Med_Surg_Chapter_26

MED-SURG Chapter 26: Management of Patients With Dysrhythmias and Conduction Problems Question Which medication is the drug of choice for sinus bradycardia? • Atropine Question A nursing student is giving to a client with heart failure a medication with a positive inotropic effect on the heart. The student asks what a "positive inotropic" effect is. The correct response would be which of the following? • It increases the force of the myocardial contraction. Question A pacemaker is the treatment of choice for what cardiac dysrhythmia? • Complete heart block Question A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? Begin cardiopulmonary resuscitation Question A patient is being examined for medical management of atrial flutter. The nurse reviews the ECG strip. He expects to see which of the following? • “Sawtooth” pattern to the waveform Question The nurse is caring for a client with atrial fibrillation. The client's symptoms started about 1 week ago, but he is just now seeking medical attention. The client asks the nurse why he has to wait several weeks before the cardioversion takes place. The best answer by the nurse is which of the following? • "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Question A nursing student working today on the cardiac unit asks the instructor why loss of the "atrial kick" causes a decrease in cardiac output, because ventricles are still contracting. The instructor's best answer is which of the following? • "The atrial contraction fills the ventricles and accounts for nearly one third of the volume ejected during ventricular contraction." Question Which PR interval presents a first-degree heart block? • 0.24 seconds Question Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? • Anticoagulant Question A patient experiences a faster-than-normal heart rate when she drinks more than two cups of coffee in the morning. The nurse knows that an indicator of sinus tachycardia on an ECG would be which of the following? • Heart rate of 118 bpm Question A nurse is caring for a client who's experiencing sinus bradycardia with a pulse rate of 40 beats/minute. His blood pressure is 80/50 mm Hg and he complains of dizziness. Which medication does the nurse anticipate administering to treat his bradycardia? • Atropine Question After observing a code blue situation, a nursing student asks a member of the code team what the treatment of choice is for witnessed ventricular fibrillation. The best response by the nurse is which of the following? • Defibrillation Question The nurse is assessing a client with mitral regurgitation. The nurse expects to note which of the following findings in this client? • Dyspnea, fatigue, and weakness Question A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client’s problems. Which test is used to identify cardiac rhythms? • electrocardiogram Question The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed. • Atropine sulfate Question A nursing student is caring for one of the nurse's assigned cardiac clients. The student asks, "How can I tell the difference between ventricular tachycardia and ventricular fibrillation when I look at the EKG strip?" The best reply by the nurse is which of the following? • "Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast with wide QRS complexes." Question The nurse is caring for a 32-year-old client admitted with a medical diagnosis of atrial fibrillation, related to "holiday heart" syndrome. A nursing student working with the nurse asks for information about "holiday heart" syndrome. The best response by the nurse is which of the following? • "This is the association of heart dysrhythmias, especially atrial fibrillation, with binge drinking." Question A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have? • sinus bradycardia Question A nurse provides morning care for a client in the intensive care unit (ICU). Suddenly, the bedside monitor shows ventricular fibrillation and the client becomes unresponsive. After calling for assistance, what action should the nurse take next? • Begin cardiopulmonary resuscitation Question The nurse in the intensive care unit (ICU) hears an alarm sound in the patient’s room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? • Begin cardiopulmonary resuscitation (CPR) Question A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents: • ventricular depolarization. Question A client has a medical diagnosis of an advanced AV block and is symptomatic due to a slow heart rate. With what initial treatment(s) should the nurse be prepared to assist? • IV bolus of atropine or temporary pacing Question The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as • normal sinus rhythm. Question The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and “sawtooth” P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? • Atrial flutter Question A patient has had an implantable cardioverter defibrillator inserted. What should the nurse be sure to include in the education of this patient prior to discharge? (Select all that apply.) • Avoid magnetic fields such as metal detection booths. • Call for emergency assistance if feeling dizzy. • Record events that trigger a shock sensation. question To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? • P wave Question The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? • Fluttering Question The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? • A client with atrial dysrhythmias Question The nurse is attempting to determine the ventricular rate and rhythm of a patient’s telemetry strip. What should the nurse examine to determine this part of the analysis? • RR interval Question The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed. • Atropine sulfate Question After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have? • Decreased cardiac output and decreased systolic and diastolic blood pressure Question A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? • "I'll keep a log of each time my ICD discharges." Question Which of the following medication classifications is more likely to be expected when the nurse is caring for a client with atrial fibrillation? • Anticoagulant Question The nurse is assigned to care for several clients admitted to a telemetry unit. Which clients should the nurse assess first? • A client whose implantable cardioverter defibrillator (ICD) fired twice on the prior shift, requiring amiodarone IV Question A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? • Ventricular fibrillation Question Which dysrhythmia is common in older clients? • Sinus bradycardia Question Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? • Elective electrical cardioversion Question A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the: • inherent rhythmicity of cardiac muscle tissue. Question Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following? • Atrial rate of 300 to 400 Question A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? • The need to have regular blood levels drawn Question You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients? • Clients with recurrent life-threatening tachydysrhythmias Question The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment? • A defibrillator Question A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? • Document the findings and continue to monitor the client Question A client with a history of mitral stenosis is admitted to the intensive care unit (ICU) with the abrupt onset of atrial fibrillation. The client’s heart rate ranges from 120 to 140 bpm. The nurse recognizes that interventions are implemented to prevent the development of • embolic stroke. Question The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? • Delayed conduction, producing a prolonged PR interval Question Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block? • PR interval Question A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? • Atrial flutter Question The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up? • QT interval that is 0. 46 seconds long Question A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, “I thought this was normal.” What does the nurse understand is occurring with this patient? • Lead wire dislodgement Question Cardioversion is used to terminate dysrhythmias. With cardioversion, the: • Defibrillator should be set to deliver a shock during the QRS complex. Question After evaluating a client for hypertension, a physician orders atenolol (Tenormin), 50 mg P.O. daily. Which therapeutic effect should atenolol have? • Decreased cardiac output and decreased systolic and diastolic blood pressure Question The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? • A client with atrial dysrhythmias Question A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding? • Peaked T waves Question The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and “sawtooth” P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? • Atrial flutter Question A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? • Warfarin (Coumadin) Question A client has a heart rate greater than 155 beats/minute and the ECG shows a regular rhythm with a rate of 162 beats/minute. The client is intermittently alert and reports chest pain. P waves supraventricular tachycardia Question A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? • Document the findings and continue to monitor the client Question Sam, a retired professional NFL player, visits his cardiologist for his annual physical. The nurse takes an ECG and notices an abnormal finding. However, the nurse realizes that this result can be normal when present without symptoms. This finding is a: • Heart rate of 42 beats per minute (bpm). Question The patient is told that she has second-degree AV block with symptomatic bradycardia. The patient will be treated with an anticholinergic that blocks the effects of the vagal nerve. Choose the most likely drug that will be prescribed. • Atropine sulfate Question Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves? Correct response: • Atrial flutter Question A client with second-degree atrioventricular heart block is admitted to the coronary care unit. The nurse closely monitors the client's heart rate and rhythm. When interpreting the client's electrocardiogram (ECG) strip, the nurse knows that the QRS complex represents: • ventricular depolarization. Question What is the treatment of choice for ventricular fibrillation? • Immediate bystander CPR Question Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following? • Atrial rate of 300 to 400 Question Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block? • PR interval Question A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? • The need to have regular blood levels drawn