ADV Med-Surg Cardiac arrhythmias Questions

ADV Med-Surg Cardiac arrhythmias Questions (2018) ScienceMedicineNursing ashley_coots7 Save Arrhythmia NCLEX-style questions 26 terms Alix_VanderWiele Preview Respiratory Exam Med-Surg 27 terms meagan_nance9 Preview Sherpath - ChAPTER 36 - Primary H...24 terms marajrussellPreview Pneum 34 terms Dan A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as:

• Normal sinus rhythm
• Sinus bradycardia
• Sick sinus syndrome
• First-degree heart block
• Normal sinus rhythm

Rationale: measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second, respectively.A nurse notices frequent artifact on the ECG monitor for a client whose leads are connected by cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for the artifact?

• Frequent movement of the client
• Tightly secured cable connections
• Leads applied over hairy areas
• Leads applied to the limbs
• Tightly secured cable connections

Rationale: Motion artifact, or "noise," can be caused by frequent client movement, electrode placement on limbs, and insufficient adhesion to the skin, such as placing electrodes over hairy areas of the skin

A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing:

• Premature ventricular contractions
• Ventricular tachycardia
• Ventricular fibrillation
• Sinus tachycardia
• Ventricular tachycardia

Rationale: Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular.A nurse is viewing the cardiac monitor in a client's room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following?

• Immediately defibrillate
• Prepare for pacemaker insertion
• Administer amiodarone (Cordarone) intravenously
• Administer epinephrine (Adrenaline) intravenously
• Administer amiodarone (Cordarone) intravenously

Rationale: First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of anti-dysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl).A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the client to do which of the following, if prescribed, during an episode of ventricular tachycardia?

• Breathe deeply, regularly, and easily
• Inhale deeply and cough forcefully every 1 to 3 seconds
• Lie down flat in bed
• Remove any metal jewelry
• Inhale deeply and cough forcefully every 1 to 3 seconds

Rationale: Cough cardiopulmonary resuscitation (CPR) sometimes is used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough CPR, if prescribed, by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a short time until other measures can be implemented.A client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following items?

• Blood pressure and peripheral perfusion
• Sensation of palpitations
• Causative factors such as caffeine
• Precipitating factors such as infection
• Blood pressure and peripheral perfusion

Rationale: The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and, if frequent enough, to decreased cardiac output.

A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute. A nurse assesses the client for:

• Hypotension and dizziness
• Nausea and vomiting
• Hypertension and headache
• Flat neck veins
• Hypotension and dizziness

Rationale: The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.A nurse is watching the cardiac monitor, and a client's rhythm suddenly changes. There are no P waves; instead there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as: A)Sinus tachycardia

• Atrial fibrillation
• Ventricular tachycardia
• Ventricular fibrillation
• Atrial fibrillation

Rationale: Atrial fibrillation is characterized by a loss of P waves; an undulating, wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate, which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled).A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform carotid massage. The nurse responds that this

procedure may stimulate the:

• Vagus nerve to slow the heart rate
• Vagus nerve to increase the heart rate; overdriving the rhythm
• Diaphragmatic nerve to slow the heart rate
• Diaphragmatic nerve to overdrive the rhythm
• Vagus nerve to slow the heart rate

Rationale: Carotid sinus massage is one of the maneuvers used for vagal stimulation to decrease a rapid heart rate and possibly terminate a tachydysrhythmia.A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client's rhythm suddenly changes to one with no P waves or definable QRS complexes. Instead there are coarse wavy lines of varying amplitude. The

nurse assesses this rhythm to be:

• Ventricular tachycardia
• Ventricular fibrillation
• Atrial fibrillation
• Asystole
• Ventricular fibrillation

Rationale: Ventricular fibrillation is characterized by irregular, chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles.

While caring for a client who has sustained an MI, the nurse notes eight PVCs in one minute on the cardiac monitor. The client is receiving an IV infusion of D5W and oxygen at 2 L/minute. The nurse's first course of action should be to:

• Increase the IV infusion rate
• Notify the physician promptly
• Increase the oxygen concentration
• Administer a prescribed analgesic
• Notify the physician promptly

Rationale: PVCs are often a precursor of life-threatening dysrhythmias, including ventricular tachycardia and ventricular fibrillation. More than 6 PVCs per minute is considered serious and usually calls for decreasing ventricular irritability by administering medications such as lidocaine.When ventricular fibrillation occurs in a CCU, the first person reaching the client should:

• Administer oxygen
• Defibrillate the client
• Initiate CPR
• Administer sodium bicarbonate intravenously
• Defibrillate the client

Rationale: Ventricular fibrillation is a death-producing dysrhythmia and, once identified, must be terminated immediately by precordial shock (defibrillation) When auscultating the apical pulse of a client who has atrial fibrillation, the nurse would expect to hear a rhythm that is characterized by:

• The presence of occasional coupled beats
• Long pauses in an otherwise regular rhythm
• A continuous and totally unpredictable irregularity
• Slow but strong and regular beats
• A continuous and totally unpredictable irregularity Terms (13)

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