Elsevier Adaptive Quizzing: Dysrhythmias

Elsevier Adaptive Quizzing: Dysrhythmias The nurse monitoring the electrocardiogram (ECG) of a patient with hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial rate 250 beats/minute. How should the nurse document this pattern? a) sinus bradycardia b) sinus tachycardia c) atrial flutter d) atrial fibrillation - C. atrial Flutter Atrial flutter is an atrial tachydysrhythmia identified by flutter (F) waves, a sawtoothed pattern, with a 200-350 beats/minute atrial rate. In sinus bradycardia, the heart rate is less than 60 beats/minute, with regular rhythm and normal P waves. Sinus tachycardia is identified by 101- 200 beats/minute, with regular rhythm and normal P waves. In atrial fibrillation, atrial rate is 350-600 beats/minute, with irregular rhythm, and fibrillatory (f) waves. A patient is admitted complaining of heart palpitations and dizziness for the past three days. The electrocardiogram (ECG) shows the following rhythm. The nurse identifies that the patient is at risk for: a) stroke b) DM c) myocardial infarction d) sudden cardiac death - A. Stroke A risk of atrial fibrillation is clot formation in the atria caused by altered blood flow through the heart. If the clot forms on the right side of the heart, it can travel to the lungs, causing a pulmonary embolism. If the clot forms on the left side of the heart, the risk is of it traveling to the brain, causing a stroke or an embolism to other arteries in the body. The risk of an embolus is particularly high when the patient converts back to a normal sinus rhythm. To reduce the risk of clot formation in the heart, most patients with chronic atrial fibrillation are on some type of anticoagulation. Coumadin (Warfarin) often is prescribed. For which dysrhythmia is defibrillation primarily indicated? a) ventricular fibrillation b) third-degree atrio-ventricular (AV) block c) uncontrolled atrial fibrillation d) ventricular tachycardia with a pulse - A. Ventricular fibrillation Defibrillation always is indicated in the treatment of ventricular fibrillation. Pacemakers are the treatment of choice for third-degree heart block. Drug treatments normally are used in the treatment of uncontrolled atrial fibrillation and for ventricular tachycardia with a pulse (if the patient is stable). Otherwise, synchronized cardioversion is used (as long as the patient has a pulse). A patient's ECG tracing has changed from sinus tachycardia (ST) to the following rhythm. The nurse should notify the primary health care provider because the patient is ___. a) at risk for PE b) at risk of ventricular tachycardia c) experiencing an MI d) showing signs of an elevated K+ level - C. Experiencing an MI ST elevation is a manifestation of a myocardial infarction (MI). ST elevation does not increase a patient's risk of a pulmonary embolism. A patient can go into ventricular tachycardia because of an MI, but it is not the main reason the nurse would notify the primary health care provider in this situation. Hyperkalemia is evidenced by a peaked T wave, not ST elevation. The nurse is caring for a patient who is 24 hours post-pacemaker insertion. Which nursing intervention is most appropriate at this time? a) reinforce the pressure dressing as needed b) encouraging ROM exercises of the involved arm c) Assessing the incision for any redness, swelling, or discharge d) Applying wet-to-dry dressings every four hours to the insertion site - C. Assessing the incision for any redness, swelling, or discharge After pacemaker insertion, it is important for the nurse to observe signs of infection by assessing for any redness, swelling, or discharge from the incision site. The nonpressure dressing is kept dry until removed, usually 24 hours postoperatively. It is important for the patient to limit activity of the involved arm to minimize pacemaker lead displacement. A nurse is monitoring a patient on a wireless electrocardiogram (ECG) monitor. Which observation is a cause for concern? a) upright P wave b) Flat ST segment c) prolonged QT interval d) Upright T wave - C. prolonged QT interval Prolonged QT interval is a cause for concern. QT disturbance may be caused by drugs, electrolyte imbalances, and changes in heart rate. Upright P wave, flat ST segment, and upright T wave are normal findings. A patient in asystole is likely to receive which drug treatment? a. Epinephrine and atropine b. Lidocaine and amiodarone c. Digoxin and procainamide d. beta-adrenergic blockers and dopamine - A.