Question 1

A client's electrocardiograph (ECG)tracing shows a run of sustained ventricular tachycardia.What is the nurse's first action?

Accepted Answer

The first action that the nurse should take when ventricular tachycardia is observed is to assess the client's airway,breathing,and level of consciousness.If the client is unconscious or has experienced respiratory arrest,defibrillation and CPR are begun.

Question 2

When analyzing a client's electrocardiograph (ECG)tracing,the nurse observes that not all QRS complexes are preceded by a P wave.What is the nurse's interpretation of this observation?

Accepted Answer

Normal rhythm shows one P wave preceding each QRS,indicating that all depolarization is initiated at the sinoatrial node.QRS complexes without a P wave indicate a different source of initiation of depolarization.

Question 3

The nurse is caring for a client with atrial fibrillation.What manifestation most alerts 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 4

The nurse is caring for a client on a cardiac monitor.The monitor shows a rapid rhythm with a "saw tooth" configuration.What physical assessment findings does the nurse expect?

Accepted Answer

The rhythm described is atrial flutter with a rapid ventricular response.Rapid atrial flutter may manifest with palpitations,shortness of breath,and anxiety.Syncope,angina,and evidence of heart failure also may be present.

Question 5

The nurse has administered adenosine (Adenocard).What is the expected therapeutic response?

Accepted Answer

Clients usually respond to this medication with a short period of asystole,bradycardia,hypotension,dyspnea,and chest pain.

Question 6

A client with myocardial ischemia is having frequent early,wide ventricular complexes seen on the cardiac monitor.Which medication does the nurse administer?

Accepted Answer

Early,wide ventricular complexes are premature ventricular contractions (PVCs).Amiodarone,an antidysrhythmic,is the treatment of choice for frequent PVCs.The other medications are not appropriate for this condition.

Question 7

The nurse is assessing clients at a community clinic.Which client does the nurse assess most carefully for atrial fibrillation?

Accepted Answer

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

Question 8

A nurse notes that the PR interval on a client's electrocardiograph (ECG)tracing is 0.14 second.What action does the nurse take?

Accepted Answer

The PR interval normally ranges from 0.12 to 0.20 second.This is a normal finding,so the nurse simply documents this.No further action is required.

Question 9

The client's heart rate increases slightly during inspiration and decreases slightly during expiration.What action does the nurse take?

Accepted Answer

Sinus dysrhythmia is noted when the heart rate increases slightly during inspiration and decreases slightly during expiration.Sinus dysrhythmia is a variant of normal sinus rhythm that is frequently observed in healthy children and adults.No other actions are needed.

Question 10

A client's cardiac status is being observed by telemetry monitoring.The nurse observes a P wave that changes shape in lead II.What conclusion does the nurse make about the P wave?

Accepted Answer

If the P wave is firing consistently from the SA node,the P wave will have a consistent shape in a given lead.If the impulse is from an ectopic focus,then the P wave will vary in shape in that lead.

Question 11

A client experiences occasional premature atrial contractions (PACs)accompanied by palpitations that resolve spontaneously without treatment.What instruction does the nurse include in the client's teaching plan?

Accepted Answer

PACs usually have no hemodynamic consequences.For a client experiencing infrequent bouts of 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 12

The nurse is assessing the client's electrocardiography (ECG).What does the P wave on the ECG tracing represent?

Accepted Answer

The ECG tracing of a P wave represents electrical changes caused by atrial depolarization.

Question 13

A client with unstable ventricular tachycardia is receiving amiodarone by intravenous infusion.The nurse notes that the client's heart rate has decreased from 68 to 50 beats/min.The client is asymptomatic.What is the nurse's priority intervention?

Accepted Answer

IV administration of amiodarone may cause bradycardia and atrioventricular (AV)block.The correct action for the nurse to take at this time is to slow the infusion,because the client is asymptomatic and no evidence reveals AV block that might require pacing.Abruptly ceasing the medication could allow fatal dysrhythmias to occur.A precordial thump is not required at this time because the client still has a heart rate.A side-lying position will not increase the client's heart rate.

Question 14

The nurse identifies a client's rhythm to be a sustained supraventricular tachycardia.What medication does the nurse administer?

Accepted Answer

Diltiazem,a calcium channel blocker,slows depolarization through the conduction system and is commonly used as an agent to terminate a sustained episode of supraventricular tachycardia.

Question 15

A client has a heart rate averaging 56 beats/min with no adverse symptoms.What activity modifications does 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 16

A client is experiencing sinus bradycardia with hypotension and dizziness.What medication does the nurse administer?

Accepted Answer

Atropine is a cholinergic antagonist that inhibits parasympathetically-induced hyperpolarization of the sinoatrial node.This inhibition results in an increased heart rate.The other medications are not appropriate.

Question 17

A client with tachycardia is experiencing clinical manifestations.Which 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.

Question 18

The nurse is caring for a client admitted for myocardial infarction.The client's monitor shows frequent premature ventricular contractions (PVCs).What dysrhythmia does the nurse remain alert for?

Accepted Answer

With an acute myocardial infarction (MI),the onset of PVCs may be considered as a warning that could herald the onset of ventricular tachycardia or ventricular fibrillation.

Question 19

The nurse is caring for a client with chronic atrial fibrillation.Which drug does the nurse expect to administer 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.The other drugs are not appropriate for this complication.

Question 20

The nurse observes a prominent U wave on the client's electrocardiograph (ECG)tracing.What is the most appropriate action for the nurse to take?

Accepted Answer

Prominent U waves may be the result of hypokalemia.The nurse should review the client's daily electrolyte results.Although documentation is important,this is not a normal variant.Moving the crash cart closer to the room may or may not be warranted.The client does not need an immediate ECG.

Quiz 36: Care of Patients With Dysrhythmias

A client's electrocardiograph (ECG) tracing shows a run of sustained ventricular tachycardia.What is the nurse's first action?

When analyzing a client's electrocardiograph (ECG) tracing,the nurse observes that not all QRS complexes are preceded by a P wave.What is the nurse's interpretation of this observation?

The nurse is caring for a client with atrial fibrillation.What manifestation most alerts the nurse to the possibility of a serious complication from this condition?

The nurse is caring for a client on a cardiac monitor.The monitor shows a rapid rhythm with a "saw tooth" configuration.What physical assessment findings does the nurse expect?

The nurse has administered adenosine (Adenocard) .What is the expected therapeutic response?

A client with myocardial ischemia is having frequent early,wide ventricular complexes seen on the cardiac monitor.Which medication does the nurse administer?

The nurse is assessing clients at a community clinic.Which client does the nurse assess most carefully for atrial fibrillation?

A nurse notes that the PR interval on a client's electrocardiograph (ECG) tracing is 0.14 second.What action does the nurse take?

The client's heart rate increases slightly during inspiration and decreases slightly during expiration.What action does the nurse take?

A client's cardiac status is being observed by telemetry monitoring.The nurse observes a P wave that changes shape in lead II.What conclusion does the nurse make about the P wave?

A client experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment.What instruction does the nurse include in the client's teaching plan?

The nurse is assessing the client's electrocardiography (ECG) .What does the P wave on the ECG tracing represent?