Question 1

The nurse monitors for which clinical manifestation in the patient with atrial fibrillation at a heart rate of 90 beats per minute. Which manifestation should the nurse expect to assess in this patient?

Accepted Answer

Palpitations are a common symptom in patients with atrial fibrillation due to the irregular and often rapid heart rate.

Question 2

Once ventricular fibrillation has been confirmed in a patient, which action is the priority?

Accepted Answer

Starting chest compressions is the priority once ventricular fibrillation has been confirmed in a patient, as it helps maintain blood flow to the brain and heart, buying time until defibrillation can be performed.

Question 3

The nurse provides care to a patient who is undergoing cardioversion. Which is the priority nursing action before initiating the shock?

Accepted Answer

Before delivering a shock during cardioversion, it is crucial to ensure that no one is in contact with the patient or the bed to prevent accidental injury. The statement "I am clear, you are clear, we are all clear" is a safety check to confirm this.

Question 4

In preparing a patient with atrial fibrillation for cardioversion, the nurse prepares the patient for which diagnostic before the cardioversion?

Accepted Answer

A Transesophageal echocardiogram (TEE) is often performed before cardioversion in patients with atrial fibrillation to check for the presence of atrial clots, which could dislodge and cause a stroke during the procedure.

Question 5

A patient is in normal sinus rhythm with prolonged PR intervals. What prescribed treatment does the nurse plan for this patient?

Accepted Answer

A prolonged PR interval indicates first-degree heart block, which is often asymptomatic and does not usually require treatment other than monitoring unless it progresses or is associated with other cardiac conditions.

Question 6

When analyzing a patient's electrocardiogram, the nurse correlates which information as descriptive of a normal P wave?

Accepted Answer

The P wave on an electrocardiogram represents atrial depolarization, which normally lasts up to 0.11 seconds. Therefore, a P wave length of 0.10 seconds is considered normal.

Question 7

A patient is being cardioverted for symptomatic atrial fibrillation. At which point of the cardiac cycle will the electric impulse occur?

Accepted Answer

Cardioversion aims to restore normal heart rhythm by delivering an electric shock synchronized to the peak of the R wave, minimizing the risk of inducing ventricular fibrillation.

Question 8

The nurse notes that PR intervals are getting progressively longer before a QRS complex is dropped on a patient's cardiac rhythm strip. The nurse interprets this as which cardiac dysrhythmia?

Accepted Answer

This description matches a second-degree AV block, Mobitz I (also known as Wenckebach phenomenon), where there is progressive lengthening of the PR interval until a QRS complex is eventually dropped.

Question 9

The nurse correlates the P wave on the electrocardiogram (ECG) tracing to which cardiac action?

Accepted Answer

The P wave on an electrocardiogram (ECG) tracing represents the depolarization of the atria, which is the electrical activity that leads to atrial contraction.

Question 10

The nurse is monitoring the electrocardiogram (ECG) of a patient who has an internal ventricular pacemaker. Which pacer spike indicates the pacemaker is functioning properly?

Accepted Answer

The pacer spike before the QRS complex indicates that the pacemaker is functioning properly by initiating ventricular depolarization, which is the intended action of a ventricular pacemaker.

Question 11

The nurse develops the nursing diagnosis "Decreased Cardiac Output related to impaired conduction as evidenced by consistent PR intervals and dropped QRS complexes" for which cardiac dysrhythmia?

Accepted Answer

Second-degree AV block type II is characterized by consistent PR intervals before a dropped QRS complex, which aligns with the nursing diagnosis description.

Question 12

The nurse is concerned that a patient is at risk for pulseless electrical activity. What information from the assessment did the nurse use to make this clinical decision?

Accepted Answer

A blood pH of 7.30 indicates acidosis, which is a risk factor for pulseless electrical activity (PEA) as it can lead to significant electrolyte imbalances and impaired cardiac function.

Question 13

A patient is being prepared for a transvenous pacemaker. What should the nurse include when explaining this pacemaker to the family?

Accepted Answer

The answer of A patient is being prepared for a...

Question 14

The nurse prepares to administer which prescribed medication to the patient with shortness of breath and a heart rhythm of 46 beats per minute.

Accepted Answer

Atropine sulfate is used to treat bradycardia (heart rate that is too slow), which is indicated by the patient's heart rhythm of 46 beats per minute. It increases heart rate by inhibiting the action of the vagus nerve on the heart.

Question 15

A patient's heart rate is 48 beats per minute. The nurse correlates this heart rate to the inherent rate of which structure?

Accepted Answer

The atrioventricular (AV) node has an inherent rate of 40 to 60 beats per minute. A heart rate of 48 beats per minute falls within this range, indicating that the heart's rhythm could be governed by the AV node if the sinoatrial (SA) node fails to function properly.

Question 16

The nurse is observed marching out the rhythm on a patient's cardiac monitor tracing. What is this nurse assessing?

Accepted Answer

The nurse is assessing the regularity of the cardiac rhythm by marching out the rhythm on the monitor tracing to see if the intervals between heartbeats are consistent.

Question 17

The nurse is preparing to defibrillate a patient and selects which setting before the first shock?

Accepted Answer

The initial energy setting for defibrillation in adults is typically 200 Joules (J) when using a biphasic defibrillator, which is the most common type used in clinical settings today. This setting is chosen based on guidelines that suggest starting with a higher energy level to increase the chance of successful defibrillation.

Question 18

A patient is being evaluated for a blockage in the cardiac ventricles. The nurse assesses which part of the electrocardiogram as evidence of this blockage?

Accepted Answer

The QRS interval on an electrocardiogram (ECG) represents the time it takes for the ventricles to depolarize, which corresponds to ventricular contraction. A blockage in the cardiac ventricles would likely affect the QRS interval, either by prolonging it or altering its shape, as it directly relates to ventricular activity.

Question 19

The nurse notes that the patient with atrial fibrillation has hypotension and correlates this to decreased cardiac output secondary to which factor?

Accepted Answer

Loss of atrial kick in atrial fibrillation leads to decreased cardiac output because the atria do not effectively contract to push blood into the ventricles, reducing the volume of blood pumped out of the heart.

Question 20

The nurse provides care to a patient who is prescribed intravenous (IV) adenosine (Adenocard). Which is the priority nursing action before administering the medication?

Accepted Answer

Adenosine (Adenocard) can cause transient heart block or asystole as a side effect, so having a transcutaneous pacemaker available is a priority to manage potential severe bradycardia or asystole.

Quiz 29: Coordinating Care for Patients With Cardiac Dysrhythmia