
c.
Calculate the number of small squares between one QRS complex and the next and divide into
1500.
d.
Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
d.
Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heartrate of _____ beats/minute.
a.
15 to 20
b.
20 to 40
c.
40 to 60
d.
60 to 100
c.
40 to 60.
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 patients cardiac rhythm as
a.
atrial flutter.
b.
sinus tachycardia.
c.
ventricular fibrillation.
d.
ventricular tachycardia.
d.
ventricular tachycardia.
SN: 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.
The nurse notes that a patients cardiac monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm?
a.
Ventricular couplets.
b.
Ventricular bigeminy.
c.
Ventricular R-on-T phenomenon.
d.
Multifocal premature ventricular contractions.
b.
Ventricular bigeminy.
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.
d.
document the finding and continue to monitor the patient.
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.
d.
Prepare to give IV amiodarone (Cordarone) per agency dysrhythmia protocol.

SN: 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.
After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV)block, which finding indicates that the medication has been effective?
a.
Increase in the patients heart rate.
b.
Increase in strength of peripheral pulses.
c.
Decrease in premature atrial contractions.
d.
Decrease in premature ventricular contractions.
a.
Increase in the patients heart rate.

SN: Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness.
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)
a.
anticoagulant therapy.
Which information will the nurse include when teaching a patient who is scheduled for a radio frequency catheter ablation for treatment of atrial flutter?
a.
The procedure will prevent or minimize the risk for sudden cardiac death.
b.
The procedure will use cold therapy to stop the formation of the flutter waves.
c.
The procedure will use electrical energy to destroy areas of the conduction system.
d.
The procedure will stimulate the growth of new conduction pathways between the atria.
c.
The procedure will use electrical energy to destroy areas of the conduction system.

SN: Radiofrequency catheter ablation therapy uses electrical energy to burn or ablate areas of the conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and tachydysrhythmias. All other statements regarding the procedure are incorrect.
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 wont lift the arm on the pacemaker side up very high until I see the doctor.
d.
I wont lift the arm on the pacemaker side up very high until I see the doctor.
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 ICD?
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.
a.
The nurse assists the patient to do active range of motion exercises for all extremities.

SN: 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.
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.
b.
Give a sedative before cardioversion is implemented.

SN: When a patient has a nonemergency cardioversion, sedation is used just before the procedue.
A 20-year-old has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54, and the student denies any health problems. What action by the nurse is most appropriate?
a.
Allow the student to participate on the soccer team.
b.
Refer the student to a cardiologist for further diagnostic testing.
c.
Tell the student to stop playing immediately if any dyspnea occurs.
d.
Obtain more detailed information about the students family health history.
a.
Allow the student to participate on the soccer team.
SN: In an aerobically trained individual, sinus bradycardia is normal. Dyspnea during an aerobic activity such as soccer is normal.
When analyzing the rhythm of a patients electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n)
a.
isoelectric ST segment.
b.
P-R interval of 0.18 second.
c.
Q-T interval of 0.38 second.
d.
QRS interval of 0.14 second.
d.
QRS interval of 0.14 second.
A patient has ST segment changes that support an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient?
a.
I
b.
II
c.
V2
d.
V6
b.
II
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.
d.
Serum potassium 2.9 mEq/L.

SN: 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 patients PVCs and do not require immediate correction.
A patients cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first?
a.
Perform immediate defibrillation.
b.
Give epinephrine (Adrenalin) IV.
c.
Prepare for endotracheal intubation.
d.
Give ventilations with a bag-valve-mask device.
a.
Perform immediate defibrillation.
A patients cardiac monitor shows sinus rhythm, rate 64. The P-R interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next?
a.
Place the transcutaneous pacemaker pads on the patient.
b.
Administer atropine sulfate 1 mg IV per agency dysrhythmia protocol.
c.
Document the patients rhythm and assess the patients response to the rhythm.
d.
Call the health care provider before giving the next dose of metoprolol (Lopressor).
d.
Call the health care provider before giving the next dose of metoprolol (Lopressor).
A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mmHg, 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.
d.
Apply the transcutaneous pacemaker (TCP) pads.
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).
b.
Ask the patient about current stress level and caffeine use.
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.
d.
A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due.
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 patients vital signs including oxygen saturation.
c.
Give supplemental O2 at 2 to 3 L/min via nasal cannula.
SN: Because this patient has dyspnea and chest pain in association with the new rhythm, the nurses initial actions should be to address the patients airway, breathing, and circulation (ABC) by starting with oxygen administration.
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.
b.
Start cardiopulmonary resuscitation (CPR).
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.
a.
Instruct the patient to call for assistance before getting out of bed.

SN: 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.
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 patients heart rate of 116 requires urgent treatment.
b.
Monitor a patients 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.
c.
Observe cardiac rhythms for multiple patients who have telemetry monitoring.
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.
a.
Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia.

SN: Adenosine must be given over 1 to 2 seconds to be effective. Treatment for asystole is immediate CPR.
A patient reports dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing.
The nurse interprets this heart rhythm as:
a.
junctional escape rhythm.
b.
accelerated idioventricular rhythm.
c.
third-degree atrioventricular (AV) block.
d.
sinus rhythm with premature atrial contractions (PACs).
c.
third-degree atrioventricular (AV) block.
A patient who is complaining of a racing heart and feeling anxious comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next?
a.
Prepare to perform electrical cardioversion.
b.
Have the patient perform the Valsalva maneuver.
c.
Obtain the patients vital signs including oxygen saturation.
d.
Prepare to give a b-blocker medication to slow the heart rate.
c.
Obtain the patients vital signs including oxygen saturation.
SN: The patient has sinus tachycardia, which may have multiple etiologies such as pain, dehydration, anxiety, and myocardial ischemia. Further assessment is needed before determining the treatment.
When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart rhythm, thenurse counts 30 small blocks from one R wave to the next. The nurse calculates the patients heart rate as ___
Answer: 50
There are 1500 small blocks in a minute, and the nurse will divide 1500 by 3.
When preparing to defibrillate a patient. In which order will the nurse perform the following steps?
a. Turn the defibrillator on.
b. Deliver the electrical charge.
c. Select the appropriate energy level.
d. Place the paddles on the patients chest.
e. Check the location of other staff and call out all clear.
A, C, D, E, B
a. Turn the defibrillator on.
c. Select the appropriate energy level.
d. Place the paddles on the patients chest.
e. Check the location of other staff and call out all clear.
b. Deliver the electrical charge.
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