Deck 57: Management of Clients with Dysrhythmias

Question 1

If a client admitted to the hospital for treatment of atrial fibrillation complains of dyspnea and chest pain, the nurse would suspect

A) heart block.
B) myocardial infarction.
C) pulmonary edema.
D) pulmonary emboli.

Answer 1

pulmonary emboli.

Question 2

The client who is to receive cardioversion in 3 days for treatment of continuous atrial fibrillation has laboratory values of Na 139 mEq/L, K 4.0 mEq/L, and Cl 98 mEq/L and is receiving digoxin 0.125 mg daily. Before the procedure the nurse would

A) confirm an order for a digoxin level before cardioversion.
B) monitor blood pressure more frequently.
C) notify the physician regarding the potassium level.
D) proceed with preparation for cardioversion.

Answer 2

confirm an order for a digoxin level before cardioversion.

Question 3

The client's ECG shows normal-appearing P waves that occur at regular intervals. Every third impulse from the atria is missing a QRS complex. The nurse would recognize this pattern as the dysrhythmia of

A) first-degree AV block.
B) second-degree AV block.
C) third-degree AV block.
D) fourth-degree AV block.

Answer 3

second-degree AV block.

Question 4

A client is being discharged with a prescription for procainamide to treat atrial fibrillation. An important self-care measure the nurse would explain about this medication is to

A) avoid milk products.
B) drink large amounts of citrus juice.
C) have blood pressure monitored frequently.
D) take the medication with meals.

Question 5

The nurse working on a telemetry floor would recognize that most dangerous dysrhythmias are

A) atrial dysrhythmias.
B) junctional dysrhythmias.
C) nodal dysrhythmias.
D) ventricular dysrhythmias.

Question 6

The nurse would assess a heart rate of 55 beats/min as a normal finding in a client who

A) is an athlete.
B) is obese.
C) takes a diuretic.
D) weighs less than 90 pounds.

Question 7

When a client in the CCU develops ventricular tachycardia and loses consciousness, the priority action by the nurse would be to immediately administer

A) defibrillation.
B) lidocaine.
C) quinidine.
D) verapamil.

Question 8

When a client in the cardiac care unit (CCU) suddenly develops paroxysmal atrial tachycardia (PAT) of 200 beats/min and clinical manifestations of severe dizziness, the nurse would help decrease the heart rate by

A) administering digitalis intravenously.
B) asking the client to perform the Valsalva maneuver.
C) increasing the client's oxygen.
D) lowering the head of the bed.

Question 9

When a client develops sinus bradycardia after a myocardial infarction (MI), the nurse would anticipate the administration of

A) atropine.
B) digitalis.
C) procainamide.
D) propranolol.

Question 10

A client with a serum potassium level of 6.6 mEq/L would have a characteristic ECG configuration of

A) increased PR interval.
B) inverted QRS complex.
C) no change.
D) tall T wave.

Question 11

If the first defibrillation shock at 200 J is not successful on a client with ventricular fibrillation, the nurse in charge of the code would

A) administer a second shock at 300 J.
B) reinitiate CPR.
C) reposition the client and shock at 200 J.
D) set the defibrillator to synchronous.

Question 12

A client's ECG reveals a rapid atrial rate of 300 beats/min, and the P waves resemble a picket fence without 1:1 conduction. The nurse would identify this dysrhythmia as

A) atrial fibrillation.
B) atrial flutter.
C) paroxysmal atrial tachycardia.
D) sinoatrial block.

Question 13

The nurse would explain to a client who has a demand pacemaker in place that this pacemaker functions by

A) demanding the heart to contract at a preset rate.
B) firing after the SA node has started the cycle.
C) firing if the heart's electrical activity drops below a preset rate.
D) stimulating the SA node to fire.

Question 14

A client in the CCU goes into sudden ventricular fibrillation. The priority action by the nurse would be to immediately administer

A) a lidocaine bolus.
B) atropine.
C) cardiopulmonary resuscitation (CPR).
D) intravenous (IV) magnesium.

Question 15

The nurse would be most concerned about premature ventricular contractions (PVCs) that

A) are uniform in appearance.
B) fall on a T wave.
C) occur at a rate of four per minute.
D) occur with angina.

Question 16

The nurse would clarify to a client that sinus arrest differs from sinus block in that with sinus arrest, the

A) atrial focus totally takes over pacing responsibility.
B) atrioventricular (AV) node is the primary pacemaker.
C) rhythm is regular.
D) sinoatrial (SA) node occasionally fails to fire.

Question 17

At the ambulatory care clinic, the nurse counseling a client who has presented with frequent episodes of paroxysmal atrial tachycardia would advise the client to

A) avoid all aspirin and nonsteroidal anti-inflammatory drugs.
B) eat a low-salt, low-fat diet that contains plenty of fiber.
C) get 30 minutes of exercise and drink six glasses of water per day.
D) quit smoking and avoid caffeine and alcohol.

Question 18

The nurse quickly calculating a client's heart rate by examining the electrocardiogram (ECG) would count the number of

A) large squares between P waves and multiply by 10.
B) large squares between R waves and multiply by 10.
C) P waves in a 6-inch strip and multiply by 5.
D) R waves in a 6-inch strip and multiply by 10.

Question 19

A client with no history of heart disease is seen in the clinic for periodic episodes of tachycardia with a regular rate. When taking the nursing history, the nurse would question the client about the existence of

A) asthma.
B) diabetes.
C) stress.
D) weight gain.

Question 20

When the nurse in charge of the code is ready to defibrillate a client, the nurse assisting with the defibrillation would

A) assess for unresponsiveness.
B) continue to perform CPR.
C) prepare to administer lidocaine.
D) stand away from the bed.

Question 21

Before a client receives cardioversion, the nurse should ensure that the client

A) ate only a light breakfast.
B) has signed a consent form.
C) is not wearing jewelry.
D) skipped today's digoxin dose.

Question 22

When the normal pacemaker is impaired and latent pacemaker cells in the AV node initiate the cardiac cycle, the nurse would clarify that this pacemaker is called the

A) altered pacemaker.
B) delayed pacemaker.
C) escape pacemaker.
D) junctional pacemaker.

Question 23

A young athletic client has occasional episode of syncope. On further questioning, the nurse discovers the client has several relatives who had sudden cardiac death. The nurse should suggest the client be screened for

A) atrial dysrhythmias.
B) familial sudden cardiac death syndrome.
C) long QT syndrome.
D) ventricular dysrhythmias.

Question 24

A client is being discharged after unsuccessful cardioversion for atrial fibrillation. An important self-care measure the nurse should include in the discharge teaching plan is to tell the client to

A) be sure to get plenty of rest balanced with activity.
B) not eat too much red meat and other high-fat foods.
C) reschedule the cardioversion in 2 weeks.
D) take the Coumadin as scheduled.

Question 25

A client is being discharge after having a pacemaker implantation. Self-care instructions the nurse should provide the client include (Select all that apply)

A) carry a pacemaker identification card with you; wear a medical alert bracelet.
B) do not lift more than 5-10 pounds for the first 2 weeks after discharge.
C) take your pulse as directed and notify the doctor if it is less than the pacer rate.
D) you can safely operate most appliances, tools, and office equipment.

Question 26

For a client being prepared to receive an automatic implantable cardioverter-defibrillator (AICD) after surviving two episodes of ventricular fibrillation, the nurse would address the client's

A) acute pain.
B) anxiety.
C) fatigue.
D) decreased cardiac output.

Question 27

Before the insertion of a temporary pacemaker, the nurse should assess the client's (Select all that apply)

A) anxiety level.
B) coping mechanisms.
C) knowledge level.
D) past experience with temporary pacers.

Question 28

To prevent possible complications from cardioversion, before administering the shock, the nurse would ensure that the (Select all that apply)

A) emergency equipment is nearby and in working order.
B) joules are set to 50-100 joules initially on a monophasic machine.
C) machine is set to synchronize with the client's QRS complex.
D) the Code Blue team has arrived and is prepared.