Chapter 25 Flashcards
Size or fullness of voltage
Amplitude
Electrical activation of the atria
Atrial depolarization
Contraction of the two ventricles
Ventricular systole
Originating from many foci or sites
Multifocal
Occurs every second beat, as in PVCs
Bigeminy
Coming or originating from one site
Unifocal
Belonging to anything naturally
Inherent
Local deficiency of blood supply resulting from obstruction of the circulation to another part
Ischemia
Period of relaxation of the ventricle
Ventricular diastole
Use of electrical device to apply countershocks to the heart through electrodes placed on the chest wall to stop fibrillation
Defibrillate
Electrical tracing is at zero and is neither positive nor negative
Isoelectric line
Failure of the heart to maintain adequate circulation
Decompensation
Condition in which there is a complete dissociation between atrial and ventricular systoles
Complete heart block
Contraction of the atria
Atrial systole
Force with which left ventricular ejection occurs
Contractility
Occurring every third beat, as in PVCs
Trigeminy
Defect in heart conduction system in which right bundle does not conduct impulses normally
Right bundle branch block
Elective procedure in which synchronized shock of 25 to 50 joules is delivered to restore normal sinus rhythm
Cardioversion
Reestablishment of the polarized state of the muscle after contraction
Ventricular repolarization
Naturally occurring rhythm of the ventricles when the rest of the conduction system fails
Ventricular escape rhythm
Beat occurring every fourth complex as in premature ventricular contractions (PVCs)
Quadrigeminy
Rate no less than 60
bradycardia
An early beat
Premature
Chamber of the heart that propels blood into the pulmonary artery
Right ventricle
A chaotic pattern - no visible cardiac cycles
Ventricular fibrillation
The wave that follows the QRS complex
T wave
A small wave seen after the T wave
U wave
The first positive deflection on a QRS complex
R wave
The chamber of the heart that pumps the blood to the rest of the body
Left ventricle
The downward deflection after the R wave
S wave
Heart rate of more than 100 beats per minute
Tachycardia
An early beat with no P wave and a wide, bizarre QRS complex
Premature ventricular contraction
No QRS complexes seen - straight line
Asystole
Where normal cardiac impulse originates
Sinoatrial node
Successive beats of three or more wide, bizarre QRS complexes
Ventricular tachycardia
The first negative deflection of a QRS complex
Q wave
Wave that proceeds a QRS complex
P wave
Where an impulse is delayed before going to the Purkinje fibers
Atrioventricular node
An early beat that has a P wave and a normal QRS complex
Premature atrial contraction
No identifiable P waves with a normal QRS complex: irregularly irregular
Atrial fibrillation
Rhythm with normal P waves, QRS, T waves with a heart rate of 60 to 100 beats per minute
Normal sinus rhythm
The chamber of the heart that receives blood from the pulmonary veins
Left atrium
Rhythm with normal P waves, QRS, T waves with a heart rate of more than 100 beats per minute
Sinus tachycardia
Chamber of the heart that receives blood returning to the heart
Right atrium
Rhythm with normal P waves, QRS, T waves with a heart rate of less than 60 beats per minute
Sinus bradycardia
The nurse understands that which of the following defines a cardiac cycle?
a) Circulation of the blood through the body
b) Circulation of the blood through the heart
c) Depolarization and repolarization of heart chambers
d) Pumping action of the heart
c) Depolarization and repolarization of heart chambers
The heart receives blood returning from the body through which of the following?
a) Pulmonary vein
b) Aorta
c) Vena cavae
d) Right coronary artery
c) Vena cavae
Which of the following separates the right side of the heart from the left?
a) Chamber
b) Pericardium
c) Valve
d) Septum
d) Septum
Which of the following chambers of the heart is the largest and has the thickest myocardium?
a) Left ventricle
b) Right ventricle
c) Right atrium
d) Left atrium
a) Left ventricle
Which of the following waveforms represents the resting state of the ventricle on the ECG?
a) P wave
b) QRS complex
c) U wave
d) T wave
d) T wave
Which of the following is the inherent rate for the atrioventricular node?
a) 20 to 40 bpm
b) 40 to 60 bpm
c) 60 to 100 bpm
d) more than 100 bpm
b) 40 to 60 bpm
The nurse understands that rhythms arising from the primary pacing node of the heart are referred to as which of the following?
a) Escape beats
b) Bundle branch blocks
c) Sinus rhythms
d) Ectopic rhythms
c) Sinus rhythms
The nurse notes a life-threatening dysrhythmia on a patient’s cardiac monitor. Which of the following is the nurse’s first appropriate action?
a) Notify the physician immediately
b) Assess the patient
c) Administer the appropriate medication for the noted dysrhythmia
d) Obtain vital signs
b) Assess the patient
The nurse is teaching a patient about digoxin. Which of the following should the nurse include in the teaching?
a) Digoxin decreases ectopic beats
b) The force of contractions is increased with digoxin
c) The resting heart rate increases when digoxin is taken
d) Digoxin raises the resting blood pressure
b) The force of contractions is increased with digoxin
The nurse is providing care to a patient with atrial fibrillation. Which of the following statements, if made by the patient, would be of the most concern?
a) Aspirin upsets my stomach, so I quit taking it
b) IT seems like my feet are a little swollen
c) My wife and I got a membership at the local health club
d) Ive been having trouble falling asleep at night
a) Aspirin upsets my stomach, so I quit taking it
Which of the following treatments is appropriate for a patient with atrial fibrillation? (Select all that apply)
a) Amiodarone (Cordarone)
b) Nitroglycerin
c) Warfarin (Coumadin)
d) Digoxin (Lanoxin)
e) Cardioversion
f) Epinephrine
a) Amiodarone (Cordarone)
c) Warfarin (Coumadin)
d) Digoxin (Lanoxin)
e) Cardioversion
The nurse is caring for a patient who has had a run of three or more PVCs together. The nurse should document this as which of the following?
a) Ventricular tachycardia
b) Bigeminy
c) Trigeminy
d) Multifocal PVCs
a) Ventricular tachycardia
The nurse is caring for a patient in ventricular tachycardia who is hemodynamically stable. Which of the following is the initial treatment for this dysrhythmia?
a) Cardioversion
b) Pacemaker
c) Defibrillation
d) Antiarrhythmic intravenous medication
d) Antiarrhythmic intravenous medication
The nurse is caring for a patient whose ECG monitor shows a total absence of electrical impulse. The nurse does not detect a pulse. The nurse documents this as which of the following rhythms?
a) Agonal
b) Asystole
c) Sinus arrest
d) Ventricular standstill
b) Asystole
A patient with a cardiac disorder is having increased PVCs and feels “anxious”. After assessment and vital signs, what is the next action for the nurse to take?
a) Order an ECG and cardiac enzymes
b) Call the physician
c) Elevate the head of the bed and start oxygen at 2 L/min
d) Put the bed in modified Trendelenburg’s position
c) Elevate the head of the bed and start oxygen at 2 L/min
For which of the following dysrhythmias will the nurse anticipate a patient’s need for a permanent pacemaker? (Select all that apply)
a) Ventricular fibrillation
b) First-degree heart block
c) Atrial fibrillation
d) Third-degree heart block
e) Symptomatic bradycardia
f) Premature atrial contractions (PACs)
d) Third-degree heart block
e) Symptomatic bradycardia
Increases clotting time. Reduces risk of blood clots in atrial fibrillation
Example - warfarin (Coumadin)
Anticoagulant
Inhibit ventricular dysrhythmias, atrial fibrillation, atrial flutter.
Example - amiodarone (Cordarone, Pacerone)
Inhibits atrial fibrillation, atrial flutter
Example - dronedarone (Multaq)
Antidysrhythmics
Increases heart rate. Treats symptomatic bradycardia, asystole
Example - atropine
Anticholinergic
Decrease myocardial contractility
Example - atenolol (Tenormin)
Controls rate in sinus tachycardia, PAC, atrial flutter, atrial fibrillation, PVC
Example - metoprolol succinate (Lopressor, Toprol XL)
Beta blockers
Decreases myocardial contractility and depresses conduction system
Controls rate in sinus tachycardia, atrial flutter, and atrial fibrillation
Example - amlodipine (Norvasc)
Calcium channel blocker
Slows heart rate
Maintains sinus rhythm for sinus tachycardia, atrial flutter, atrial fibrillation
Example - digoxin (Lanoxicaps, Lanoxin)
Inotrope - Cardiac glycoside (Positive inotrope and negative chronotrope)
*Cardiac stimulation, vasoconstriction, bronchodilation
Treats asystole, ventricular tachycardia, ventricular fibrillation, symptomatic bradycardia
Example - epinephrine (Adrenalin)
*Vasoconstricts. Reduces urine volume. Single dose may replace dose of epinephrine.
Treats pulseless ventricular tachycardia, ventricular fibrillation, asystole
Example - vasopressin (Pitressin)
*Increases cardiac output and blood pressure
Treats bradycardia
Example - dopamine
Vasopressors
What is the most common factor that increases the risk of dysrhythmias in older adults?
Digitalis toxicity
____ is a lifesaving procedure used for pulseless ventricular tachycardia to ventricular fibrillation. It delivers an electrical shock to reset the heart’s rhythm
Defibrillation
Patients are placed on a cardiac monitor and rest for several hours after insertion of a _______
pacemaker
The dressing at the pacemaker insertion site is monitored every __ to __ hours for signs of bleeding
2 to 4
Place the following in the correct sequence for normal electrical impulse movement through the cardiac conduction system
a) AV node
b) SA node
c) bundle of His
d) Purkinje fibers
e) Internodal tracts
b, e, a, c, d
Why is it important for the nurse to use a systematic method for analyzing heart rhythm tracing?
a) So abnormalities are not missed
b) To save time
c) To develop a routine for examining tracing
d) To increase memory of the analysis steps
a
If a patient is in pulseless ventricular tachycardia, which of the following is the first choice of treatment?
a) Synchronized cardioversion
b) Pacemaker
c) Defibrillation
d) Antiarrythmic meds
c
Which of the following instructions should the nurse give the patient regarding pacemaker care?
a) Avoid microwaves
b) You may have an MRI
c) Take your radial pulse daily
d) You will need to be on bedrest for 48 hours
c
The nurse is ambulating a patient who is recovering from an MI when the patient develops chest pain with an irregular pulse. What is the safest way to return the patient to bed?
a) Ambulation to room with one assistant
b) With assistance by gurney
c) With assistance by a wheelchair
d) After completion of ambulation
b
A patient has a radial pulse of 58 bpm. Which of the following is the appropriate term for documenting this rhythm?
a) Normal
b) Asystole
c) Tachycardia
d) Bradycardia
d
The nurse is to give a patient amiodarone 800 mg/day PO in 2 divided doses. The nurse has available 200-mg tablets. How many tablets should the nurse give for each dose?
2 tablets per dose
