CHAPTER 7: DYSRHYTHMIA INTERPRETATION AND MANAGEMENT QUESTIONS AND CORRECT ANSWERS

CHAPTER 7: DYSRHYTHMIA
INTERPRETATION AND MANAGEMENT
QUESTIONS AND CORRECT ANSWERS

TheA2nurseA2isA2caringA2forA2aA2patientA2whoA2isA2onA2aA2cardiacA2monitor.A2TheA2nurseA2r
ealizesA2thatA2theA2sinusA2nodeA2isA2theA2pacemakerA2ofA2theA2heartA2becauseA2itA2is:
a.A2theA2fastestA2pacemakerA2cellA2inA2theA2heart.
b.A2theA2onlyA2pacemakerA2cellA2inA2theA2heart.
c.A2theA2onlyA2cellA2thatA2doesA2notA2affectA2theA2cardiacA2cycle.
d.A2locatedA2inA2theA2leftA2sideA2ofA2theA2heart.A2-A2Ans--
a.A2theA2fastestA2pacemakerA2cellA2inA2theA2heart.

ANS:A2A
TheA2cardiacA2cycleA2beginsA2withA2anA2impulseA2thatA2isA2generatedA2fromA2aA2smallA2co
ncentratedA2areaA2ofA2pacemakerA2cellsA2highA2inA2theA2rightA2atriaA2calledA2theA2sinoatria
lA2nodeA2(sinusA2nodeA2orA2SAA2node).A2TheA2SAA2nodeA2hasA2theA2fastestA2rateA2ofA2disc
hargeA2andA2thusA2isA2theA2dominantA2pacemakerA2ofA2theA2heart.A2TheA2AVA2nodeA2hasA2
pacemakerA2propertiesA2andA2canA2dischargeA2anA2impulseA2ifA2theA2SAA2nodeA2fails.A2Th
eA2ventriclesA2haveA2pacemakerA2capabilitiesA2ifA2theA2sinusA2nodeA2orA2theA2AVA2nodeA2c
easesA2toA2generateA2impulses.

OneA2ofA2theA2functionsA2ofA2theA2atrioventricularA2(AV)A2nodeA2isA2to:
a.A2paceA2theA2heartA2ifA2theA2ventriclesA2fail.
b.A2slowA2theA2impulseA2arrivingA2fromA2theA2SAA2node.
c.A2sendA2theA2impulseA2toA2theA2SAA2node.
d.A2allowA2forA2ventricularA2fillingA2duringA2systole.A2-A2Ans--
b.A2slowA2theA2impulseA2arrivingA2fromA2theA2SAA2node.

ANS:A2B
TheA2impulseA2fromA2theA2SAA2nodeA2quicklyA2reachesA2theA2atrioventricularA2(AV)A2node
A2locatedA2inA2theA2areaA2calledA2theA2AVA2junction,A2betweenA2theA2atriaA2andA2theA2ventr
icles.A2HereA2theA2impulseA2isA2slowedA2toA2allowA2timeA2forA2ventricularA2fillingA2duringA2r
elaxationA2orA2ventricularA2diastole.A2TheA2AVA2nodeA2hasA2pacemakerA2propertiesA2andA
2canA2dischargeA2anA2impulseA2ifA2theA2SAA2nodeA2(notA2theA2ventricle)A2fails.A2TheA2electr
icalA2impulseA2isA2thenA2rapidlyA2conductedA2throughA2theA2bundleA2ofA2HisA2toA2theA2ventr
iclesA2(notA2theA2SAA2node)A2viaA2theA2leftA2andA2rightA2bundleA2branches.

TheA2normalA2rateA2forA2theA2SAA2nodeA2whenA2theA2patientA2isA2atA2restA2is:
a.A240A2toA260A2beatsA2perA2minute.
b.A260A2toA2100A2beatsA2perA2minute.
c.A220A2toA240A2beatsA2perA2minute.
d.A2moreA2than100A2beatsA2perA2minute.A2-A2Ans--b.A260A2toA2100A2beatsA2perA2minute.
ANS:A2B

, TheA2sinusA2nodeA2reachesA2thresholdA2atA2aA2rateA2ofA260A2toA2100A2timesA2perA2minute.
A2BecauseA2thisA2isA2theA2fastestA2pacemakerA2inA2theA2heart,A2theA2SAA2nodeA2isA2theA2d
ominantA2pacemakerA2ofA2theA2heart.A2TheA2AVA2nodeA2hasA2anA2inherentA2rateA2ofA240A2t
oA260A2beatsA2perA2minuteA2andA2theA2His-
PurkinjeA2systemA2canA2fireA2atA2aA2rateA2ofA220A2toA240A2beatsA2perA2minute.A2SinusA2tac
hycardiaA2resultsA2whenA2theA2SAA2nodeA2firesA2fasterA2thanA2100A2beatsA2perA2minute.

WhenA2assessingA2theA212-
leadA2electrocardiogramA2(ECG)A2orA2aA2rhythmA2strip,A2itA2isA2helpfulA2toA2understandA2th
atA2theA2electricalA2activityA2isA2viewedA2inA2relationA2toA2theA2positiveA2electrodeA2ofA2that
A2particularA2lead.A2WhenA2anA2electricalA2signalA2isA2aimedA2directlyA2atA2theA2positiveA2el
ectrode,A2theA2inflectionA2willA2be:
a.A2negative.
b.A2upsideA2down.
c.A2upright.
d.A2equallyA2positiveA2andA2negative.A2-A2Ans--c.A2upright.

ANS:A2CWhenA2anA2electricalA2signalA2isA2aimedA2directlyA2atA2theA2positiveA2electrode,A2
anA2uprightA2inflectionA2isA2visualized.A2IfA2theA2impulseA2isA2goingA2awayA2fromA2theA2posi
tiveA2electrode,A2aA2negativeA2deflectionA2isA2seen;A2andA2ifA2theA2signalA2isA2perpendicula
rA2toA2theA2imaginaryA2lineA2betweenA2theA2positiveA2andA2negativeA2polesA2ofA2theA2lead,A
2theA2tracingA2isA2equiphasic,A2withA2equallyA2positiveA2andA2negativeA2deflection.


TheA2patientA2isA2admittedA2withA2aA2conditionA2thatA2requiresA2cardiacA2rhythmA2monitori
ng.A2ToA2applyA2theA2monitoringA2electrodes,A2theA2nurseA2mustA2first:
a.A2applyA2aA2moistA2gelA2toA2theA2chest.
b.A2makeA2certainA2thatA2theA2electrodeA2gelA2isA2dry.
c.A2avoidA2soapsA2toA2avoidA2skinA2irritation.
d.A2clipA2chestA2hairA2ifA2needed.A2-A2Ans--d.A2clipA2chestA2hairA2ifA2needed.
ANS:A2DAdequateA2skinA2preparationA2ofA2electrodeA2sitesA2requiresA2clippingA2theA2hair,
A2cleansingA2theA2skin,A2andA2dryingA2vigorouslyA2(moistureA2gelsA2areA2notA2applied).A2Cl
eansingA2includesA2washingA2withA2soapA2andA2water,A2orA2alcohol,A2toA2removeA2skinA2d
ebrisA2andA2oils.A2BeforeA2application,A2theA2electrodesA2areA2checkedA2toA2ensureA2thatA2
theA2gelA2isA2moist.A2ItA2isA2difficultA2forA2electrodesA2toA2adhereA2toA2theA2chestA2inA2theA2p
resenceA2ofA2chestA2hair.A2Clipping,A2notA2shaving,A2isA2recommendedA2sinceA2shavingA2
mayA2createA2smallA2nicksA2thatA2canA2becomeA2aA2portalA2forA2infection.

ElectrocardiogramA2(ECG)A2paperA2containsA2aA2standardizedA2gridA2whereA2theA2horizon
talA2axisA2measuresA2timeA2andA2theA2verticalA2axisA2measuresA2voltageA2orA2amplitude.A2
TheA2nurseA2mustA2understandA2thatA2eachA2horizontalA2boxA2indicates:
a.A2200A2millisecondsA2orA20.20A2secondsA2duration.
b.A240A2millisecondsA2orA20.04A2secondsA2duration.
c.A23A2secondsA2duration.
d.A2millivoltsA2ofA2amplitude.A2-A2Ans--b.A240A2millisecondsA2orA20.04A2secondsA2duration.