Quiz 3 Flashcards
What happens during diastole?
atria and ventricles are relaxed and filling with blood
What happens during systole?
atria and ventricles contract and eject blood
What happens during the P wave?
atrial depolarization (contracts)
before each QRS complex
What happens during the PR interval?
impulse travels down AV node and purkinje fibers to next segment (QRS)
starts at P wave to beginning of QRS
What does an issue with the PR interval indicate?
heart block
long pr interval
What happens during the QRS complex?
ventricular depolarization (contracts)
What happens during the ST segment?
ventricular depolarization complete and beginning of ventricular repolarization
line should be flat (no depression or elevation)
end of S to start of T
What happens during the T wave?
ventricular repolarization (relaxes)
What happens during the QT interval?
time it takes for signals to cause ventricles to contract and rest
starts at QRS and ends after T wave
How to assess a normal sinus rhythm EKG strip?
- R-R interval (rhythm): regular
- HR: normal 60-100 bpm (count peaks in a 6 sec strip, multiply by 10)
- P waves: present and upright (sinus)
- P-R interval: normal 0.12-0.20 secs
- QRS complex: upright and normal <0.12 secs
- Q-T interval: 0.36-0.44 seconds
- S-T segment: straight
- T waves: present and upright
What causes sinus bradycardia?
vagal maneuver
medications
What is the treatment of sinus bradycardia?
- Atropine 1mg (3 doses max)
- Transcutaneous pacing if meds aren’t working
Describe sinus tachycardia on an EKG strip
same as normal sinus rhythm
except
rate: rapid
QRS: not normal
ST seg: elevated
What is the treatment of sinus tachycardia?
beta blockers
Ca channel blockers
but always treat cause of symptoms
Describe supraventricular tachycardia (SVT) on an EKG strip
rate: rapid (150-220)
P wave absent
What can cause SVT?
stimulants
strenuous exercise
hypoxia
heart disease
What is the treatment of SVT?
vagal maneuver
adenosine (rapid push and flush) 6mg
cardioversion if doesn’t meds don’t work
What 2 cardiac rhythms are at high risk for stroke? Why?
atrial flutter and atrial fibrillation
blood is not moving
Describe atrial flutter on an EKG strip
P waves: multiple “sawtooth”
QRS: normal
atrial tachycardia
irregular palpitations
irregular HR
What can cause atrial flutter?
heart failure
pulmonary HTN
CAD
What is the treatment of atrial flutter?
amiodarone (antiarrhythmic) + lidocaine
beta blocker
Ca channel blockers
anticoagulants
cardioversion if doesn’t meds don’t work
Describe atrial fibrillation on an EKG strip
fibrillatory or quivering P waves (not identifiable)
irregular rhythm
PR interval: not measurable
What can cause atrial fibrillation?
heart failure
pulmonary HTN
CAD
What is the treatment of atrial fibrillation?
amiodarone + lidocaine
beta blocker and ca channel blocker
cardioversion if doesn’t meds don’t work
If nurse wants to lower the heart rate of a patient, what should the nurse be aware of in terms of medications and BP?
beta blockers and ca channel blockers can be given, ONLY IF, BP is controlled
these meds lower BP, safer to give amiodarone and lidocaine
Describe ventricular tachycardia on an EKG strip
no P waves
wide QRS
rapid
pts cannot be in vtach for long bc then they will go pulseless
What is the cause of vtach?
post MI
hypoxia
low potassium
low magnesium
What is the treatment of vtach?
always check pulse
pulse: beta blockers, ca channel blockers, amiodarone, cardioversion
no pulse: chest compressions, defibrillation, epinephrine
What rhythms are considered shockable rhythms?
pulseless vtach and vfib
Describe torsades de pointes on an EKG
prolonged QT interval
polymorphic vtach
What causes torsades de pointes?
low magnesium
post MI
hypoxia
prolonged QT interval
What is the treatment for torsades de pointes?
magnesium
no pulse: compressions, defibrillation, epi
Describe ventricular fibrillation on an EKG
ventricle quivering
no effective contraction
electrical activity present
What causes vfib?
untreated vtach
post mi
electrolyte imbalance
What is the treatment of vfib?
Check pulse and leads
no pulse: compressions, defibrillation, epi
Describe a first degree heart block
PR interval is consistent/same, but longer than 0.20
asymptomatic
Describe a second degree type 1 heart block
PR interval will be long, then longer, then QRS dropped (blocked)
“pt is in wenckebach”
asymptomatic, bradycardia
Describe a second degree type 2 heart block
PR interval is consistent, consistent, QRS dropped (blocked)
symptomatic: decreased cardiac output
Describe a third degree heart block
atria and ventricles are not communicating, contract independently
Describe asystole on an EKG strip
flatline
no ventricular electrical activity
What is the treatment of asystole?
CPR
epinephrine
Describe pulseless electrical activity (PEAs)
- no electrical activity
- can look like any rhythm
What is the treatment of PEAs?
CPR
epinephrine
What rhythms are cardioversion used for?
vtach w/ pulse
SVT
afib
a flutter
What is cardioversion?
synchronized with R wave to deliver countershock
What are the precautions for cardioversion?
- SYNCH turned on
- anticoagulation 4-6 weeks before procedure if pt has afib
- stable pt sedated before procedure (midazolam)
- if pt goes pulseless turn off SYNCH
What rhythms will require a pacemaker?
bradycardia
What If a pacer spike comes before the P wave, what rhythm is this considered?
atrial paced rhythm
What if a pacer spike comes before QRS complex, what rhythm is this considered?
ventricular paced rhythm
What if a pacer spike comes before the P wave and before QRS complex, what rhythm is this considered?
dual chamber (AV) paced rhythm
What should you teach a patient who has an implantable cardioverter defibrillator (ICD)?
- check pulse 1 min everyday
- report infection
- avoid lifting, driving, contact sports
- no tight clothes
- avoid magnets
- know what to do if ICD fires
What is radiofrequency catheter ablation therapy?
- for afib and aflutter
- catheter burns pathways in atria
- invasive
- postop similar to cardiac cath
What is an adverse effect of hypertension medication?
hypotension
A person with premature ventricular contraction will display what symptoms?
irregular pulsations
light headedness
A nurse is caring for a client who has pericarditis and reports feeling a new onset of palpitations and shortness of breath. Which of the following assessments should indicate to the nurse that the client may have developed atrial fibrillation?
A. Different blood pressures in the upper limbs.
B. Differences in upper and lower lung sounds.
C. Differences between oral and axillary temperatures.
D. Different apical and radial pulses.
D. Different apical and radial pulses.
A nurse is caring for a client who recently had surgery for the insertion of a permanent pacemaker. Which of the following prescriptions should the nurse clarify?
A. Physical therapy
B. Serum cardiac enzyme levels
C. MRI of the chest
D. Low sodium diet
C. MRI of the chest
A nurse is providing discharge teaching to a client who has an implantable cardioverter/defibrillator (ICD). Which of the following information should the nurse include?
A. The client cannot travel by air due to security screening.
B. The client should hold his cell phone on the side opposite the ICD.
C. The client can carry his ICD in a small pocket.
D. The client should avoid the use of small electric devices.
B. The client should hold his cell phone on the side opposite the ICD.
A nurse in a coronary care unit is admitting a patient who has had CPR following a cardiac arrest.
The patient is receiving lidocaine IV at 2 mg/min.
When the patient asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions?
A. Relieves pain.
B. Slows intestinal motility.
C. Dissolves blood clots.
D. Prevents dysrhythmias.
D. Prevents dysrhythmias.
A nurse is caring for a client who has a cardiopulmonary arrest. The nurse anticipates the emergency response team will administer which of the following medications if the client’s restored rhythm is symptomatic bradycardia?
A. Magnesium
B. Sodium bicarbonate
C. Epinephrine
D. Atropine
D. Atropine
What is a symptom of bradycardia?
lightheadedness
(poor perfusion)
If a patient has no pulse, what will you use?
If a patient has a pulse what will you use?
no pulse: defibrillator
pulse: cardioversion
A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a college soccer team. The patient is found to have sinus bradycardia, rate 52 and blood pressure (BP) 114/54 mm Hg. The student denies any health problems. Which action would the nurse take?
a. Approve the student to participate on the soccer team.
b. Refer the student to a cardiologist for further testing.
c. Tell the student to stop playing immediately if any dyspnea occurs.
d. Obtain more detailed information about the student‘s family health history.
a. Approve the student to participate on the soccer team.
A patient‘s heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action would the nurse take first?
a. Place the transcutaneous pacemaker pads on the patient.
b. Give atropine sulfate 1 mg IV per agency dysrhythmia protocol.
c. Hold the scheduled metoprolol (Lopressor) and call the health care provider.
d. Document the patient‘s rhythm and PR measurements in the medical record.
c. Hold the scheduled metoprolol (Lopressor) and call the health care provider.
The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient would the nurse see first?
a. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin (Coumadin) due
b. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating
c. A patient who is in a sinus rhythm, rate 98 and regular, recovering from an elective cardioversion 2 hours ago
d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due
d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due
A patient on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action in the agency dysrhythmia protocol would the nurse take first?
a. Obtain a 12-lead electrocardiogram (ECG).
b. Notify the health care provider of the change in rhythm.
c. Give supplemental O2 at 2 to 3 L/min via nasal cannula.
d. Assess the patient‘s blood pressure and discomfort level.
c. Give supplemental O2 at 2 to 3 L/min via nasal cannula.
A patient is apneic and has no palpable pulses. The heart monitor shows sinus tachycardia, rate 132. Which action would the nurse take next?
a. Perform synchronized cardioversion.
b. Start cardiopulmonary resuscitation(CPR).
c. Give atropine per agency dysrhythmia protocol.
d. Apply supplemental O2 via non-rebreather mask.
b. Start cardiopulmonary resuscitation(CPR).
A nurse is analyzing a client’s electrocardiogram (ECG) strip and identifies the following information:
Heart rate: 92/min
Rhythm: Irregular
P wave: Unable to identify
PR interval: Unable to measure
QRS duration: O. 1 0 seconds
Based upon this information, the nurse should interpret the client’s rhythm as indicating which of the following?
A. Atrial fibrillation
B. Sinus bradycardia
C. Supraventricular tachycardia
D. First-degree heart block
A. Atrial fibrillation
A nurse is assisting with obtaining an electrocardiogram (ECG) for a client who has atrial fibrillation. Which of the following actions should the nurse take? (Select all that apply.)
A. Inspect the electrode pads
B. Instruct the client not to talk during the test
C. Administer an analgesic prior to the procedure
D. Wash the skin with plain water before placing the electrodes
E. Keep the client NPO after midnight
A. Inspect the electrode pads
B. Instruct the client not to talk during the test
A nurse is teaching a client who is postoperative following the insertion of a permanent pacemaker. Which of the following instructions should the nurse include? (Select all that apply)
A. Do not have a microwave oven in the home.
B. Request to be scanned with a handheld metal detector when in the airport.
C. Count your pulse for 1 min each morning.
D. Do not wear tight clothing over the insertion area.
E. Resume activities that can cause jolting, such as horseback riding, after 4 weeks.
C. Count your pulse for 1 min each morning.
D. Do not wear tight clothing over the insertion area.
The nurse is caring for the client immediately following the insertion of the permanent pacemaker.
Complete the following sentence by using the list of options.
The nurse should monitor the client for _____ and ______ following permanent pacemaker placement.
Incision Site Bleeding
Bradycardia
Bow Tie
What will the nurse suspect?
What will the nurse do (action)?
What will the nurse monitor?
ventricular tachycardia
action:
- EKG
- prepare for cardioversion
monitor:
- heart rate
- potassium
