Management of Dysrhythmias Flashcards
Which type of dysrhythmia is associated with a fever? 1 Atrial fibrillation 2 Sinus tachycardia 3 Sinus bradycardia 4 Junctional tachycardia
2
Sinus tachycardia
A fever may cause tachycardia with a decrease in cardiac output and hypotension. Atrial fibrillation can cause significant problems for a patient with complex disease processes, but it is not related to fever. Bradycardia and junctional tachycardia are not typical results of fever.
Which electrocardiogram (ECG) characteristic is consistent with ventricular tachycardia (VT)?
1
Unmeasurable rate and rhythm
2
Rate 140 beats/minute; inverted P wave
3
Rate 200 beats/minute; P wave not visible
4
Rate 125 beats/minute; normal QRS complex
3
Rate 200 beats/minute; P wave not visible
VT is associated with a rate of 150 to 250 beats/minute; the P wave normally is not visible. Rate and rhythm are not measurable in ventricular fibrillation. P wave inversion and a normal QRS complex are not associated with VT.
The nurse is caring for a patient 24 hours after the patient underwent pacemaker insertion surgery. Which action will be included on the postoperative plan of care?
1
Changing the surgical dressing as needed
2
Encouraging range-of-motion exercises of the involved arm
3
Assessing the incision for any redness, swelling, or discharge
4
Applying wet-to-dry dressings every four hours to the insertion site
3
Assessing the incision for any redness, swelling, or discharge
After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site. The dressing is kept on and dry until removed 24 hours postoperatively. It is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement.
Which property of heart cells is defined as the ability of the heart to respond mechanically to an impulse? 1 Automaticity 2 Excitability 3 Conductivity 4 Contractility
4
Contractility
Contractility enables the cardiac cells to respond mechanically to an impulse. Automaticity provides the ability to initiate an impulse spontaneously and continuously. Excitability enables the cardiac cells to be electrically stimulated. Conductivity allows transmission of an impulse along a membrane in an orderly manner.
In which order would the nurse take the steps for applying telemetry monitoring electrodes? 1. Monitor for artifact. 2. Affix the electrodes. 3. Clip excessive hair with scissors. 4. Gently rub the skin with dry gauze.
1. Clip excessive hair with scissors. 2. Gently rub the skin with dry gauze. 3. Affix the electrodes. 4. Monitor for artifact.
The first step during the measurement of an electrocardiogram (ECG) is to remove excess hair on the skin. The presence of hair may not facilitate the proper adherence of electrodes to the skin. This could interfere with the recording of the cardiac impulses. It is followed by wiping the skin with alcohol to remove dirt and oil, and gently rubbing with gauze until the skin becomes pale pink. Wiping of the skin is followed by attaching the electrodes to the patient at the designated areas. Artifact may occur for various reasons. This indicates deformity of baseline and waveforms on electrocardiograph.
A patient’s electrocardiogram (ECG) has changed from a normal sinus rhythm to the following rhythm. The patient is sleeping, respirations are 16 breaths/min and unlabored, and the BP has dropped from 110/70 mm Hg to 104/68 mm Hg. Which action would the nurse take?
1 Continue monitoring the patient. 2 Perform an in-depth assessment. 3 Notify the health care provider. 4 Check the medical record for hyperkalemia.
1
Continue monitoring the patient.
Sinus bradycardia can be a normal finding for athletes or patients when they sleep. Sinus bradycardia becomes clinically significant if the patient is symptomatic (hypotensive, chest pain, shortness of breath, change of level of consciousness). Because the respiratory status of the patient is stable and the BP is only slightly lower because the patient is sleeping, the nurse should continue monitoring the patient. Hyperkalemia is characterized by a peaked T wave, and in advanced stages a widened QRS complex, neither of which are demonstrated on this ECG tracing.
A patient states, "I feel tired all the time, and I struggle with activities of daily living." The patient’s heart rate is 120 beats/minute. Which rhythm does the nurse anticipate observing on the electrocardiogram tracing? 1 Asystole 2 Atrial fibrillation 3 Sinus bradycardia 4 Ventricular fibrillation
2
Atrial fibrillation
Atrial fibrillation can reduce cardiac output due to the loss of atrial kick and a rapid ventricular rate, causing a reduced exercise tolerance and an elevated heart rate above 100 beats/minute. The patient will not have a pulse and will not be responsive if the rhythm is ventricular fibrillation or asystole. A patient with sinus bradycardia will have a heart rate less than 60 beats/minute.
A patient develops symptomatic sinus tachycardia. Which drug will likely be included in the patient's treatment plan? 1 Atropine 2 Dopamine 3 Adenosine 4 Epinephrine
3
Adenosine
Hypotension, dizziness, and dyspnea are symptoms of sinus tachycardia. Sinus tachycardia manifests as increased heart rate from 101 beats/minute to 180 beats/minute. Adenosine is used in the treatment of sinus tachycardia. Adenosine decreases the heart rate caused by inhibition of the vagus nerve and myocardial oxygen consumption. Anticholinergic drugs like atropine, dopamine, and epinephrine are the drugs of choice in the treatment of sinus bradycardia.
Defibrillation is indicated for which dysrhythmia? 1 Ventricular fibrillation 2 Uncontrolled atrial fibrillation 3 Ventricular tachycardia with a pulse 4 Third-degree atrioventricular (AV) block
1
Ventricular fibrillation
Defibrillation is always indicated in the treatment of ventricular fibrillation. Drug treatments are normally used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used, as long as the patient has a pulse. Pacemakers are the treatment of choice for third-degree heart block.
A patient in asystole is likely to receive which drug treatment? 1 Digoxin 2 Lidocaine 3 Epinephrine 4 β-adrenergic blockers
3
Epinephrine
Treatment of asystole consists of cardiopulmonary resuscitation (CPR) with initiation of advanced cardiac life support (ACLS) measures. These include definitive drug therapy with epinephrine and intubation. Digoxin is used for ventricular rate control. Lidocaine is used for premature ventricular contractions (PVCs). β-adrenergic blockers are used to slow the heart rate.
A patient has sought care following a syncopal episode of unknown etiology. Which item will be included in the patient’s treatment plan? 1 A head-up tilt-test 2 IV β-adrenergic blocker 3 Pacemaker insertion 4 Antiplatelet therapy
1
A head-up tilt-test
In patients without structural heart disease, the head-up tilt-test is a common component of the diagnostic workup following episodes of syncope. IV β-adrenergic blockers are not indicated, although an IV infusion of low-dose isoproterenol may be started in an attempt to provoke a response if the head-up tilt-test did not produce a response. Addressing pacemakers is premature at this stage. There is no data to support the initiation of antiplatelet therapy.
Which type of arrhythmia is associated with the absence of P waves on an electrocardiogram (ECG)? 1 Sinus tachycardia 2 Sinus bradycardia 3 Ventricular fibrillation 4 Type II second-degree atrioventricular (AV) block
3
Ventricular fibrillation
Ventricular fibrillation is associated with the absence of P waves on an ECG. P waves are visible with sinus tachycardia, sinus bradycardia, and type II second-degree AV block rhythms.
