Exam 1 Flashcards
Dysrhythmia
The nurse observes a client during an exercise stress test (bicycle). Which finding indicates a positive test and the need for further diagnostic testing?
A. Dizziness and leg cramping
B. BP changes from 148/80 mm Hg to 166/90 mm Hg
C. ST-segment changes on the ECG
D. Heart rate changes from 78 bpm to 112 bpm
C. ST-segment changes on the ECG
During the test, the following are monitored: two or more ECG leads for heart rate, rhythm, and ischemic changes; blood pressure; skin temperature; physical appearance; perceived exertion; and symptoms, including chest pain, dyspnea, dizziness, leg cramping, and fatigue. The test is terminated when the target heart rate is achieved or if the client experiences signs of myocardial ischemia. Further diagnostic testing, such as cardiac catheterization, may be warranted if the client develops chest pain, extreme fatigue, decreased blood pressure or pulse rate, serious dysrhythmias, or ST-segment changes on the ECG during the stress test. The other findings would not warrant stopping the test.
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 heart’s natural pacemaker (nodes) rates.
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
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
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 aspirin
B. Low molecular weight heparin or intravenous heparin
C. Warfarin, direct thrombin inhibitor, or factor Xa inhibitor
D. Anti-arrhythmic agents and aspirin
C. Warfarin, direct thrombin inhibitor, or factor Xa inhibitor
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
A client the nurse cares 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
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 non-sync 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, 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.”
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
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.
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.
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. What medication should the nurse anticipate the administration of?
A. Epinephrine 1mg iv push
B. Lidocaine 100 mg IV push
C. Amiodarone 300 mg IV push
D. Sodium bicarbonate 1 amp IV push
A. Epinephrine 1mg 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 immediately 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 anti-theft 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.
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 healthcare 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.
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 the treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine?
A. Administer atropine 0.5mg as an IV bolus every 3 to 5 minutes to a maximum of 3mg.
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 1mg sublingually.
A. Administer atropine 0.5mg as an IV bolus every 3 to 5 minutes to a maximum of 3mg.
An ECG has been ordered for a newly admitted client. What should the nurse do before electrode placement?
A. Clean the skin with povidone-iodine solution.
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. Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
D. Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
The nurse cares for a client who has just undergone catheter ablation therapy. What assessment should the nurse in the step-down unit prioritize?
A. Cardiac monitoring
B. Monitoring the implanted device signal
C. Pain assessment
D. Monitoring the client’s level of consciousness(LOC)
A. Cardiac monitoring
Rationale: Following catheter ablation therapy, the client is closely monitored to ensure the dysrhythmia does not reemerge. This is a priority over monitoring LOC and pain, although these are valid and important assessments. Ablation does not involve the implantation of a device.
The ED nurse is caring for a client who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform?
A. Place gel pads over the apex and posterior chest for better conduction.
B. Ensure no one touches the client when the shock is delivered.
C. Continue to ventilate the client via endotracheal tube during the procedure.
D. Allow at least 3 minutes between shocks.
B. Ensure no one touches the client when the shock is delivered.
Rationale: In external defibrillation, both paddles may be placed on the front of the chest, 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 client’s skin to prevent leaking. Second, ensure that no one is in contact with the client or with anything touching the client when the defibrillator is discharged to minimize the chance the electrical current will be conducted to anyone other than the client. Ventilation should be stopped during defibrillation.
