Deck 25: Nursing Care of Patients With Cardiac Dysrhythmias

Question 1

The nurse is conducting a community health screening. Which individual should the nurse recognize as being the highest risk for atrial fibrillation?

A)A 44-year-old obese male with asthma
B)A 62-year-old male smoker with a history of rheumatic heart disease
C)A 56-year-old female with diabetes who has elevated cholesterol levels
D)A 68-year-old female with Parkinson disease who takes carbidopa-levodopa (Sinemet)

Answer 1

A 62-year-old male smoker with a history of rheumatic heart disease

Question 2

The nurse is reinforcing teaching for a patient who has a pacemaker. Which measure should the nurse include when explaining how the pulse should be monitored?

A)Take radial pulse for 1 minute.
B)Take apical pulse for 1 minute.
C)Take jugular pulse for 30 seconds.
D)Take brachial pulse for 30 seconds.

Answer 2

Take radial pulse for 1 minute.

Question 3

The nurse is preparing to administer digoxin (Lanoxin). The nurse assesses the apical pulse and notes a rate of 54 beats/min. Which action should the nurse take?

A)Notify the health care provider (HCP).
B)Prepare to administer atropine sulfate.
C)Administer the medication.
D)Withhold the medication.

Answer 3

Notify the health care provider (HCP).

Question 4

The nurse is caring for a patient who develops sinus tachycardia. What action should the nurse take?

A)Inform the registered nurse (RN) promptly.
B)Turn the patient onto the left side.
C)Recheck vital signs in 15 minutes.
D)Have the patient cough forcefully.

Question 5

A patient is diagnosed with ventricular fibrillation. For which emergency intervention should the nurse anticipate preparing?

A)Defibrillation
B)Endotracheal intubation
C)Synchronized cardioversion
D)Cardiopulmonary resuscitation

Question 6

The nurse is caring for a patient in respiratory acidosis who also had a myocardial infarction (MI). For which rhythm should the nurse assess?

A)Ventricular fibrillation
B)Atrial fibrillation
C)Ventricular tachycardia
D)Atrial flutter

Question 7

The nurse is reviewing orders for a patient and notes an order for epinephrine. Which medication in the patient's history should cause the nurse to question this order?

A)Propranolol (Inderal)
B)Amlodipine (Norvasc)
C)Lisinopril (Prinivil)
D)Verapamil (Calan)

Question 8

The nurse is sitting at the desk watching the telemetry monitors and notes a patient's rhythm suddenly shows asystole. Which action should the nurse take first?

A)Start cardiopulmonary resuscitation (CPR).
B)Document the rhythm as normal.
C)Prepare to administer adenosine (Adenocard).
D)Prepare the patient for cardioversion.

Question 9

The nurse is reinforcing teaching for a patient with premature ventricular contractions (PVCs) and is being discharged. Which lifestyle recommendation should be the most important for the nurse to include?

A)"It is important for you to drink decaffeinated beverages."
B)"You should increase the amount of exercise you do each day."
C)"It is important for you to reduce the amount of fat in your diet."
D)"Weight gain and fluid retention are likely causing your abnormal heart rhythm."

Question 10

A patient is experiencing palpitations that are found to be PVCs. Which manifestation should the nurse expect to observe in this patient?

A)Headache
B)Confusion
C)Lightheadedness
D)Tingling of extremities

Question 11

The nurse is reading a cardiac monitor of a patient and observes a regular rhythm, a flutter of P waves with a sawtooth pattern, QRS interval 0.08 second, and an atrial rate of 300 beats/min. The nurse recognizes this as which arrhythmia?

A)Atrial fibrillation
B)Atrial flutter
C)Sinus tachycardia
D)Ventricular tachycardia

Question 12

The nurse is caring for a patient receiving warfarin (Coumadin). Which finding would be of most concern to the nurse?

A)The patient reports blood in the urine.
B)The patient reports nausea.
C)The patient's apical heart rate is 72 beats/min.
D)The patient has a dry cough.

Question 13

The nurse notices that the ST segment is depressed on a patient reporting chest pain. What action should the nurse take?

A)Review the electrocardiogram (ECG) recordings in the patient's chart.
B)Auscultate chest sounds and continue physical assessment.
C)Alert the supervising RN and patient's physician immediately.
D)Continue to monitor the ECG to determine if ST segment depression continues.

Question 14

The nurse observes two PACs in 1 minute on a patient's cardiac monitor. The patient is asymptomatic. What action is required by the nurse?

A)Administer digoxin (Lanoxin).
B)Notify the physician.
C)Continue monitoring the patient.
D)Take vital signs every 15 minutes.

Question 15

The nurse is reinforcing teaching for a patient who has had a pacemaker implanted in the right side of the chest. Which patient statement indicates correct understanding of the discharge teaching?

A)"I may lift 20 pounds safely."
B)"I may move my arm freely."
C)"I may resume normal activity in 1 week."
D)"Grounded microwave ovens may be safely used."

Question 16

The nurse is caring for a group of patients on the telemetry unit. Which patient should the nurse see first?

A)A patient with sinus bradycardia with a heart rate of 58 beats/min
B)A patient with sinus tachycardia with a heart rate of 104 beats/min
C)A patient with premature atrial contractions who is asymptomatic
D)A patient with atrial fibrillation reporting dyspnea

Question 17

The nurse is reviewing laboratory results for a patient receiving warfarin (Coumadin) and notes the international normalized ratio (INR) is 6.

A)Adenosine (Adenocard)
B) Which medication should the nurse prepare to administer?
C)Lidocaine (Xylocaine)
D)Vitamin K
E)Atropine sulfate

Question 18

The nurse is caring for a group of patients. Which patient is at risk for developing premature atrial contractions (PACs)?

A)A 40-year-old smoker who takes digoxin (Lanoxin)
B)A 50-year-old who occasionally drinks alcohol who takes atenolol (Tenormin)
C)A 60-year-old with sinus tachycardia who takes diltiazem (Cardizem)
D)A 70-year-old with atrial flutter who metoprolol succinate (Lopressor)

Question 19

The nurse is reviewing the cardiac strip for a patient and notes the following: No identifiable P waves, QRS complex measures 0.06 second and irregular, and heart rate 120 beats/min. The nurse should interpret this as which arrhythmia?

A)Normal sinus rhythm
B)Atrial fibrillation
C)Sinus bradycardia
D)Ventricular fibrillation

Question 20

After reviewing an electrocardiogram, the nurse determines that an electrical impulse originated in a patient's sinoatrial node. What did the nurse see on this tracing?

A)An upright T wave
B)An inverted T wave
C)A positive P wave before a QRS complex
D)A negative P wave before a QRS complex

Question 21

Place in order, from 1 to 5, the sequence for normal electrical impulse movement through the cardiac conduction system.

A) ____ Internodal tracts
B) ____ SA node
C) ____ AV node
D) ____ Purkinje fibers
E) ____ Bundle of His

Question 22

A patient recovering from an acute MI has a heart rate of 30 beats/min. Which area of the heart should the nurse consider as pacing this patient's heart rate?

A)SA node
B)Ventricular rate
C)Aortic valve rate
D)Atrioventricular (AV) node

Question 23

The nurse is reinforcing discharge teaching for a patient who has had a permanent pacemaker inserted. What is important for the nurse to include? (Select all that apply.)

A)Patient should avoid all grounded appliances.
B)Patient should wear medical alert identification.
C)Patient should avoid magnetic fields and high voltage.
D)Patient should avoid lifting anything more than 10 pounds.
E)Patient may return to normal activities, including sports, in 3 weeks.
F)Patient should report dizziness, irregular heartbeats, and palpitations.

Question 24

The nurse is caring for a patient with failure of the SA node and the AV node is unable to initiate an impulse. The ventricular rate ranges from 20 to 40 beats/min. Which clinical manifestations can the nurse expect to document? (Select all that apply.)

A)Dyspnea
B)Decreased level of consciousness
C)Syncope
D)Energetic
E)Chest pain

Question 25

Place in order, from 1 to 6, the six-step process for arrhythmia interpretation.

A) ____ QRS interval
B) ____ P waves
C) ____ Heart rate
D) ____ Regularity of the rhythm
E) ____ PR Interval
F) ____ QT interval

Question 26

The nurse is preparing to administer atropine sulfate (Atropine) 2 mg IV. Available vials are 0.4 mg/mL. How many mL will the nurse administer? Enter the numeral only.

Question 27

The nurse is preparing to administer adenosine (Adenocard) 6 mg IV. Available is 6 mg/2 mL. How many mL will the nurse administer? Enter the numeral only.

Question 28

The nurse is caring for a patient recovering from cardioversion. For what should the nurse monitor in this patient? (Select all that apply.)

A)Skin burns
B)Blood pressure
C)Sensory disturbances
D)Respiratory problems
E)Rhythm disturbances
F)Changes in ST segment

Question 29

The nurse is reviewing laboratory results for a patient with ventricular fibrillation. The nurse should anticipate which finding?

A)Sodium 140 mEq/L
B)Magnesium 1.7 mEq/L
C)Calcium 9.1 mg/dL
D)Potassium 7.8 mEq/L

Question 30

The nurse is interpreting a cardiac strip. The strip reveals a regular QRS complex and regular P wave. The PR interval is 0.16 second and the QRS complex measures 0.06 second. The patient's heart rate is 62 beats/min. Which is the correct interpretation of this rhythm?

A)Sinus bradycardia
B)Atrial flutter
C)Normal sinus rhythm
D)Atrial fibrillation