Question 1

If a client admitted to the hospital for treatment of atrial fibrillation complains of dyspnea and chest pain, the nurse would suspect

Accepted Answer

Blood pools in the "quivering" atria because contraction of the atrial muscle is inadequate. This blood can clot, which increases the potential for cerebral and pulmonary vascular emboli.

Question 2

The client who is to receive cardioversion in 3 days for treatment of continuous atrial fibrillation has laboratory values of Na 139 mEq/L, K 4.0 mEq/L, and Cl 98 mEq/L and is receiving digoxin 0.125 mg daily. Before the procedure the nurse would

Accepted Answer

If the client has been taking a digitalis preparation, a therapeutic drug level must be present. Digitalis toxicity may predispose the client to the development of ventricular dysrhythmias during cardioversion.

Question 3

The client's ECG shows normal-appearing P waves that occur at regular intervals. Every third impulse from the atria is missing a QRS complex. The nurse would recognize this pattern as the dysrhythmia of

Accepted Answer

Some impulses are conducted and others are blocked in second-degree AV block, a dysrhythmia that results in intermittently dropped QRS complexes. First-degree AV block is a lengthened PR interval. Third-degree AV block is complete atrial-ventricular dissociation. There is no fourth-degree AV block.

Question 4

A client is being discharged with a prescription for procainamide to treat atrial fibrillation. An important self-care measure the nurse would explain about this medication is to

Accepted Answer

Procainamide may cause gastrointestinal upset and should be taken with meals. The other three options are not related to taking procainamide.

Question 5

The nurse working on a telemetry floor would recognize that most dangerous dysrhythmias are

Accepted Answer

Ventricular dysrhythmias are generally more serious and life-threatening than atrial or junctional dysrhythmias.

Question 6

The nurse would assess a heart rate of 55 beats/min as a normal finding in a client who

Accepted Answer

In some people, sinus bradycardia can be a normal condition. Athletes often have sinus bradycardia because their heart is an effective pump with a greater-than-normal stroke volume.

Question 7

When a client in the CCU develops ventricular tachycardia and loses consciousness, the priority action by the nurse would be to immediately administer

Accepted Answer

Ventricular tachycardia that cause loss of consciousness must be terminated immediately with defibrillation. Like ventricular fibrillation, the only effective treatment in this situation is defibrillation.

Question 8

When a client in the cardiac care unit (CCU) suddenly develops paroxysmal atrial tachycardia (PAT) of 200 beats/min and clinical manifestations of severe dizziness, the nurse would help decrease the heart rate by

Accepted Answer

Any maneuver that stimulates the vagus nerve can successfully terminate PAT or increase AV block. Vagotonic maneuvers include carotid sinus massage and the Valsalva maneuver (bearing down as with bowel movements).

Question 9

When a client develops sinus bradycardia after a myocardial infarction (MI), the nurse would anticipate the administration of

Accepted Answer

The goal of intervention is to increase the heart rate just enough to relieve manifestations but not enough to cause tachycardia. The intervention sequence for treating symptomatic bradycardia is atropine, transcutaneous pacing if available, dopamine, epinephrine, and isoproterenol or insertion of a temporary transvenous pacemaker.

Question 10

A client with a serum potassium level of 6.6 mEq/L would have a characteristic ECG configuration of

Accepted Answer

An abnormally high serum potassium level will cause the T wave to become very tall, sometimes the height of the QRS complex.

Question 11

If the first defibrillation shock at 200 J is not successful on a client with ventricular fibrillation, the nurse in charge of the code would

Accepted Answer

Consecutive shocks at 200, 300, and 400 J is the normal protocol for treatment of ventricular fibrillation.

Question 12

A client's ECG reveals a rapid atrial rate of 300 beats/min, and the P waves resemble a picket fence without 1:1 conduction. The nurse would identify this dysrhythmia as

Accepted Answer

Atrial flutter is a dysrhythmia arising in an ectopic pacemaker or the site of a rapid reentry circuit in the atria, characterized by rapid "saw-toothed" atrial wave formations and usually a slower ventricular response. Atrial flutter differs from PAT in that it produces a much more rapid atrial rate. The P waves are actually inverted or bidirectional, producing a "picket fence" or saw-toothed pattern of "fluttering waves." The atrial rate generally ranges from 220 to 350 beats/min.

Question 13

The nurse would explain to a client who has a demand pacemaker in place that this pacemaker functions by

Accepted Answer

There are two basic types of pacemakers. A fixed-rate pacemaker fires constantly at a preset rate without regard to the electrical activity of the client's heart. A demand pacemaker fires when the SA node has not fired at a preset rate.

Question 14

A client in the CCU goes into sudden ventricular fibrillation. The priority action by the nurse would be to immediately administer

Accepted Answer

When ventricular fibrillation appears, the nurse must immediately initiate CPR until the defibrillator is engaged, and should defibrillate up to three times if needed. The only true effective treatment for ventricular fibrillation is defibrillation, which should occur as soon as possible.

Question 15

The nurse would be most concerned about premature ventricular contractions (PVCs) that

Accepted Answer

The downward slope of the T wave is the most vulnerable period of the cardiac cycle. PVCs occurring during this vulnerable period can precipitate the more life-threatening dysrhythmias of ventricular tachycardia and ventricular fibrillation.

Question 16

The nurse would clarify to a client that sinus arrest differs from sinus block in that with sinus arrest, the

Accepted Answer

Sinus arrest differs from SA exit block in that the SA node intermittently fails to fire at all with sinus arrest.

Question 17

At the ambulatory care clinic, the nurse counseling a client who has presented with frequent episodes of paroxysmal atrial tachycardia would advise the client to

Accepted Answer

Cardiac problems precipitating PAT include MI, cardiomyopathy, extreme emotions, caffeine ingestion, fatigue, smoking, and excessive alcohol intake.

Question 18

The nurse quickly calculating a client's heart rate by examining the electrocardiogram (ECG) would count the number of

Accepted Answer

The simplest method for obtaining the heart rate is to count the number of R waves in a 6-inch strip of the ECG tracing (which equals 6 seconds) and then multiply this sum by 10 to obtain the rate per minute.

Question 19

A client with no history of heart disease is seen in the clinic for periodic episodes of tachycardia with a regular rate. When taking the nursing history, the nurse would question the client about the existence of

Accepted Answer

Causes of sinus tachycardia include fever; emotional and physical stress; heart failure; hyperthyroidism; hypercalcemia; medications, including caffeine, atropine, nitrates, epinephrine, isoproterenol, and nicotine; and exercise.

Question 20

When the nurse in charge of the code is ready to defibrillate a client, the nurse assisting with the defibrillation would

Accepted Answer

To ensure safe defibrillation, clinicians must always announce that they are about to shock. Because electricity is carried along metal devices and the client, all personnel, including the clinician administering the shock, must stand back from the bed. The person defibrillating the client is ultimately responsible for everyone's safety.

Quiz 57: Management of Clients with Dysrhythmias