Chapter 34: Care of Patients with Dysrhythmias: Medical-Surgical Nursing, 8th Edition

Question 1

1. A nurse assesses a clients electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation?
   a. The client has hyperkalemia causing irregular QRS complexes.
   b. Ventricular tachycardia is overriding the normal atrial rhythm.
   c. The clients chest leads are not making sufficient contact with the skin.
   d. Ventricular and atrial depolarizations are initiated from different sites.

Answer 1

d. Ventricular and atrial depolarizations are initiated from different sites.

Question 2

2. A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?
   a. Make certain that your bath water is warm.
   b. Avoid straining while having a bowel movement.
   c. Limit your intake of caffeinated drinks to one a day.
   d. Avoid strenuous exercise such as running.

Answer 2

b. Avoid straining while having a bowel movement.

Question 3

3. A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation?
   a. A 45-year-old who takes an aspirin daily
   b. A 50-year-old who is post coronary artery bypass graft surgery
   c. A 78-year-old who had a carotid endarterectomy
   d. An 80-year-old with chronic obstructive pulmonary disease

Answer 3

b. A 50-year-old who is post coronary artery bypass graft surgery

Question 4

4. A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition?
   a. Sinus tachycardia
   b. Speech alterations
   c. Fatigue
   d. Dyspnea with activity

Answer 4

b. Speech alterations

Question 5

5. A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this clients medication administration record to prevent a common complication of this condition?
   a. Sotalol (Betapace)
   b. Warfarin (Coumadin)
   c. Atropine (Sal-Tropine)
   d. Lidocaine (Xylocaine)

Answer 5

b. Warfarin (Coumadin)

Question 6

6. A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response?
   a. Decreased intraocular pressure
   b. Increased heart rate
   c. Short period of asystole
   d. Hypertensive crisis

Answer 6

c. Short period of asystole

Question 7

7. A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment should the nurse complete next?
   a. Pulmonary auscultation
   b. Pulse strength and amplitude
   c. Level of consciousness
   d. Mobility and gait stability

Answer 7

c. Level of consciousness

Question 8

8. A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the clients electrocardiogram. Which action should the nurse take next?
   a. Administer intravenous diltiazem (Cardizem).
   b. Assess vital signs and level of consciousness.
   c. Administer sublingual nitroglycerin.
   d. Assess capillary refill and temperature.

Answer 8

b. Assess vital signs and level of consciousness.

Question 9

9. A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client?
   a. Make sure the defibrillator is set to the synchronous mode.
   b. Administer 1 mg of intravenous epinephrine.
   c. Test the equipment by delivering a smaller shock at 100 joules.
   d. Ensure that everyone is clear of contact with the client and the bed.

Answer 9

d. Ensure that everyone is clear of contact with the client and the bed.

Question 10

10. After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching?
    a. I should wear a snug-fitting shirt over the ICD.
    b. I will avoid sources of strong electromagnetic fields.
    c. I should participate in a strenuous exercise program.
    d. Now I can discontinue my antidysrhythmic medication.

Answer 10

b. I will avoid sources of strong electromagnetic fields.

Question 11

11. A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions should the nurse implement to address this clients concerns?
    a. Administer oxygen therapy at 2 liters per nasal cannula.
    b. Provide the client with a sleeping pill to stimulate rest.
    c. Schedule periods of exercise and rest during the day.
    d. Ask unlicensed assistive personnel to help bathe the client.

Answer 11

c. Schedule periods of exercise and rest during the day.

Question 12

12. A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action should the nurse take prior to the initiation of cardioversion?
    a. Administer intravenous adenosine.
    b. Turn off oxygen therapy.
    c. Ensure a tongue blade is available.
    d. Position the client on the left side.

Answer 12

b. Turn off oxygen therapy.

Question 13

13. A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services. Which priority information should be communicated to the home health nurse upon discharge?
    a. Medication reconciliation
    b. Immunization history
    c. Religious beliefs
    d. Nutrition preferences

Answer 13

a. Medication reconciliation

Question 14

14. A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse?
    a. Mid-sternal chest pain
    b. Increased urine output
    c. Mild orthostatic hypotension
    d. P wave touching the T wave

Answer 14

a. Mid-sternal chest pain

Question 15

15. A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement should the nurse include in this clients teaching?
    a. Minimize or abstain from caffeine.
    b. Lie on your side until the attack subsides.
    c. Use your oxygen when you experience PACs.
    d. Take amiodarone (Cordarone) daily to prevent PACs.

Answer 15

a. Minimize or abstain from caffeine.

Question 16

16. The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, Why do you want to know if I use cocaine? How should the nurse respond?
    a. Substance abuse puts clients at risk for many health issues.
    b. The hospital requires that I ask you about cocaine use.
    c. Clients who use cocaine are at risk for fatal dysrhythmias.
    d. We can provide services for cessation of substance abuse

Answer 16

c. Clients who use cocaine are at risk for fatal dysrhythmias.

Question 17

17. A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring. Which statement should the nurse provide to the UAP related to this procedure?
    a. Clean the skin and clip hairs if needed.
    b. Add gel to the electrodes prior to applying them.
    c. Place the electrodes on the posterior chest.
    d. Turn off oxygen prior to monitoring the client.

Answer 17

a. Clean the skin and clip hairs if needed.

Question 18

18. A nurse assesses a clients electrocardiogram (ECG) and observes the reading shown below:

How should the nurse document this clients ECG strip?

a. Ventricular tachycardia
b. Ventricular fibrillation
c. Sinus rhythm with premature atrial contractions (PACs)
d. Sinus rhythm with premature ventricular contractions (PVCs)

Answer 18

d. Sinus rhythm with premature ventricular contractions (PVCs)

Question 19

19. A nurse cares for a client who is on a cardiac monitor. The monitor displayed the rhythm shown below:

Which action should the nurse take first?
a. Assess airway, breathing, and level of consciousness.
b. Administer an amiodarone bolus followed by a drip.
c. Cardiovert the client with a biphasic defibrillator.
d. Begin cardiopulmonary resuscitation (CPR).
ANS: A

Answer 19

a. Assess airway, breathing, and level of consciousness.

Question 20

20. A nurse performs an admission assessment on a 75-year-old client with multiple chronic diseases. The clients blood pressure is 135/75 mm Hg and oxygen saturation is 94% on 2 liters per nasal cannula. The nurse assesses the clients rhythm on the cardiac monitor and observes the reading shown below:

Which action should the nurse take first?

a. Begin external temporary pacing.
b. Assess peripheral pulse strength.
c. Ask the client what medications he or she takes.
d. Administer 1 mg of atropine.

Answer 20

c. Ask the client what medications he or she takes.

Question 21

21. The nurse is caring for a client on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below:

After calling for assistance and a defibrillator, which action should the nurse take next?

a. Perform a pericardial thump.
b. Initiate cardiopulmonary resuscitation (CPR).
c. Start an 18-gauge intravenous line.
d. Ask the clients family about code status

Answer 21

b. Initiate cardiopulmonary resuscitation (CPR).