ch 22 arrythmias Flashcards
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?
recognize that the view of the electrical current changes in relation to the lead placement
the nurse is analyzing a rhythm strip. what component of the ECG corresponds to the resting state of the heart
T wave
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?
QRS complex
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
fewer QRS complexes than p waves
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
warfarin, direct thrombin inhibitor, or factor Xa inhibitor
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
bleeding at the implantation site
a client has a permanent pacemaker implanted, with id code starting with VVI. what does this indicate
ventricular paced, ventricular sensed, inhibited
the nurse is caring for a client who has gone into ventricular fibrillation. when assisting with defibrillating the patient, what must the nurse do?
maintain firm contact between paddles and the client’s skin
a client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse the purpose of the device. what would you say
to detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia
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?
vigilant monitoring of the clients ECG
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
defibrillation
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
control ventricular heart rate
a client has converted to ventricular fibrillation (VF). was defibrillated unsuccessfully and remains in vf. administer which medication?
epinephrine 1 mg IV push
for a newly inserted permanent pacemaker, what is priority teaching point
avoid exposure to strong electromagnetic fields (EX: mri) as they can reprogram pacemakers
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?
administer 0.5 mg as an iv bolus every 3 to 5 minutes to a maximum of 3 mg
an ECG has been ordered for a newly admitted patient. what should the nurse do prior to electrode placement
gently abrade the skin by rubbing the electrode sites with dry gauze or cloth
the nurse is caring for a client who has just undergone ablation therapy. the nurse in the stepdown unit should prioritize what assessment
cardiac monitoring
the ed nurse is caring for a client who has gone into cardiac arrest. during external defibrillation what action should the nurse perform ?
ensure no one is touching the client at the time shock is delivered.
ST segments are:
representative of early ventricular repolarization
for a patient who has just undergone an electro physiologic (EP) study. if the client is nervous, what should you say
the whole team will be monitoring you very closely the entire procedure
for a patient with complicated cardiac history, how would you best explain the process of depolarization?
electrical stimulation of the heart muscles
for a patient who is experiencing positive chronotropy, what effect should the nurse prepare for?
increased heart rate
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?
recognize this as a therapeutic goal of the procedure
for catheter ablation therapy, the nurse should address which aspect of the treatment when educating patient’s family?
destruction of specific cardiac cells. does not reset heart contractility and does not address structural or vascular abnormalities
a client has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. which nursing diagnosis is most appropriate?
risk for activity intolerance
ecg shows atrial fibrillation, wide QRS and a fast, irregular ventricular rhythm. what does the ecg show?
wolff-parkinson’s-white (WPW) syndrome
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
monitoring the pacemaker for malfunction or battery failure
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
transcutaneous pacemaker
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?
changes in LOC
what is the goal of a biventricular pacemaker implantation?
resynchronization
when planning care for a client with an implanted pacemaker, what assessment is priority?
heart rate and rhythm
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?
ineffective coping related to pacemaker implantation
a patient has developed ventricular tachycardia (VT) after an implantation of an ICD. what should the nurse assess and document?
ECG to compare time of onset of VT and onset of device shock
the staff educator is teaching a cpr class. which of the following aspects of defibrillation should be prioritized
use a conducting medium between the paddles and the skin
during a cpr class a participant asks about the difference between cardioversion and defibrillation. what would you say
the difference is the timing and the delivery of the electric current
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
oversensing of dysrhythmias
