Chapter 22 - Arrhythmias and Conduction Problems Flashcards
The nurse is caring for a client who has had an ECG. The nurse notices 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 health care provider that the client is experiencing a new onset of dysrhythmia.
A. Recognize that the view of the electrical current changes in relation to the lead placement.
Rationale: 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 is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the client's heart? A. P wave B. T wave C. U wave D. QRS complex
B. T wave
Rationale: 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.
The nursing educator is presenting a case study of an adult client 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. QRS complex
Rationale: The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.
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?
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. Fewer QRS complexes than P waves
Rationale: 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.
A 62-year-old client with atrial fibrillation and a CHA2DS2-VASC score of 3 is being discharged home today. Based on this score, which additional medications or medications would be prescribed for this client?
A. No antithrombotic therapy, oral anticoagulant or aspirin
B. Low molecular weight heparin or intravenous heparin
C. Warfarin, direct thrombin inhibitor, or factor Xa inhibitor
D. Antiarrhythmic agents and aspirin
C. Warfarin, direct thrombin inhibitor, or factor Xa inhibitor
Rationale: Clients with atrial fibrillation are assessed for the risk of stroke using the mnemonic CHA2DS2-VASC with age, sex, and medical history determining a score. With a score of zero, clients may choose no antithrombotic therapy. With a score of 1, the client may choose no therapy, oral anticoagulant or aspirin. With a score of 2 or greater in men or 3 or greater in women, clients may choose warfarin, direct thrombin, or factor Xa inhibitor. Heparin can be used as a short-term or immediate anticoagulation medication and is not used as part of this scoring process. And intravenous heparin is not typically used in a home setting for prevention. The antiarrhythmic medication treats atrial fibrillation and is not part of the scoring process.
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? A. Chest pain B. Bleeding at the implantation site C. Malignant hyperthermia D. Bradycardia
B. Bleeding at the implantation site
Rationale: 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.
A client 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. Ventricular paced, ventricular sensed, inhibited
Rationale: The identification of VVI indicates ventricular paced, ventricular sensed, inhibited.
The nurse is caring for an adult client who has gone into ventricular fibrillation. When assisting with defibrillating the client, what must the nurse do?
A. Maintain firm contact between paddles and the client’s 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. Maintain firm contact between paddles and the client’s skin.
Rationale: When defibrillating an adult client, the nurse should maintain good contact between the paddles and the client’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.
A client 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. “To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia.”
Rationale: 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
The nurse is caring for a client who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse’s assessment?
A. Assessing the client’s mobility
B. Facilitating transthoracic echocardiography
C. Vigilant monitoring of the client’s ECG
D. Close monitoring of the client’s peripheral perfusion
C. Vigilant monitoring of the client’s ECG
Rationale: After a permanent electronic device (pacemaker or ICD) is inserted, the client’s heart rate and rhythm are monitored by ECG. This is a priority over peripheral circulation and mobility because the consequences of abnormalities are more serious. Echocardiography is not indicated.
A nurse is caring for a client who is exhibiting ventricular tachycardia (VT). Because the client is pulseless, the nurse should prepare for what intervention?
A. Defibrillation
B. ECG monitoring
C. Implantation of a cardioverter defibrillator
D. Angioplasty
A. Defibrillation
Rationale: Any type of VT in a client 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.
A client 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 diltiazem are given. The nurse caring for the client understands that the treatment has what main goal? A. Decrease SA node conduction. B. Control ventricular heart rate. C. Improve oxygenation. D. Maintain anticoagulation
B. Control ventricular heart rate.
Rationale: 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
The nurse and the other members of the team are caring for a client who converted to ventricular fibrillation (VF). The client was defibrillated unsuccessfully and the client remains in VF. 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. Epinephrine 1 mg IV push
Rationale: Epinephrine should be given as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and lidocaine are given if ventricular dysrhythmia persists.
The nurse is planning discharge teaching for a client with a newly inserted permanent pacemaker. What is the priority teaching point for this client?
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 strong electromagnetic fields
D. Avoid walking through store and library antitheft devices.
C. Avoid exposure to strong electromagnetic fields
Rationale: High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows clients 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 clients 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.
A client is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this client 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. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg
Rationale: 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.
