Question 1

The nurse is caring for a client who has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the P-R interval is 0.24 seconds. Which of the following actions should the nurse implement?

Accepted Answer

First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.

Question 2

Which of the following laboratory results for a client whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?

Accepted Answer

Electrolyte imbalances increase the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation; the health care provider will need to prescribe a potassium infusion to correct this hypokalemia. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the client's PVCs and do not require immediate correction.

Question 3

The nurse is caring for a young adult client who had a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54 mm Hg, and the student denies any health problems. Which of thefollowing actions by the nurse is best?

Accepted Answer

In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the health history. Dyspnea during an aerobic activity such as swimming is normal.

Question 4

The nurse is interpreting an ECG strip to determine whether there is a delay in impulse conduction through the atria. Which of the following components of an ECG strip should the nurse measure?

Accepted Answer

The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibres. The QRS represents ventricular depolarization. The Q-T interval represents depolarization and repolarization of the entire conduction system.

Question 5

The nurse is caring for a client whose cardiac monitor shows sinus rhythm, rate 60-70. The P-R interval is 0.18 seconds at 1:00 A.M., 0.20 seconds at 2:30 P.M., and 0.23 seconds at 4:00 P.M. Which of the following actions should the nurse take at this time?

Accepted Answer

The client has progressive first-degree atrioventricular (AV) block, and the ?-blocker should be held until discussing the medication with the health care provider.
Documentation and assessment are appropriate but not fully adequate responses. The client with first-degree AV block usually is asymptomatic, and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this client is symptomatic.

Question 6

Aclient has a junctional escape rhythm on the monitor. The nurse will expect the client to have a heart rate of how many beats/minute?

Accepted Answer

If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40-60. The slower rates are typical of the bundle of His and the Purkinje system and may be seen with failure of both the SA and AV nodes to discharge. The normal SA node rate is 60-100 beats/minute.

Question 7

The nurse is caring for a client with dilated cardiomyopathy who has an atrial fibrillation that has been unresponsive to drug therapy for several days. Which of the following actions should the nurse anticipate?

Accepted Answer

Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion; this is done to prevent embolization of clots from the atria. Adenosine is not used to treat atrial fibrillation.
Cardioversion may be done after several weeks of Coumadin therapy. ICDs are used for clients with recurrent ventricular fibrillation.

Question 8

The nurse notes that a client's cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How should the nurse document the rhythm?

Accepted Answer

Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as couplets. There is no indication that the premature ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.

Question 9

The nurse is caring for a client who was admitted with a myocardial infarction and experiences a 50-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following actions should the nurse take next?

Accepted Answer

The burst of sustained ventricular tachycardia indicates that the client has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes and accelerate repolarization. The nurse should notify the health care provider after the medications are administered. Defibrillation is not indicated given that the client is currently in a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation.

Question 10

The nurse needs to estimate quickly the heart rate for a client with a regular heart rhythm. Which of the following methods is best to use?

Accepted Answer

This is the quickest way to determine the ventricular rate for a client with a regular rhythm. All the other methods are accurate, but take longer.

Question 11

The nurse is caring for a client whose cardiac monitor has a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The client is unconscious and pulseless. Which of the following actions should the nurse take first?

Accepted Answer

The client's rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the client to a better rhythm, the other actions may be appropriate.

Question 12

The nurse obtains a monitor strip on a client who has had a myocardial infarction and makes the following analysis: P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. Which of the following cardiac rhythms should the nurse interpret from these findings?

Accepted Answer

The absence of P waves, wide QRS, rate >150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has Pwaves.
Ventricular fibrillation is irregular and does not have a consistent QRSduration.

Question 13

The nurse is caring for a client who has a ST segment change that indicates an acute inferior wall myocardial infarction. Which of the following leads is best for monitoring the client?

Accepted Answer

Lead II reflects the inferior area of the heart that is experiencing the ST segment changes and will best reflect any electrocardiographic changes that indicate further damage to the myocardium. The other leads do not reflect the inferior part of the myocardial wall and will not provide data about further ischemic changes.

Question 14

When analyzing the waveforms of a client's electrocardiogram (ECG), the nurse will need to investigate further upon assessing which of the following findings?

Accepted Answer

Because the normal QRS interval is 0.04-0.10 seconds, the client's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval, Q-T interval, and T-wave interval are within the normal range.

Question 15

Which of the following information will the nurse include when teaching a client who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response?

Accepted Answer

The permanent pacemaker will discharge when the ventricular rate drops below the set rate. The pacemaker will not decrease ventricular irritability or discharge if the client develops ventricular fibrillation. Since the client has a slow ventricular rate, overdrive pacing will not be used.

Question 16

The nurse is caring for a client who develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and symptoms of feeling faint. Which of the following actions should the nurse take?

Accepted Answer

The client is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva manoeuvre will further decrease the rate.

Question 17

Which of the following actions should the nurse take when preparing for cardioversion of a client with supraventricular tachycardia who is alert and has a blood pressure of 110/66 mm Hg?

Accepted Answer

When a client has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). CPR is not indicated for this client.

Question 18

Which of the following actions by a new nurse who is caring for a client who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of clients with ICDs?

Accepted Answer

The client should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this client.

Question 19

The nurse is providing instruction to a client on the management of a new implantable cardioverter-defibrillator (ICD). Which of the following client statements indicate that the teaching has been effective?

Accepted Answer

The client is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The client should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period.

Question 20

The nurse administers IV atropine to a client with symptomatic type 1, second-degree atrioventricular (AV) block. Which of the following findings indicate that the medication has been effective?

Accepted Answer

Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The client does not have ventricular ectopy or premature contractions.

Quiz 38: Nursing Management Dysrhythmias