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Med Surg > Chp. 29 EKG > Flashcards

Chp. 29 EKG Flashcards

1
Q

What is the normal second measurement for the QRS complex?

A

0.12 sec

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2
Q

The nurse is administrating atropine. Which rhythm would the client show on the EKG monitor?

A

Sinus Bradycardia

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3
Q 
A client shows a HR of 130 bpm on the EKG monitor. What would be that cause of this rhythm?
Hypovolemia
Use of beta-blockers
Well trained athlete
Sleeping
A

Hypovolemia

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4
Q

A client is in new-onset A fib with a rapid ventricular rate. What Ca+ channel blocker would be administered to help control the rate?

A

Diltiazem

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5
Q

The telemetry tech calls the nursing station and tells the secretary that the client is in V tach. What would be the nurse’s priority when walking into the room?

A

Assess the client

Pulse or no Pulse V Tach? will determine Tx

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6
Q

The ambulance is bringing in a client in cardiac arrest. When they arrive tot he room a rhythm check is done and the client is in V fib. What is your priority?

A

Defibrilation

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7
Q

You are watching the monitor at the nursing station and notice a client’s rhythm turn from normal sinus rhythm to asystole. What should you do?

A

Check the leads and client

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8
Q

You are working in the ICU and you are assessing your client when all of a sudden they become unresponsive but they have an organized rhythm on the monitor. What is your priority?

A

Check for a pulse

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9
Q

What electrolyte imbalance can change T wave?

A

Hypo/hyperkalemia

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10
Q

When would you see a U wave on the EKG?

A

Digoxin toxicity or hypokalemia

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11
Q

What is the normal measurement fro PR interval?

A

< 0.20 sec.

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12
Q

A Pt. is having an EKG done. You notice they are bradycardic. You assess the pt. and they are not showing any symptoms. How do you treat the bradycardia?

A

You do not treat bradycardia unless they are symptomatic.

Symptoms: SOB, chest pain, syncope, diaphoresis, dizziness

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13
Q

You notice your Pt. has suddenly become bradycardic and they complain of dizziness, SOB, and chest pain. What is the treatment for this Pt.?

A

Atropine (Anticholinergic) 0.5-1 mg

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14
Q

What is the maximum dose of Atropine you the nurse can administer?

A

3 mg IVP

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15
Q

What are some causes of Bradycardia?

A

Hypoxia, Hypothermia, Sleeping, well trained athletes, drugs

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16
Q

Your Pt. is showing a HR: 150 with regular R waves and P waves are present. What is the treatment for this Pt.?

A 
#1 Treat the underlying cause 
Also admin beta-block or Ca+ channel blocker (Diltiazem)
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17
Q

What are some causes of Sinus Tachycardia?

A

Fever, anemia, hypovolemia, hypotension, MI, Sepsis, PE, and anxiety

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18
Q

Your Pt. is showing a HR: 146 with regular R waves and P waves are present. On assessment: Temp: 99 BP: 96/60 What is the treatment for this Pt.?

A

Fluids ASAP

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19
Q

Beta-Blockers

A

“-olol”

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20
Q

Ca+ Channel Blockers

A

“Very Nice Drugs”
Verapamil
Nifedipine
Diltiazem

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21
Q

What is the nurse’s concern with a Pt. with new onset A Fib?

A

Clots!

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22
Q

On EKG assessment you find your admit has no P wave, the R waves are irregular, and BP: 157. What type of rhythm does the nurse expect?

A

A Fib

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23
Q

On EKG assessment you find your admit has no P wave, the R waves are irregular, and BP: 157. What does the nurses expect the orders for Tx to be?

A

Blood thinner
Beta-blocker
Ca+ Channel Blocker
Digoxin (control rate)

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24
Q

A Pt. with A Fib is expecting a Cardioversion tomorrow morning. What should the nurse educate the Pt. about?

A

Before the Cardioversion they must do a Transesophageal Echo to determine if there are clots inside the atria

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25
Q

What are some causes of A Fib?

A

Increased Age, Hypertension, hyperthyroidism, obesity, diabetes, chronic kidney disease, cardiac surgeries, and CAD

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26
Q

What is a concern with A Fib?

A 
#1 clots
#2 decreased CO
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27
Q

What can a Atrial Flutter rhythm look like on EKG?

A

Shark fins

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28
Q

When do you perform a Cardioversion?

A

When they have a pulse. Must be synchronized.

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29
Q

When do you perform a defibrilaiton?

A

When they have NO pulse. Considered unsynchronized

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30
Q

What are some causes of A Flutter?

A

CHF, CAD, valve disease, MI, PE, HTN, digoxin toxicity

31
Q

A pt. has an EKG done. You determine there are no P waves, the rhythm is regular. Instead of P wave you see several shark fin like waves. What do you expect the orders to be?

A

Beta-blocker
Ca+ Channel Blocker
Digoxin
Cardioversion (not first line defense)

32
Q

What is your goal with A Fib or A Flutter?

A

Control the heart rate (Controlled)

33
Q

What are examples of Vagal Maneuvers?

A

Bearing down
Blowing paper off a straw
Placing an ice on pt.

34
Q

A pt.’s EKG has came you assess it to find: HR: 200, regular rhythm, and no P waves. The pt. is showing symptoms of palpitations, chest pain, SOB, diaphoretic, and BP: 80/74. What do you determine the rhythm to be?

A

Supraventricular Tachycardia

35
Q

A pt.’s EKG has came you assess it to find: HR: 200, regular rhythm, and no P waves. The pt. is showing symptoms of palpitations, chest pain, SOB, diaphoretic, and BP: 80/74. What do you expect the orders to be?

A

This is an unstable pt. w/ supraventricular tachycardia (SOB, diaphoretic, chest pain)
Tx: Adenosine 6 mg IVP (if does not work: push 12 mg), or Cardioversion
A pt. is stable if not showing symptoms

36
Q

A pt.’s EKG has came you assess it to find: HR: 170, regular rhythm, and no P waves. The pt. is not showing symptoms of distress. How can your treat the pt.?

A

Vagal maneuvers

37
Q

What is the goal to treating Supraventricular Tachycardia?

A

Get HR normal

38
Q

What can cause Supraventricular Tachycardia?

A

Caffeine, drugs, lung disease, med toxicity, heart problems

39
Q

Pt. EKG: P waves absent, rhythm irregular, QRS wide (greater than 0.12 sec), and has an underlying regular rhythm. What kind of rhythm is this?

A

Premature Ventricular Contractions

40
Q

What are causes of Premature Ventricular Contractions?

A

CAD, MI, hypokalemia, hypoxia, stress, drug toxicity, HTN, caffeine

41
Q

What is the nurse’s main concern with PVCs?

A

If they become more frequent PVCs can turn into V tach or V fib

42
Q

A nurse finds the patient is unresponsive with no pulse or blood pressure. Which dysrhythmia does the nurse anticipate?

A

Asystole

43
Q

Which are true regarding the QRS wave? Select all that apply.

a. ) The QRS wave is the first wave that is normally seen in pt.
b. ) The QRS wave represents ventricular depolarization
c. ) Normal QRS waves are usually rounded in width
d. ) Wide QRS waves may indicate that there is a block in the ventricles
e. ) QRS waves can take on many different forms

A

B, D, E

44
Q

A nurse overhears another team member saying that atrial fibrillation begins in the atrioventricular (AV) node of the heart. What action should the nurse take?

A

Correct her. A Fib begins in the SA node

45
Q

While assessing the electrocardiogram (ECG) report of a patient, the nurse observes that there is an absence of P waves and the QRS complex is narrow with irregular RR intervals. Which dysrhythmia is the patient experiencing?

A

A Fib

46
Q

The nurse is caring for a patient taking multiple cardiac medications. The patient asks which medication should be taken during episodes of chest pain. Which medication is correct?

A

Nitro

47
Q

Which dysrhythmias requires defibrillation?

A

V Fib

Pulseless V Tach

48
Q

The nurse is performing an Allen test in preparation for the placement of an arterial line. What would be a positive finding?

A

Color returns in 7-10 sec.

49
Q

If you determine a pt. heart is only working off of the purkinje fibers firing and no other electrical activity, what is the treatment?

A

Pt needs to be on pacemaker or will not last long. Need to increase HR ASAP

50
Q

As the nurse, you know that the following can cause rhythm disorders: (Select all that apply.)

a. ) Exercise
b. ) Electrolyte imbalances
c. ) Myocardial hypertrophy
d. ) Myocardial damage
e. ) Eating Red Meat

A

B, C, D

All can lead to dysrhythmias

51
Q

If the PR interval is longer than 0.20 sec what does the nurse suspect?

A

AV Heart Block

52
Q

5 Questions to ask yourself when interpreting EKG Strip

A 
Rate?
Rhythm?
P wave present?
What is the PR interval?
What is the QRS complex?
53
Q

Premature Atrial Contraction

A

The atria is firing earlier than it should. Tx: stop the thing causing PAC (ex. stop drinking caffiene)

54
Q

A Fib RVR (Rapid Ventricular Response)

A

Means: A fib with high heart rate (uncontrolled)

55
Q

Safety Alert: Adenosine

A

Adenosine is given IVP and it stops the heart to reset, which results in asystole and then you are hoping the SA node kicks back in and starts working. Have a crash cart nearby

56
Q

Key patient teaching points for A Fib include which of the following? (Select all that apply.)

a. ) Medications for HR control
b. ) Bleeding precautions
c. ) Signs and symptoms of A Fib with RVR
d. ) Cardioversion
e. ) Defibrilation

A

A, B, C, D
Rationale: Medications may be used for rate control. A Fib pt. are typically on anticoagulants. A rapid ventricular response may occur with A Fib, resulting in adverse symptoms and decrease CO. Cardioversion, not defibrillation, is sometime indicated for A Fib pt.

57
Q

Which of the following is not an appropriate intervention for all atrial dysrhythmias?

a. ) An EKG
b. ) A pulse check
c. ) BP check
d. ) Cardioversion

A

D

Cardioversion is only used with symptomatic atrial dysrhythmias

58
Q

Your pt. goes into V Tach. but has a pulse and is able to maintain BP. What is the Tx?

A

Amiodarone then synched cardioversion

Treat H’s and T’s (Stable but won’t be stable for long, treat cause early)

59
Q

Your pt. goes into V Tach. and has no pulse. What is your priority?

A

Defibrillate ASAP

60
Q

Your pt. goes into V Tach. and has no pulse. What do you do?

A

Assess, CPR, Epi (1 mg q 3 min), amiodarone, and Defibrillate ASAP

61
Q

Your pt. goes into V Tach. you cannot get them back unless you treat ___ and ___

A

H’s and T’s

62
Q

What are H’s and T’s?

A

Hypovolemic, Hypoxia, Hypothermia, Hydrogen imbalance (Acidotic - ABG’s), Hypo/Hyperkalemia, Hypoglycemic, Toxins, Thrombosis, pneumothorax

63
Q

What kind of V Tach is Tordes de Pointes and what does it look like?

A

Polymorphic

A twisted ribbon

64
Q

What king of people do you see with Tordes de Pointes? Tx?

A 
Low Mg (Alcoholics)
Tx - Mg Sulfate
65
Q

V Fib never has a ___

A

Never has a pulse

66
Q

Tx for V Fib:

A 
Assess
CPR
Epi and amiodarone
Defibrillate (#1 priority after CPR intiated)
Treat H's and T's
67
Q

When pt. is in Asystole you should ___ ___

A

NOT SHOCK!

DO NOT SHOCK ASYSTOLE!

68
Q

Tx asystole:

A

CPR
Epi (1 mg q3min)
H’s and T’s

69
Q

What must be done to confirm cardiac death?

A

Asystole must be checked in 2 leads

70
Q

Tx for Pulseless Electrical Activity (PEA):

A

CPR
Epi (1 mg q3min)
H’s and T’s

71
Q

Amiodarone is contraindicated in what kind of pt.’s?

A

Pt. that have complete heart block because can prolong QT interval

72
Q

Why is your priority with pulselessness V Tach and V Fib Defibrilation?

A

You want to restore circulation ASAP

73
Q

The nurse understands that rhythms originating in the ventricle have which of the following characteristics? (Select all that apply.)

a. ) Wide QRS complex
b. ) Narrow QRS complexes
c. ) Only QRS complexes
d. ) Only fast rates
e. ) Only slow rates

A

A, C
Rationale: Rhythms originating in the ventricles can be slow/fast, have wide QRS complexes and sometime only have QRS complexes (VT). Narrow QRS complexes indicate rhythm originating above the AV node

Med Surg (22 decks)

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