Question 1

A nurse supervises an unlicensed assistive personnel (UAP)applying electrocardiographic monitoring.Which statement should the nurse provide to the UAP related to this procedure?

Accepted Answer

To ensure the best signal transmission,the skin should be clean and hairs clipped.Electrodes should be placed on the anterior chest,and no additional gel is needed.Oxygen has no impact on electrocardiographic monitoring.

Question 2

A nurse cares for a client with an intravenous temporary pacemaker for bradycardia.The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiogram.Which action should the nurse take next?

Accepted Answer

In temporary pacing,the wires are threaded onto the epicardial surface of the heart and exit through the chest wall.The pacemaker spike should be followed immediately by a QRS complex.Pacing spikes seen without subsequent QRS complexes imply loss of capture.If there is no capture,then there is no ventricular depolarization and contraction.The nurse should assess for cardiac output via vital signs and level of consciousness.The other interventions would not determine if the client is tolerating the loss of capture.

Question 3

A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms.Which activity modification should the nurse suggest to avoid further slowing of the heart rate?

Accepted Answer

Bearing down strenuously during a bowel movement is one type of Valsalva maneuver,which stimulates the vagus nerve and results in slowing of the heart rate.Such a response is not desirable in a person who has bradycardia.The other instructions are not appropriate for this condition.

Question 4

After teaching a client who has an implantable cardioverter-defibrillator (ICD),a nurse assesses the client's understanding.Which statement by the client indicates a correct understanding of the teaching?

Accepted Answer

The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields.Clients should avoid tight clothing,which could cause irritation over the ICD generator.The client should be encouraged to exercise but should not engage in strenuous activities that cause the heart rate to meet or exceed the ICD cutoff point because the ICD can discharge inappropriately.The client should continue all prescribed medications.

Question 5

A nurse administers prescribed adenosine (Adenocard)to a client.Which response should the nurse assess for as the expected therapeutic response?

Accepted Answer

Clients usually respond to adenosine with a short period of asystole,bradycardia,hypotension,dyspnea,and chest pain.Adenosine has no conclusive impact on intraocular pressure.

Question 6

A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services.Which priority information should be communicated to the home health nurse upon discharge?

Accepted Answer

The home health nurse needs to know current medications the client is taking to ensure assessment,evaluation,and further education related to these medications.The other information will not assist the nurse to develop a plan of care for the client.

Question 7

A nurse assesses a client's electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave.How should the nurse interpret this observation?

Accepted Answer

Normal rhythm shows one P wave preceding each QRS complex,indicating that all depolarization is initiated at the sinoatrial node.QRS complexes without a P wave indicate a different source of initiation of depolarization.This finding on an electrocardiograph tracing is not an indication of hyperkalemia,ventricular tachycardia,or disconnection of leads.

Question 8

A nurse cares for a client who is on a cardiac monitor.The monitor displayed the rhythm shown below:

Which action should the nurse take first?

Accepted Answer

Ventricular tachycardia occurs with repetitive firing of an irritable ventricular ectopic focus,usually at a rate of 140 to 180 beats/min or more.Ventricular tachycardia is a lethal dysrhythmia.The nurse should first assess if the client is alert and breathing.Then the nurse should call a Code Blue and begin CPR.If this client is pulseless,the treatment of choice is defibrillation.Amiodarone is the antidysrhythmic of choice,but it is not the first action.

Question 9

A nurse assesses a client with atrial fibrillation.Which manifestation should alert the nurse to the possibility of a serious complication from this condition?

Accepted Answer

Clients with atrial fibrillation are at risk for embolic stroke.Evidence of embolic events includes changes in mentation,speech,sensory function,and motor function.Clients with atrial fibrillation often have a rapid ventricular response as a result.Fatigue is a nonspecific complaint.Clients with atrial fibrillation often have dyspnea as a result of the decreased cardiac output caused by the rhythm disturbance.

Question 10

A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living.What interventions should the nurse implement to address this client's concerns?

Accepted Answer

Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing activities of daily living.The nurse should schedule periods of exercise and rest during the day to decrease fatigue.The other interventions will not assist the client with self-care activities.

Question 11

A nurse assesses a client's electrocardiogram (ECG)and observes the reading shown below:

How should the nurse document this client's ECG strip?

Accepted Answer

Sinus rhythm with PVCs has an underlying regular sinus rhythm with ventricular depolarization that sometimes precede atrial depolarization.Ventricular tachycardia and ventricular fibrillation rhythms would not have sinus beats present.Premature atrial contractions are atrial contractions initiated from another region of the atria before the sinus node initiates atrial depolarization.

Question 12

A nurse is assessing clients on a medical-surgical unit.Which client should the nurse identify as being at greatest risk for atrial fibrillation?

Accepted Answer

Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft surgery.The other conditions do not place these clients at higher risk for atrial fibrillation.

Question 13

A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor.Which assessment should the nurse complete next?

Accepted Answer

A heart rate of 40 beats/min or less with widened QRS complexes could have hemodynamic consequences.The client is at risk for inadequate cerebral perfusion.The nurse should assess for level of consciousness,light-headedness,confusion,syncope,and seizure activity.Although the other assessments should be completed,the client's level of consciousness is the priority.

Question 14

A nurse assesses a client with tachycardia.Which clinical manifestation requires immediate intervention by the nurse?

Accepted Answer

Chest pain,possibly angina,indicates that tachycardia may be increasing the client's myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace.This results in myocardial hypoxia and pain.Increased urinary output and mild orthostatic hypotension are not life-threatening conditions and therefore do not require immediate intervention.The P wave touching the T wave indicates significant tachycardia and should be assessed to determine the underlying rhythm and cause; this is an important assessment but is not as critical as chest pain,which indicates cardiac cell death.

Question 15

A nurse prepares to defibrillate a client who is in ventricular fibrillation.Which priority intervention should the nurse perform prior to defibrillating this client?

Accepted Answer

To avoid injury,the rescuer commands that all personnel clear contact with the client or the bed and ensures their compliance before delivery of the shock.A precordial thump can be delivered when no defibrillator is available.Defibrillation is done in asynchronous mode.Equipment should not be tested before a client is defibrillated because this is an emergency procedure; equipment should be checked on a routine basis.Epinephrine should be administered after defibrillation.

Question 16

A nurse teaches a client who experiences occasional premature atrial contractions (PACs)accompanied by palpitations that resolve spontaneously without treatment.Which statement should the nurse include in this client's teaching?

Accepted Answer

PACs usually have no hemodynamic consequences.For a client experiencing infrequent PACs,the nurse should explore possible lifestyle causes,such as excessive caffeine intake and stress.Lying on the side will not prevent or resolve PACs.Oxygen is not necessary.Although medications may be needed to control symptomatic dysrhythmias,for infrequent PACs,the client first should try lifestyle changes to control them.

Question 17

The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse.The client asks,"Why do you want to know if I use cocaine?" How should the nurse respond?

Accepted Answer

Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias.The other responses do not adequately address the client's question.

Question 18

A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation.Which action should the nurse take prior to the initiation of cardioversion?

Accepted Answer

For safety during cardioversion,the nurse should turn off any oxygen therapy to prevent fire.The other interventions are not appropriate for a cardioversion.The client should be placed in a supine position.

Question 19

A nurse performs an admission assessment on a 75-year-old client with multiple chronic diseases.The client's blood pressure is 135/75 mm Hg and oxygen saturation is 94% on 2 liters per nasal cannula.The nurse assesses the client's rhythm on the cardiac monitor and observes the reading shown below:

Which action should the nurse take first?

Accepted Answer

This client is stable and therefore does not require any intervention except to determine the cause of the bradycardia.Bradycardia is often caused by medications.Clients who have multiple chronic diseases are often on multiple medications that can interact with each other.The nurse should assess the client's current medications first.

Question 20

A nurse evaluates prescriptions for a client with chronic atrial fibrillation.Which medication should the nurse expect to find on this client's medication administration record to prevent a common complication of this condition?

Accepted Answer

Atrial fibrillation puts clients at risk for developing emboli.Clients at risk for emboli are treated with anticoagulants,such as heparin,enoxaparin,or warfarin.Sotalol,atropine,and lidocaine are not appropriate for this complication.

Quiz 34: Care of Patients with Dysrhythmias

A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring.Which statement should the nurse provide to the UAP related to this procedure?