Deck 36: Nursing Management: Dysrhythmias

Question 1

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and is complaining of feeling faint. Which action should the nurse take?

A) Continue to monitor the rhythm and BP.
B) Apply the transcutaneous pacemaker (TCP).
C) Have the patient perform the Valsalva maneuver.
D) Give the scheduled dose of diltiazem (Cardizem).

Answer 1

Apply the transcutaneous pacemaker (TCP).

Question 2

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

A) Blood glucose 228 mg/dL
B) Serum chloride 90 mEq/L
C) Serum sodium 133 mEq/L
D) Serum potassium 2.8 mEq/L

Answer 2

Serum potassium 2.8 mEq/L

Question 3

Which action 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?

A) The nurse assists the patient to do active range of motion exercises for all extremities.
B) The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet.
C) The nurse gives atenolol ( Tenormin ) to the patient without consulting first with the health care provider.
D) The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.

Answer 3

The nurse assists the patient to do active range of motion exercises for all extremities.

Question 4

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

A) 15 to 20
B) 20 to 40
C) 40 to 60
D) 60 to 100

Question 5

A patient has received instruction on the management of a new permanent pacemaker before discharge from the hospital. The nurse recognizes that teaching has been effective when the patient tells the nurse,

A) "It will be 6 weeks before I can take a bath or return to my usual activities."
B) "I will notify the airlines when I make a reservation that I have a pacemaker."
C) "I won't lift the arm on the pacemaker side up very high until I see the doctor."
D) "I must avoid cooking with a microwave oven or being near a microwave in use."

Question 6

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

A) Turn the synchronizer switch to the "off" position.
B) Perform cardiopulmonary resuscitation (CPR) until the paddles are in correct position.
C) Set the defibrillator/cardioverter energy to 300 joules.
D) Administer a sedative before cardioversion is implemented.

Question 7

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

A) T wave of 0.16 second.
B) P-R interval of 0.18 second.
C) Q-T interval of 0.34 second.
D) QRS interval of 0.14 second.

Question 8

The nurse obtains a monitor strip on a patient 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. The nurse interprets the patient's cardiac rhythm as

A) atrial fibrillation.
B) sinus tachycardia.
C) ventricular fibrillation.
D) ventricular tachycardia.

Question 9

A patient who was admitted with a myocardial infarction experiences a 50-second episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which action should the nurse take next?

A) Notify the health care provider.
B) Perform synchronized cardioversion.
C) Administer the PRN IV lidocaine (Xylocaine).
D) Document the rhythm and monitor the patient.

Question 10

After the nurse administers IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective?

A) Increase in the patient's heart rate
B) Decrease in premature contractions
C) Increase in peripheral pulse volume
D) Decrease in ventricular ectopic beats

Question 11

The nurse notes that a patient'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 will the nurse document the rhythm?

A) Ventricular couplets
B) Ventricular bigeminy
C) Ventricular R-on-T phenomenon
D) Ventricular multifocal contractions

Question 12

A patient with dilated cardiomyopathy has an atrial fibrillation that has been unresponsive to drug therapy for several days. The nurse anticipates that the patient may need teaching about

A) electrical cardioversion.
B) IV adenosine ( Adenocard ).
C) anticoagulant therapy with warfarin ( Coumadin ).
D) insertion of an implantable cardioverter-defibrillator ( ICD ).

Question 13

A patient's cardiac monitor shows sinus rhythm, rate 60 to 70. The P-R interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 2:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take at this time?

A) Prepare for possible temporary pacemaker insertion.
B) Administer atropine sulfate 1 mg IV per agency protocol.
C) Document the patient's rhythm and assess the patient's response to the rhythm.
D) Call the health care provider before giving the prescribed metoprolol (Lopressor).

Question 14

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

A) I
B) II
C) V6
D) MCL1

Question 15

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

A) The pacemaker prevents or minimizes ventricular irritability.
B) The pacemaker paces the atria at rates up to 500 impulses/minute.
C) The pacemaker discharges if ventricular fibrillation and cardiac arrest occur.
D) The pacemaker stimulates a heart beat if the patient's heart rate drops too low.

Question 16

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

A) Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes.
B) Count the number of large squares in the R-R interval and divide by 300.
C) Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
D) Calculate the number of small squares between one QRS complex and the next and divide into 1500.

Question 17

A patient's cardiac monitor has 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?

A) Defibrillate at 360 joules.
B) Give O₂ per bag-valve-mask.
C) Give epinephrine (Adrenalin) IV.
D) Prepare for endotracheal intubation.

Question 18

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

A) P wave.
B) PR interval.
C) QT interval.
D) QRS complex.

Question 19

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the PR interval is 0.24 seconds. The appropriate intervention by the nurse is to

A) notify the patient's health care provider immediately.
B) administer atropine per agency bradycardia protocol.
C) prepare the patient for temporary pacemaker insertion.
D) document the finding and continue to monitor the patient.

Question 20

A 19-year-old has a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54, and the student denies any health problems. What action by the nurse is appropriate?

A) Allow the student to participate on the swim team.
B) Refer the student to a cardiologist for further assessment.
C) Obtain more detailed information about the student's health history.
D) Tell the student to stop swimming immediately if any dyspnea occurs.

Question 21

A 21-year-old student arrives at the student health center at the end of the quarter complaining that, "My heart is skipping beats." An electrocardiogram ( ECG ) shows occasional premature ventricular contractions ( PVCs ). What action should the nurse take first?

A) Have the patient transported to the hospital emergency department ( ED ).
B) Administer O₂ at 2 to 3 L/min using nasal prongs.
C) Ask the patient about any history of coronary artery disease.
D) Question the patient about current stress level and coffee use.

Question 22

A patient experiences dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department ( ED ), the nurse obtains the following electrocardiographic ( ECG ) tracing.
The nurse interprets this cardiac rhythm as

A) sinus rhythm with premature ventricular contractions ( PVCs ).
B) junctional escape rhythm.
C) third-degree atrioventricular ( AV ) block.
D) sinus rhythm with premature atrial contractions ( PACs ).

Question 23

A patient whose cardiac monitor shows sinus tachycardia, rate 102, is apneic and no pulses are palpable by the nurse. What is the first action that the nurse should take?

A) Start CPR.
B) Defibrillate.
C) Administer atropine per hospital protocol.
D) Give 100% oxygen per non-rebreather mask.

Question 24

A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and diaphoresis. Which of these actions that are included in the hospital dysrhythmia protocol should the nurse take first?

A) Obtain a 12-lead electrocardiogram (ECG).
B) Give O₂ at 3 to 4 L/min.
C) Take the patient's blood pressure and respiratory rate.
D) Notify the health care provider of the change in rhythm.

Question 25

When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular cardiac rhythm, the nurse finds there are 25 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as ____________________.

Question 26

A patient who is complaining of a "racing" heart and nervousness comes to the emergency department. The nurse places the patient on a cardiac monitor and obtains the following electrocardiographic (ECG) tracing.
Which action should the nurse take next?

A) Get ready to perform electrical cardioversion.
B) Have the patient perform the Valsalva maneuver.
C) Obtain the patient's blood pressure and oxygen saturation.
D) Prepare to give b-blocker medication to slow the heart rate.

Question 27

The nurse has received change-of-shift report about the following patients on the telemetry unit. Which patient should the nurse see first?

A) A patient with atrial fibrillation, rate 88, who has a new order for warfarin ( Coumadin )
B) A patient with type 1 second-degree atrioventricular ( AV ) block, rate 60, who is dizzy when ambulating
C) A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago
D) A patient whose implantable cardioverter-defibrillator ( ICD ) fired three times today who has a dose of amiodarone ( Cordarone ) due

Question 28

When a patient requires defibrillation, in which order will the nurse accomplish the following steps? Put a comma and space between each solve choice (a, b, c, d, etc.) ____________________

A) Turn the defibrillator on.
B) Deliver the electrical charge.
C) Select the appropriate energy level.
D) Place the paddles on the patient's chest.
E) Check the location of other personnel and call out "all clear."