Dysrthythmias and conduction problems Flashcards
- The nurse is caring for a patient who is receiving an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. Why is this?
A) The view of the electrical current changes in relation to the lead placement.
B) Conduction of the heart differs with lead placement.
C) Electrocardiogram (ECG) equipment has malfunctioned.
D) The circadian rhythm has changed.
Ans: A Chapter: 27 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 722, Dysrhythmias
Feedback: 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.
2. The nurse is analyzing a rhythm strip. What does the nurse look at to identify the resting state of the heart? A) P wave B) T wave C) U wave D) QRS complex
Ans: B Chapter: 27 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 723, Dysrhythmias
Feedback: The T wave represents ventricular muscle depolarization, also referred to as the resting state.
3. The staff educator is teaching a class on conduction problems in the heart. The educator explains that in an adult patient who has damage to the electrical conduction of the ventricles of the heart, the nurse would expect to see changes in what? A) P wave B) T wave C) QRS complex D) U wave
Ans: C Chapter: 27 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 723, Dysrhythmias
Feedback: The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle.
- An adult patient with third-degree AV block is admitted to your unit and placed on continuous cardiac monitoring. What rhythm characteristics will the EKG show?
A) PP interval and RR interval are irregular
B) PP interval equal to RR interval
C) Fewer QRS complexes than P waves
D) PR interval constant
Ans: C Chapter: 27 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 739, Dysrhythmias
Feedback: 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.
5. You are writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient? A) Maintain nutritional intake B) Maintain fluid intake C) Maintain cardiac output D) Maintain social contacts
Ans: C Chapter: 27 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 5 Page and Header: 740, Dysrhythmias
Feedback: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output.
- Your patient has returned from the operating room after having a permanent pacemaker implantation. Which potential complication should you assess for in a postoperative patient with permanent pacemaker implantation?
A) Decreased urinary output
B) Bleeding at the generator-implantation site
C) Decreased respiratory rate
D) Decreased pulse rate
Ans: B Chapter: 27 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 749, Adjunctive Modalities and Management
Feedback: Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations.
- Each permanent pacemaker has a universal code to provide a means of safe communication about its function. A patient you are caring for has a permanent pacemaker implanted with the identification code beginning with VVI. What does this indicates?
A) Ventricular paced, ventricular sensed, inhibited
B) Atrial paced, ventricular sensed, inhibited
C) Ventricular sensed, ventricular paced, inhibited
D) Atrial sensed, atrial paced, inhibited
Ans: A Chapter: 27 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 744, Adjunctive Modalities and Management
Feedback: The identification of VVI indicates ventricular paced, ventricular sensed, inhibited.
- The nurse is caring for an adult patient who is in ventricular fibrillation. When defibrillating the patient, what must the nurse do?
A) Maintain good contact between paddles and patient skin
B) Use ultrasound gel as a conducting agent
C) Call “all clear” once before discharging the defibrillator
D) Ensure the defibrillator is in the sync mode
Ans: A Chapter: 27 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Page and Header: 742, Adjunctive Modalities and Management
Feedback: When defibrillating an adult patient, the nurse should maintain good contact between the paddles and the patient’s skin to prevent arcing, apply an appropriate conducting agent between the skin and the paddles, and ensure the defibrillator is in the nonsync mode. “All clear” should be called three times before discharging the paddles.
- A patient who has undergone an implantable cardioverter defibrillator (ICD) procedure asks the nurse about the purpose of this device. What would be the nurse’s best response?
A) “To detect and treat ventricular fibrillation and ventricular tachycardia”
B) “To detect and treat bradycardia”
C) “To detect and treat atrial fibrillation”
D) “To shock your heart if you have a heart attack at home”
Ans: A Chapter: 27 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 9 Page and Header: 747, Adjunctive Modalities and Management
Feedback: The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation.
- The nurse is aware that cryoablation therapy involves
A) peeling away the area of endocardium responsible for the dysrhythmia.
B) using electrical shocks directly to the endocarduim to eliminate the source of dysrhythmia.
C) using high-frequency sound waves to eliminate the source of dysrhythmia.
D) using a probe cooled to a temperature of -60°C (-76°F) to eliminate the source of dysrhythmia.
Ans: D Chapter: 27 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 10 Page and Header: 753, Adjunctive Modalities and Management
Feedback: Cryoablation therapy involves using the cooled probe to create a small scar on the endocarduim to eliminate the source of the dysrythmias. Endocardium resection involves peeling away a specified area of the endocardium. Electrical ablation involves using shocks to eliminate the area causing the dysrythmias. Radio frequency ablation uses high-frequency sound waves to destroy the area causing the dysrythmias.
- The nurse is caring for a patient who has had an acute MI. The patient is receiving lidocaine IV. What is the most relevant factor to administration of this medication?
A) Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter
B) Increase in systemic blood pressure
C) Presence of premature ventricular contractions (PVCs) on cardiac monitor
D) Increase in intracranial pressure (ICP)
ANS: C
Chapter: 27 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 734, Dysrhythmias
Feedback: Lidocaine (xylocaine) may be used in the patient with acute MI. Patients with acute MI who did not receive thrombolytics and had more than 10 PVCs per hour and those who did receive thrombolytics and had more than 25 PVCS per hour were found to be at the greatest risk for sudden cardiac death. SaO2, blood pressure, and ICP are important factors but aren’t as significant as PVCs in this situation.
- The nursing instructor is talking with her clinical group about cardiac conduction surgery. What would be the criteria for a patient to have this surgery?
A) Sinus bradycardia not responsive to other treatments
B) Functional rhythms not responsive to other treatments
C) Atrial and ventricular tachycardias not responsive to other treatments
D) Ventricular fibrillation not responsive to other treatments
Ans: C Chapter: 27 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 10 Page and Header: 752, Adjunctive Modalities and Management
Feedback: Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing.
13. A nurse is caring for a patient who is exhibiting ventricular tachycardia with an irregular rhythm. Which dysrhythmia should the nurse suspect as the cause of the ventricular tachycardia? A) Atrial fibrillation B) Atrial flutter C) Premature ventricular complex D) Sinus bradycardia
Ans: A Chapter: 27 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 729, Dysrhythmias
Feedback: Atrial fibrillation should be suspected as the cause of a ventricular tachycardia with an irregular rhythm, and it should be treated appropriately.
14. A patient converts from normal sinus rhythm at 80 beats per minute to atrial fibrillation with a ventricular response at 166 beats per minute. Blood pressure is 162/74. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and cardizem are given. The nurse caring for the patient understands that the goal of treatment is what? A) Decrease SA node conduction B) Control ventricular rate C) Improve oxygenation D) Maintain anticoagulation
Ans: B Chapter: 27 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 731, Dysrhythmias
Feedback: Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. 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.
15. You are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated at 200 joules, 300 joules, and 360 joules, respectively. The patient remains in VF. According to national standards, you are aware that what medication should be used? 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
Ans: A Chapter: 27 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Page and Header: 736, Dysrhythmias
Feedback: Epinephrine should be administered as soon as possible after the second rhythm check (immediately before or after the second defibrillation) and then every 3 to 5 minutes to make it easier to convert the dysrythmia to a normal sinus rhythm with defribrillation. Epinephrine may also increase cerebral and coronary artery blood flow. Antiarrhythmic medications such as amiodarone and licocaine are given if ventricular dysrhythmia persists.
- The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What would be important for the nurse to teach this patient?
A) Start lifting the arm above the shoulder right away to prevent shoulder restriction
B) Avoid cooking with a microwave oven
C) Avoid exposure to high-voltage electrical generators
D) Avoid walking through store and library antitheft devices
Ans: C Chapter: 27 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 746, Adjunctive Modalities and Management
Feedback: High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (eg, 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 patients 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 patient is brought to the emergency department who is experiencing symptomatic sinus bradycardia. The nurse caring for this patient 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 rapidly as an IV bolus every 3 to 5 minutes to a maximum total dose of 3 mg
B) Administer atropine 0.5 mg slowly as an IV bolus every minute to a maximum total dose of 3 mg
C) Administer atropine 1.0 mg rapidly as an IV bolus every 3 to 5 minutes to a maximum total dose of 3 mg
D) Administer atropine 1.0 mg slowly as an IV bolus every minute to a maximum total dose of 3 mg
Ans: A Chapter: 27 Client Needs: D-2 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 726, Dysrhythmias
Feedback: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3 mg is the medication of choice in treating symptomatic sinus bradycardia. Therefore, options B, C, and D are incorrect.
- A patient you are caring for has had an ECG ordered. What do you need to do prior to electrode placement?
A) Clean the skin with providone-iodine solution prior to applying the electrodes
B) Ensure that the area for electrode placement is dry
C) Apply tincture of benzoin to the electrode sites and wait for it to become “tacky”
D) Abrade the skin by rubbing the electrode sites briskly with a rough surface such as a clean dry gauze/washcloth
Ans: D Chapter: 27 Client Needs: D-1 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 721, Dysrhythmias
Feedback: An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission.
19. The nurse is caring for a patient with a tachydysrhythmia. The nurse would teach and prepare the patient for which of the following procedures? A) Catheter ablation therapy B) Transubcutaneous pacemaker C) Cardioversion D) Implantable cardiac device
Ans: A Chapter: 27 Client Needs: D-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 10 Page and Header: 733, Dysrhythmias
Feedback: Catheter ablation therapy uses radiofrequency energy to ablate or burn accessory pathways or ectopic sites in the atria, AV node, or ventricles that cause tachyarrhythmias
- You are an emergency-department nurse caring for a patient who has gone into cardiac arrest. You are performing external defibrillation. Which of the following is a vital step in the procedure?
A) Gel pads are placed anterior over the apex and posterior for better conduction
B) No one is to be touching the patient at the time shock is delivered
C) Continue to ventilate the patient via endotracheal tube during the procedure
D) Second shock cannot be administered for 1 minute to allow recharging
Ans: B Chapter: 27 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Page and Header: 742, Adjunctive Modalities and Management
Feedback: In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads, or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patient’s skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation.
- A group of new nurses is going to work on the telemetry unit. They are taking a class on ECGs and arrhythmias. What would the staff educator tell this class about ST segments?
A) The part of an ECG that reflects repolarization of the ventricles
B) The part of an ECG used to calculate ventricular rate and rhythm
C) The part of an ECG that reflects the time from ventricular depolarization through repolarization
D) The part of an ECG that reflects the end of the QRS complex to the beginning of the T wave
Ans: D Chapter: 27 Client Needs: A-1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 1 Page and Header: 724, Dysrhythmias
Feedback: ST segment is the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave. The part of an ECG that reflects repolarization of the ventricles is the T wave. The part of an ECG used to calculate ventricular rate and rhythm is the RR interval. The part of an ECG that reflects the time from ventricular depolarization through repolarization is the QT interval.
- You work on a unit that provides care to patients who have had either a pacemaker or an implantable cardioverter defibrillator placed. A student nurse asks what the criteria are to determine which device the patient has implanted. What should be your response?
A) “Patients with CAD and an elevated ejection fraction receive the ICD.”
B) “Patients with an arrhythmia and a reduced afterload receive the ICD.”
C) “Patients with arrhythmia and an increased afterload receive the ICD.”
D) “Patients with CAD and a reduced ejection fraction receive the ICD.”
Ans: D Chapter: 27 Client Needs: D-4 Cognitive Level: Application Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 9 Page and Header: 747, Adjunctive Modalities and Management
Feedback: Pacemaker technology also may be used in an implantable cardioverter defibrillator (eg, in patients with coronary artery disease and a reduced ejection fraction).
- There are new nurses on the telemetry unit who have been paired with preceptors for their first 8 weeks on the unit. One new nurse asks her preceptor to explain depolarization. What would be the best answer by the preceptor?
A) “Depolarization is the mechanical contraction of the heart muscles.”
B) “Depolarization is the electrical stimulation of the heart muscles.”
C) “Depolarization is the electrical relaxation of the heart muscles.”
D) “Depolarization is the mechanical relaxation of the heart muscles.”
Ans: B Chapter: 27 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 1 Page and Header: 721, Dysrhythmias
Feedback: The electrical stimulation is called depolarization, and the mechanical contraction is called systole. Electrical relaxation is called repolarization, and mechanical relaxation is called diastole. This makes options A, C, and D incorrect.
- While learning about the cardiovascular system in the prenursing anatomy and physiology class, the students are studying positive chronotropy. What is this?
A) The force of myocardial contraction
B) The constriction of peripheral blood vessels
C) Conduction through the AV node
D) Stimulation of the sympathetic system that increases heart rate
Ans: D Chapter: 27 Client Needs: A-1 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 1 Page and Header: 721, Dysrhythmias
Feedback: The heart rate is influenced by the autonomic nervous system, which consists of sympathetic and parasympathetic fibers. Sympathetic nerve fibers (also referred to as adrenergic fibers) are attached to the heart and arteries as well as several other areas in the body. Stimulation of the sympathetic system increases heart rate (positive chronotropy), conduction through the AV node (positive dromotropy), and the force of myocardial contraction (positive inotropy). Sympathetic stimulation also constricts peripheral blood vessels, therefore increasing blood pressure. Parasympathetic nerve fibers are also attached to the heart and arteries. Parasympathetic stimulation reduces the heart rate (negative chronotropy), AV conduction (negative dromotropy), and the force of atrial myocardial contraction. The decreased sympathetic stimulation results in dilation of arteries, thereby lowering blood pressure.
