Question 1

A patient develops sinus bradycardia at a rate of 32 beats/minute,has a blood pressure (BP)of 80/42 mm Hg,and is complaining of feeling faint.Which actions should the nurse take next?

Accepted Answer

The patient 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 maneuver will further decrease the rate.

Question 2

A patient who was admitted with a myocardial infarction experiences a 45-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 patient has significant ventricular irritability,and antidysrhythmic medication administration is needed to prevent further episodes.The nurse should notify the health care provider after the medication is started.Defibrillation is not indicated given that the patient is currently in a sinus rhythm.Documentation and continued monitoring are not adequate responses to this situation.

Question 3

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm.Which method will be best to use?

Accepted Answer

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

Question 4

Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD)inserted indicates a need for more education about care of patients with ICDs?

Accepted Answer

The patient 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 patient.

Question 5

A patient has a junctional escape rhythm on the monitor.The nurse will expect the patient to have a heart rate of _____ 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 to 60 beats/minute.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 node to discharge.The normal SA node rate is 60 to 100 beats/minute.

Question 6

When analyzing the rhythm of a patient's electrocardiogram (ECG),the nurse will need to investigate further upon finding a(n)

Accepted Answer

Because the normal QRS interval is 0.04 to 0.10 seconds,the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged.The P-R interval and Q-T interval are within normal range,and ST segment should be isoelectric (flat).

Question 7

Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs)is most important for the nurse to communicate to the health care provider?

Accepted Answer

Hypokalemia increases 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 abnormality.Although the other laboratory values also are abnormal,they are not likely to be the etiology of the patient's PVCs and do not require immediate correction.

Question 8

After the nurse gives IV atropine to a patient with symptomatic type 1,second-degree atrioventricular (AV)block,which finding indicates 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 patient does not have premature atrial or ventricular contractions.

Question 9

A 20-year-old has a mandatory electrocardiogram (ECG)before participating on a college soccer team and is found to have sinus bradycardia,rate 52.Blood pressure (BP)is 114/54,and the student denies any health problems.What action by the nurse is most appropriate?

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 family's health history.Dyspnea during an aerobic activity such as soccer is normal.

Question 10

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg?

Accepted Answer

When a patient 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).Assisted ventilations are not indicated for this patient.

Question 11

A patient has ST segment changes that support an acute inferior wall myocardial infarction.Which lead would be best for monitoring the patient?

Accepted Answer

Leads II,III,and AVF reflect the inferior area of the heart and the ST segment changes.Lead II will best capture any electrocardiographic (ECG)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 in that area.

Question 12

After providing a patient with discharge instructions on the management of a new permanent pacemaker,the nurse knows that teaching has been effective when the patient states

Accepted Answer

The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads.The patient 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 13

To determine whether there is a delay in impulse conduction through the atria,the nurse will measure the duration of the patient's

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 fibers.The QRS represents ventricular depolarization.The Q wave is the first negative deflection following the P wave and should be narrow and short.

Question 14

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days.The priority teaching needed for this patient would include information about

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.Cardioversion may be done after several weeks of anticoagulation therapy.Adenosine is not used to treat atrial fibrillation.Pacemakers are routinely used for patients with bradydysrhythmias.Information does not indicate that the patient has a slow heart rate.

Question 15

A patient's cardiac monitor shows sinus rhythm,rate 64.The P-R 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 should the nurse take next?

Accepted Answer

The patient has progressive first-degree atrioventricular (AV)block,and the â-blocker should be held until discussing the medication with the health care provider.Documentation and assessment are appropriate but not fully adequate responses.The patient 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 patient is symptomatic.

Question 16

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves,P-R interval not measurable,ventricular rate 162,R-R interval regular,and QRS complex wide and distorted,QRS duration 0.18 second.The nurse interprets the patient's cardiac rhythm as

Accepted Answer

The absence of P waves,wide QRS,rate >150 beats/minute,and the regularity of the rhythm indicate ventricular tachycardia.Atrial flutter is usually regular,has a narrow QRS configuration,and has flutter waves present representing atrial activity.Sinus tachycardia has P waves.Ventricular fibrillation is irregular and does not have a consistent QRS duration.

Question 17

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute.The nurse determines that the P-R interval is 0.24 seconds.The most appropriate intervention by the nurse would be to

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 18

The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected,has no visible P wave,and has a QRS complex that is wide and bizarre in shape.How will 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 ventricular couplets.There is no indication that the premature ventricular contractions (PVCs)are multifocal or that the R-on-T phenomenon is occurring.

Question 19

A patient's cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern.The patient is unconscious and pulseless.Which action should the nurse take first?

Accepted Answer

The patient'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 patient to a better rhythm,the other actions may be appropriate.

Question 20

Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency catheter ablation for treatment of atrial flutter?

Accepted Answer

Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of atrial flutter (i.e.,restore normal sinus rhythm)and tachydysrhythmias.All other statements regarding the procedure are incorrect.

Quiz 32: Nursing Management: Ecg Monitoring and Arrhythmias

A patient develops sinus bradycardia at a rate of 32 beats/minute,has a blood pressure (BP) of 80/42 mm Hg,and is complaining of feeling faint.Which actions should the nurse take next?