Deck 26: Cardiac Care

Question 1

The nurse is obtaining a 12-lead ECG on a patient with chest discomfort and interprets the results as a very thick-lined waveform tracing.The nurse troubleshoots this tracing by performing which appropriate intervention?

A) Unplugs the battery-operated equipment in the room one item at a time.
B) Reapplies the electrodes to ensure proper connection with the skin.
C) Adjusts the extremity electrodes on the wrists and ankles.
D) Asks the patient to hold his or her breath to see if the tracing improves.

Answer 1

Unplugs the battery-operated equipment in the room one item at a time.

Question 2

The nurse changes the electrocardiogram (ECG)electrodes on a patient who is on a continuous cardiac monitor.The patient tells the nurse that the electrodes were just changed the previous day.Which of the following rationales is the correct explanation for the nurse to share with the patient?

A) Changing the electrodes more often than every 24 hours can result in skin breakdown.
B) It is not necessary to change the electrodes daily.
C) It was not documented that the electrodes were changed.
D) Changing the electrodes daily will decrease the number of false alarms.

Answer 2

Changing the electrodes daily will decrease the number of false alarms.

Question 3

The nurse understands that it is a priority to obtain the 12-lead electrocardiogram (ECG)on the patient newly admitted with chest pain because the ECG must be obtained within how many minutes of the onset of pain?

A) 3 minutes
B) 5 minutes
C) 8 minutes
D) 10 minutes

Answer 3

10 minutes

Question 4

Proper placement of the electrocardiogram (ECG)electrodes is essential for which reason?

A) To ensure real-time detection of arrhythmias
B) To prevent painful removal of the electrodes
C) To facilitate capture of all leads
D) To reduce ventricular arrhythmias

Question 5

While the nurse is performing a 12-lead electrocardiogram (ECG)tracing,the patient complains of crushing chest pain.The nurse recognizes that the timing of the chest pain is important to note for which of the following reasons?

A) The 12-lead ECG must be held until the pain is relieved and continued as soon as it passes.
B) The physician will order a follow-up ECG exactly 5 minutes post the last episode of chest pain.
C) It helps correlate the ECG changes to symptoms of chest pain.
D) The ECG tracing must be stopped immediately.

Question 6

The nurse is assessing several patients who have returned from surgery when a 12-lead electrocardiogram (ECG)is ordered for a newly admitted patient.Prioritizing patient needs,the nurse determines that obtaining the 12-lead ECG can be most appropriately delegated to which member of the health care team?

A) Administrative secretary
B) Another registered nurse
C) Unregulated care provider
D) Admitting physician

Question 7

To determine the patient's and caregiver's levels of understanding of the rationale for obtaining the 12-lead ECG,the nurse most effectively uses which of the following statements?

A) "Can you tell me why you need this test?"
B) "Did you experience pain during the test?"
C) "Can you tell me when the test results will be shared with you?"
D) "Can you give me your name and date of birth?"

Question 8

Identify the first step toward establishing appropriate alarms and response expectations.

A) Instructing the patient and immediate family members about the necessity of the alarms
B) Obtaining a physician's prescription for electrocardiogram (ECG)monitoring
C) Adjusting the volume of the alarms so the primary nurse can hear them
D) Determining which patients require ECG monitoring

Question 9

The nurse is caring for a 6-year-old child after open-heart surgery.When assessing the patient,the nurse notes that the position of the leads may be different in the pediatric population.Which lead placement explains this special consideration?

A) The position of the green lead can be changed to mirror one of the precordial lead positions.
B) The standard placement for V1 is at the fifth intercostal space,right sternal border.
C) The standard placement for V1 is at the fourth intercostal space,left sternal border.
D) In general,mechanisms of dysrhythmias are the same in children as they are in adults.

Question 10

The nurse is supervising a nursing student while applying electrodes for continuous cardiac monitoring to an elderly patient.The nurse recognizes the need for further education when the student makes which comment about polarity while attaching the monitor leads to the electrode?

A) White is negative.
B) Black is neutral.
C) Red is the ground lead.
D) Brown is positive.

Question 11

The student nurse is preparing to perform a 12-lead electrocardiogram (ECG)on an adult patient.Which action by the student should the nursing instructor question?

A) Cleansing and preparing the isolated electrode area with soap and water
B) Wiping the area with a rough cloth or gauze to gently scrape the area
C) Clipping the excessive hair from the electrode area
D) Using alcohol to cleanse the electrode area

Question 12

The nurse analyzes the patient's cardiac rhythm as follows: regular rhythm,rate 108 beats per minute,normal PQRST complex.The nurse interprets that the clinical significance of this cardiac rhythm is most likely related to which indication?

A) Decreased cardiac output
B) Dizziness
C) Pain
D) Syncope

Question 13

Which of the following is true about alarm fatigue?

A) There is no way to reduce alarm fatigue.
B) Alarm fatigue develops when a person is exposed to an excessive number of alarms.
C) People become more sensitized with the increased exposure to alarms.
D) Alarm fatigue does not influence response time.

Question 14

The nurse is observing a nursing student perform a 12-lead electrocardiogram (ECG)tracing on a newly admitted patient.The nurse recognizes that the student requires additional training on this skill when he or she observes which of the following erroneous lead placements?

A) V1-Fourth intercostal space at the right sternal angle
B) V2-Fourth intercostal space at the right sternal border
C) V4-Fifth intercostal space at the midclavicular line
D) V6-Left midaxillary line at the level of V4 horizontally

Question 15

The nurse is preparing to apply electrodes for continuous cardiac monitoring to a newly admitted adult with syncope.Which action by the nurse follows appropriate procedure?

A) Cleanse and prepare the chest area for electrode placement with chlorhexidine.
B) Use a blanket to cover the patient's abdomen while the limb electrodes are being placed.
C) Scrape the area to roughen the dermis layer of skin to allow electrical signals to travel more easily.
D) Place the patient in a supine position.

Question 16

The nurse has explained to the patient that a 12-lead electrocardiogram (ECG)is indicated.The patient refused to have the procedure done citing that she fears that the electrodes will cause harm to her heart.The nurse recognizes that which of the following patient rationales are contraindications for a 12-lead ECG?

A) The patient refuses the test.
B) The patient is receiving chemotherapy.
C) The patient is ordered to have nothing by mouth (NPO).
D) The patient has just been medicated for a pain level of 8 on a scale of 1 to 10.

Question 17

The nurse is caring for a patient on continuous cardiac monitoring.The nurse assesses the rhythm as regular with a normal PQRST complex and a rate of 62 beats per minute.Which analysis is the correct interpretation of this cardiac rhythm?

A) Sinus bradycardia
B) Sinus tachycardia
C) Premature bradycardia
D) Normal sinus rhythm

Question 18

The nurse is reviewing the patient's do-not-resuscitate orders when the cardiac alarm sounds.The rhythm is chaotic with no identifiable waves and the rate cannot be determined.Based on these clinical findings,the nurse determines that the patient is in which of the following cardiac rhythms?

A) Asystole
B) Ventricular fibrillation
C) Ventricular tachycardia
D) Sinus bradycardia

Question 19

When applying electrocardiogram (ECG)electrodes to a woman,it is important to give special consideration to which of the following objectives?

A) Place the electrode as close to the chest wall as possible,close to the breast tissue.
B) Place the electrode away from the chest wall,close to the breast tissue.
C) Place the electrode as close to the chest wall as possible,avoiding the breast tissue.
D) Place the electrode away from the chest way,avoiding the breast tissue.

Question 20

Reduction of alarm fatigue is an important nursing practice.The nurse addresses this concern when which of the following actions is implemented?

A) Changes the electrodes once per shift
B) Provides initial and ongoing education about the intravenous pumps
C) Monitors all patients diagnosed with cancer on continuous cardiac monitoring
D) Uses preset parameters for the pulse oximetry machine

Question 21

The nurse recognizes the following indications as appropriate for continuous cardiac monitoring: (Select all that apply.)

A) Postresuscitation patients
B) Patients with heart failure
C) Patients older than age 75 years
D) Diagnosis of arrhythmias in children

Question 22

The nurse is assessing if the patient needs a 12-lead electrocardiogram (ECG).Which of the following indications,if identified,indicates that a 12-lead ECG should be obtained? (Select all that apply.)

A) Suspected acute coronary syndromes including myocardial infarction
B) History of smoking two packs per day for 30 years
C) Evaluation of syncope
D) Disorders of the cardiac rhythm

Question 23

The nurse is obtaining a 12-lead electrocardiogram (ECG)on a patient with syncope.Which of the following actions,if taken by the nurse,are effective at reducing the presence of artifact in the ECG tracing?

A) Instruct the patient to stop talking.
B) Turn the ECG machine on after all the electrodes are applied.
C) Position the patient in semi-Fowler's position.
D) Maintain the gown on the patient to provide privacy.

Question 24

The nurse is reviewing the patient's medications and recognizes that which of the following medications can cause arrhythmias? (Select all that apply.)

A) Digoxin
B) Amlodipine
C) Amiodarone
D) Lasix

Question 25

The nurse is caring for a patient who has chest discomfort.While the nurse obtains the 12-lead electrocardiogram (ECG),the patient complains of feeling very anxious.Which of the following interventions should the nurse take in caring for the patient's anxiety? (Select all that apply.)

A) Continue to monitor the patient.
B) Reassess factors contributing to anxiety or distress.
C) Ask the caregiver to leave the room.
D) Notify the health care provider.

Question 26

The nurse identifies the appropriate equipment necessary to obtain a 12-lead electrocardiogram (ECG)and gathers the following supplies: (Select all that apply.)

A) 12-lead ECG machine
B) Clean,dry towel
C) Hair clippers
D) Betadine cleanser

Question 27

The nurse is caring for a patient on continuous cardiac monitoring who is experiencing occasional premature ventricular contractions.Which of the following actions demonstrate appropriate protocol? (Select all that apply.)

A) Review alarm trends and waveforms at least once per shift.
B) Review alarm trends and waveforms on report of an alarm.
C) Record at least one rhythm strip per shift to the patient's medical record.
D) Report any unexpected outcomes to the health care provider at the end of the shift.

Question 28

A patient is being monitored on a continuous cardiac monitor.The nurse directs the unregulated care provider (UCP)to immediately report which of the following patient findings? (Select all that apply.)

A) Patient complaints of pain
B) Shortness of breath
C) Hypotension
D) Patient's request to use the bedside commode

Question 29

The nurse is obtaining a 12-lead electrocardiogram (ECG)on a patient and notices that the ECG cannot be interpreted.Which of the following interventions are appropriate for the nurse to take? (Select all that apply.)

A) Inspect the electrodes for secure placement.
B) Reposition any wires that move as a result of patient breathing or movement.
C) Reposition electrodes that are in the correct position.
D) Remind the patient to remain still to obtain a good tracing.

Question 30

When describing the rationale for connecting electrodes to each limb and around the heart,the nurse shares with the patient which appropriate explanation?

A) The leads view a specific portion of the heart's surface to help determine which part has sustained damage.
B) Multiple leads are necessary to provide a three-dimensional view of the heart.
C) The electrodes are necessary to provide a shock to the heart if needed during cardiac conversion.
D) The limb electrodes are required to provide a backup study in the event of artifact.

Question 31

After obtaining a 12-lead electrocardiogram (ECG),the nurse records the date and time the ECG was obtained,the reason for obtaining the ECG,and who the ECG was given to for interpretation in the patient's chart.After this documentation,what is the appropriate action of the nurse?

A) Immediately report any unexpected outcomes.
B) Reposition the patient to a position of comfort.
C) Report to the unregulated care provider that the 12-lead ECG is completed.
D) Invite the caregivers to visit at the bedside.