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Med Surg 3 > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

What happens during diastole?

A

atria and ventricles are relaxed and filling with blood

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2
Q

What happens during systole?

A

atria and ventricles contract and eject blood

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3
Q

What happens during the P wave?

A

atrial depolarization (contracts)

before each QRS complex

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4
Q

What happens during the PR interval?

A

impulse travels down AV node and purkinje fibers to next segment (QRS)

starts at P wave to beginning of QRS

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5
Q

What does an issue with the PR interval indicate?

A

heart block

long pr interval

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6
Q

What happens during the QRS complex?

A

ventricular depolarization (contracts)

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7
Q

What happens during the ST segment?

A

ventricular depolarization complete and beginning of ventricular repolarization

line should be flat (no depression or elevation)

end of S to start of T

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8
Q

What happens during the T wave?

A

ventricular repolarization (relaxes)

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9
Q

What happens during the QT interval?

A

time it takes for signals to cause ventricles to contract and rest

starts at QRS and ends after T wave

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10
Q

How to assess a normal sinus rhythm EKG strip?

A
  • 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
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11
Q

What causes sinus bradycardia?

A

vagal maneuver
medications

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12
Q

What is the treatment of sinus bradycardia?

A
  • Atropine 1mg (3 doses max)
  • Transcutaneous pacing if meds aren’t working
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13
Q

Describe sinus tachycardia on an EKG strip

A

same as normal sinus rhythm

except
rate: rapid
QRS: not normal
ST seg: elevated

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14
Q

What is the treatment of sinus tachycardia?

A

beta blockers
Ca channel blockers

but always treat cause of symptoms

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15
Q

Describe supraventricular tachycardia (SVT) on an EKG strip

A

rate: rapid (150-220)
P wave absent

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16
Q

What can cause SVT?

A

stimulants
strenuous exercise
hypoxia
heart disease

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17
Q

What is the treatment of SVT?

A

vagal maneuver
adenosine (rapid push and flush) 6mg
cardioversion if doesn’t meds don’t work

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18
Q

What 2 cardiac rhythms are at high risk for stroke? Why?

A

atrial flutter and atrial fibrillation

blood is not moving

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19
Q

Describe atrial flutter on an EKG strip

A

P waves: multiple “sawtooth”
QRS: normal

atrial tachycardia
irregular palpitations
irregular HR

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20
Q

What can cause atrial flutter?

A

heart failure
pulmonary HTN
CAD

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21
Q

What is the treatment of atrial flutter?

A

amiodarone (antiarrhythmic) + lidocaine

beta blocker
Ca channel blockers
anticoagulants
cardioversion if doesn’t meds don’t work

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22
Q

Describe atrial fibrillation on an EKG strip

A

fibrillatory or quivering P waves (not identifiable)
irregular rhythm
PR interval: not measurable

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23
Q

What can cause atrial fibrillation?

A

heart failure
pulmonary HTN
CAD

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24
Q

What is the treatment of atrial fibrillation?

A

amiodarone + lidocaine

beta blocker and ca channel blocker

cardioversion if doesn’t meds don’t work

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25
Q

If nurse wants to lower the heart rate of a patient, what should the nurse be aware of in terms of medications and BP?

A

beta blockers and ca channel blockers can be given, ONLY IF, BP is controlled

these meds lower BP, safer to give amiodarone and lidocaine

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26
Q

Describe ventricular tachycardia on an EKG strip

A

no P waves
wide QRS
rapid

pts cannot be in vtach for long bc then they will go pulseless

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27
Q

What is the cause of vtach?

A

post MI
hypoxia
low potassium
low magnesium

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28
Q

What is the treatment of vtach?

A

always check pulse

pulse: beta blockers, ca channel blockers, amiodarone, cardioversion

no pulse: chest compressions, defibrillation, epinephrine

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29
Q

What rhythms are considered shockable rhythms?

A

pulseless vtach and vfib

30
Q

Describe torsades de pointes on an EKG

A

prolonged QT interval
polymorphic vtach

31
Q

What causes torsades de pointes?

A

low magnesium
post MI
hypoxia
prolonged QT interval

32
Q

What is the treatment for torsades de pointes?

A

magnesium

no pulse: compressions, defibrillation, epi

33
Q

Describe ventricular fibrillation on an EKG

A

ventricle quivering
no effective contraction
electrical activity present

34
Q

What causes vfib?

A

untreated vtach
post mi
electrolyte imbalance

35
Q

What is the treatment of vfib?

A

Check pulse and leads

no pulse: compressions, defibrillation, epi

36
Q

Describe a first degree heart block

A

PR interval is consistent/same, but longer than 0.20

asymptomatic

37
Q

Describe a second degree type 1 heart block

A

PR interval will be long, then longer, then QRS dropped (blocked)

“pt is in wenckebach”

asymptomatic, bradycardia

38
Q

Describe a second degree type 2 heart block

A

PR interval is consistent, consistent, QRS dropped (blocked)

symptomatic: decreased cardiac output

39
Q

Describe a third degree heart block

A

atria and ventricles are not communicating, contract independently

40
Q

Describe asystole on an EKG strip

A

flatline
no ventricular electrical activity

41
Q

What is the treatment of asystole?

A

CPR
epinephrine

42
Q

Describe pulseless electrical activity (PEAs)

A
  • no electrical activity
  • can look like any rhythm
43
Q

What is the treatment of PEAs?

A

CPR
epinephrine

44
Q

What rhythms are cardioversion used for?

A

vtach w/ pulse
SVT
afib
a flutter

45
Q

What is cardioversion?

A

synchronized with R wave to deliver countershock

46
Q

What are the precautions for cardioversion?

A
  • 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
47
Q

What rhythms will require a pacemaker?

A

bradycardia

48
Q

What If a pacer spike comes before the P wave, what rhythm is this considered?

A

atrial paced rhythm

49
Q

What if a pacer spike comes before QRS complex, what rhythm is this considered?

A

ventricular paced rhythm

50
Q

What if a pacer spike comes before the P wave and before QRS complex, what rhythm is this considered?

A

dual chamber (AV) paced rhythm

51
Q

What should you teach a patient who has an implantable cardioverter defibrillator (ICD)?

A
  • check pulse 1 min everyday
  • report infection
  • avoid lifting, driving, contact sports
  • no tight clothes
  • avoid magnets
  • know what to do if ICD fires
52
Q

What is radiofrequency catheter ablation therapy?

A
  • for afib and aflutter
  • catheter burns pathways in atria
  • invasive
  • postop similar to cardiac cath
53
Q

What is an adverse effect of hypertension medication?

A

hypotension

54
Q

A person with premature ventricular contraction will display what symptoms?

A

irregular pulsations
light headedness

55
Q

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.

A

D. Different apical and radial pulses.

56
Q

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

A

C. MRI of the chest

57
Q

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.

A

B. The client should hold his cell phone on the side opposite the ICD.

58
Q

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.

A

D. Prevents dysrhythmias.

59
Q

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

A

D. Atropine

60
Q

What is a symptom of bradycardia?

A

lightheadedness

(poor perfusion)

61
Q

If a patient has no pulse, what will you use?

If a patient has a pulse what will you use?

A

no pulse: defibrillator

pulse: cardioversion

62
Q

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

a. Approve the student to participate on the soccer team.

63
Q

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.

A

c. Hold the scheduled metoprolol (Lopressor) and call the health care provider.

64
Q

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

A

d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due

65
Q

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.

A

c. Give supplemental O2 at 2 to 3 L/min via nasal cannula.

66
Q

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.

A

b. Start cardiopulmonary resuscitation(CPR).

67
Q

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

A. Atrial fibrillation

68
Q

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

A. Inspect the electrode pads
B. Instruct the client not to talk during the test

69
Q

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.

A

C. Count your pulse for 1 min each morning.
D. Do not wear tight clothing over the insertion area.

70
Q

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.

A

Incision Site Bleeding
Bradycardia

71
Q

Bow Tie

What will the nurse suspect?
What will the nurse do (action)?
What will the nurse monitor?

A

ventricular tachycardia

action:
- EKG
- prepare for cardioversion

monitor:
- heart rate
- potassium

Med Surg 3 (8 decks)

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