Chapter 22 Management of Patients With Arrhythmias and
Conduction Problems
The nurse is caring for a patient who has had an ECG. The nurse notes that leads I, Il, and Ill differ from
one another on the cardiac rhythm strip. How should the nurse best respond?
Recognize that the view of the electrical current changes in relation to the lead placement.
B) Recognize that the electrophysiological conduction of the heart differs with lead placement.
C) Inform the technician that the ECG equipment has malfunctioned.
D) Infonn the physician that the patient is experiencing a new onset of dysrhythmia.
Feedback:
Each lead offers a different reference point to view the electrical activity of the heart. The lead displays
the configuration of electrical activity of the heart. Differences between leads are not necessarily
attributable to equipment malfunction or dysrhythmias.
2. The nurse is analyzing a rhythm strip. What component of the ECG conesponds to the resting state of the
patients heart?
P wave
B) T wave
C) U wave
D) QRS complex
Feedback:
The T wave specifically represents ventricular muscle depolarization, also refened to as the resting
state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
3. The nursing educator is presenting a case study of an adult patient who has abnormal ventricular
depolarization. This pathologic change would be most evident in what component of the ECG?
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 509
P wave
B) T wave
C) QRS complex
D) U wave
c
Feedback:
The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of
that ventricle.
4. An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on
continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
PP interval and RR interval are inegular.
B) PP interval is equal to RR interval.
C) Fewer QRS complexes than P waves
D) PR interval is constant.
c
Feedback:
In third-degree AV block, no atrial impulse is conducted thmugh the AV node into the ventricles. As a
result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there
are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of
the heart. The other listed ECG changes are not consistent with this diagnosis.
5. The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most
appropriate goal for the patient?
Maintain a resting heart rate below 70 bpm.
B) Maintain adequate control of chest pain.
, Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 510
C) Maintain adequate cardiac output.
D) Maintain normal cardiac structure.
c
Feedback:
For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsemng
complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not
appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than
with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
6. A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For
which potential complication should the nurse most closely assess this patient?
Chest pain
B) Bleeding at the implantation site
C) Malignant hyperthermia
D) Bradycardia
Feedback:
Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are
complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia,
but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because
it is a response to anesthesia administration.
7. A patient the nurse is caring for has a permanent pacemaker implanted with the identification code
beginning with VVI. What does this indicate?
Ventricular paced, ventricular sensed, inhibited
B) Variable paced, ventricular sensed, inhibited
C) Ventricular sensed, ventricular situated, implanted
Conduction Problems
The nurse is caring for a patient who has had an ECG. The nurse notes that leads I, Il, and Ill differ from
one another on the cardiac rhythm strip. How should the nurse best respond?
Recognize that the view of the electrical current changes in relation to the lead placement.
B) Recognize that the electrophysiological conduction of the heart differs with lead placement.
C) Inform the technician that the ECG equipment has malfunctioned.
D) Infonn the physician that the patient is experiencing a new onset of dysrhythmia.
Feedback:
Each lead offers a different reference point to view the electrical activity of the heart. The lead displays
the configuration of electrical activity of the heart. Differences between leads are not necessarily
attributable to equipment malfunction or dysrhythmias.
2. The nurse is analyzing a rhythm strip. What component of the ECG conesponds to the resting state of the
patients heart?
P wave
B) T wave
C) U wave
D) QRS complex
Feedback:
The T wave specifically represents ventricular muscle depolarization, also refened to as the resting
state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex.
3. The nursing educator is presenting a case study of an adult patient who has abnormal ventricular
depolarization. This pathologic change would be most evident in what component of the ECG?
,Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 509
P wave
B) T wave
C) QRS complex
D) U wave
c
Feedback:
The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of
that ventricle.
4. An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on
continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
PP interval and RR interval are inegular.
B) PP interval is equal to RR interval.
C) Fewer QRS complexes than P waves
D) PR interval is constant.
c
Feedback:
In third-degree AV block, no atrial impulse is conducted thmugh the AV node into the ventricles. As a
result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there
are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of
the heart. The other listed ECG changes are not consistent with this diagnosis.
5. The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most
appropriate goal for the patient?
Maintain a resting heart rate below 70 bpm.
B) Maintain adequate control of chest pain.
, Test Bank - Brunner & Suddarth's Textbook of Medical-Surqical Nursinq 15e 510
C) Maintain adequate cardiac output.
D) Maintain normal cardiac structure.
c
Feedback:
For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsemng
complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not
appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than
with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart.
6. A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For
which potential complication should the nurse most closely assess this patient?
Chest pain
B) Bleeding at the implantation site
C) Malignant hyperthermia
D) Bradycardia
Feedback:
Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are
complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia,
but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because
it is a response to anesthesia administration.
7. A patient the nurse is caring for has a permanent pacemaker implanted with the identification code
beginning with VVI. What does this indicate?
Ventricular paced, ventricular sensed, inhibited
B) Variable paced, ventricular sensed, inhibited
C) Ventricular sensed, ventricular situated, implanted
