ch 22 arrythmias

Question 1

the nurse is caring for a client who has had and ECG. the leads I, II, and III differ from one another on the cardiac rhythm strip. how should the nurse best respond?

Answer 1

recognize that the view of the electrical current changes in relation to the lead placement

Question 2

the nurse is analyzing a rhythm strip. what component of the ECG corresponds to the resting state of the heart

Answer 2

T wave

Question 3

the nursing educator is presenting a case study of an adult who has abnormal ventricular depolarization. this change would be the most evident in what component of the ECG?

Answer 3

QRS complex

Question 4

an adult client 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

Answer 4

fewer QRS complexes than p waves

Question 5

a 62 yr old client with atrial fibrillation and a CHA2-VASc score of 3 is being discharged home today. Based on the score, which additional medications would be prescribed to the client

Answer 5

warfarin, direct thrombin inhibitor, or factor Xa inhibitor

Question 6

a client has returned to the cardiac care unit after having a permanent pacemaker implantation. for which potential complication should the nurse MOST closely assess this client

Answer 6

bleeding at the implantation site

Question 7

a client has a permanent pacemaker implanted, with id code starting with VVI. what does this indicate

Answer 7

ventricular paced, ventricular sensed, inhibited

Question 8

the nurse is caring for a client who has gone into ventricular fibrillation. when assisting with defibrillating the patient, what must the nurse do?

Answer 8

maintain firm contact between paddles and the client’s skin

Question 9

a client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse the purpose of the device. what would you say

Answer 9

to detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia

Question 10

the nurse is caring for a client who has just had an implantable cardioverter defribrilator (ICD) placed. what is the priority area for nurse assessment?

Answer 10

vigilant monitoring of the clients ECG

Question 11

a nurse is caring for a client who is exhibiting ventricular tachycardia (VT). if the client has no pulse what intervention should the nurse do

Answer 11

defibrillation

Question 12

a client converts form normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. bp 162/74. respirations 20. iv heparin and diltiazem are given. what is the main goal of treatment

Answer 12

control ventricular heart rate

Question 13

a client has converted to ventricular fibrillation (VF). was defibrillated unsuccessfully and remains in vf. administer which medication?

Answer 13

epinephrine 1 mg IV push

Question 14

for a newly inserted permanent pacemaker, what is priority teaching point

Answer 14

avoid exposure to strong electromagnetic fields (EX: mri) as they can reprogram pacemakers

Question 15

a client is brought to the er and determined to be experiencing symptomatic sinus bradycardia. med of choice is atropine. what are the guidelines for administering atropine?

Answer 15

administer 0.5 mg as an iv bolus every 3 to 5 minutes to a maximum of 3 mg

Question 16

an ECG has been ordered for a newly admitted patient. what should the nurse do prior to electrode placement

Answer 16

gently abrade the skin by rubbing the electrode sites with dry gauze or cloth

Question 17

the nurse is caring for a client who has just undergone ablation therapy. the nurse in the stepdown unit should prioritize what assessment

Answer 17

cardiac monitoring

Question 18

the ed nurse is caring for a client who has gone into cardiac arrest. during external defibrillation what action should the nurse perform ?

Answer 18

ensure no one is touching the client at the time shock is delivered.

Question 19

ST segments are:

Answer 19

representative of early ventricular repolarization

Question 20

for a patient who has just undergone an electro physiologic (EP) study. if the client is nervous, what should you say

Answer 20

the whole team will be monitoring you very closely the entire procedure

Question 21

for a patient with complicated cardiac history, how would you best explain the process of depolarization?

Answer 21

electrical stimulation of the heart muscles

Question 22

for a patient who is experiencing positive chronotropy, what effect should the nurse prepare for?

Answer 22

increased heart rate

Question 23

for a patient with refractory atrial fibrillation who had maze procedure, their most recent cardiac imaging shows presence of scarring on the atria. how would you interpret this finding?

Answer 23

recognize this as a therapeutic goal of the procedure

Question 24

for catheter ablation therapy, the nurse should address which aspect of the treatment when educating patient’s family?

Answer 24

destruction of specific cardiac cells. does not reset heart contractility and does not address structural or vascular abnormalities

Question 25

a client has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. which nursing diagnosis is most appropriate?

Answer 25

risk for activity intolerance

Question 26

ecg shows atrial fibrillation, wide QRS and a fast, irregular ventricular rhythm. what does the ecg show?

Answer 26

wolff-parkinson’s-white (WPW) syndrome

Question 27

a client is undergoing pre operative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. what is the nurses responsibility of care of the patient’s pacemaker

Answer 27

monitoring the pacemaker for malfunction or battery failure

Question 28

the nurse is caring for a client whose sudden onset of sinus bradycardia is not responding to atropine. what is the treatment of choice for this patient

Answer 28

transcutaneous pacemaker

Question 29

for a patient who is having a dysrhythmic event, the nurse has to assess for signs of diminished cardiac output (CO). what change in status may indicate decreased CO?

Answer 29

changes in LOC

Question 30

what is the goal of a biventricular pacemaker implantation?

Answer 30

resynchronization

Question 31

when planning care for a client with an implanted pacemaker, what assessment is priority?

Answer 31

heart rate and rhythm

Question 32

the nurse is assessing a patient who had a pacemaker implanted 4 weeks ago. the nurse identifies date that suggests the patient may be socially isolated and depressed. what is the nursing diagnosis for this data?

Answer 32

ineffective coping related to pacemaker implantation

Question 33

a patient has developed ventricular tachycardia (VT) after an implantation of an ICD. what should the nurse assess and document?

Answer 33

ECG to compare time of onset of VT and onset of device shock

Question 34

the staff educator is teaching a cpr class. which of the following aspects of defibrillation should be prioritized

Answer 34

use a conducting medium between the paddles and the skin

Question 35

during a cpr class a participant asks about the difference between cardioversion and defibrillation. what would you say

Answer 35

the difference is the timing and the delivery of the electric current

Question 36

a client with an ICD calls the cardiologist office bc they are concerned with being defribrilated too often. the what is the most frequent complication of icd therapy

Answer 36

oversensing of dysrhythmias