Dysrhythmias- Ch. 35

Dysrhythmias- Ch. 35 ScienceMedicineCardiology cjjmesser Save Mechanical Ventilation NCLEX quest...20 terms haannahsonPreview Disrhythmias 22 terms Elyse_Chadwick Preview Hemodynamic Monitoring - PAWP, ...13 terms hwebb551Preview acute c 63 terms mm observe for symptoms of hypotension or angina.A patient admitted with Acute Coronary Syndrome has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate 74 beats/min and regular; ventricular rate 62 beats/min and irregular; P wave normal shape; PR interval lengthens progressively until a P wave is not conducted; QRS normal shape. The priority nursing intervention would be to

• perform synchronized cardioversion.
• administer epinephrine 1 mg IV push.
• observe for symptoms of hypotension or angina.
• apply transcutaneous pacemaker pads on the patient.

Sinus rhythm with a depressed ST segment The nurse is monitoring the ECG of a patient admitted with Acute Coronary Syndrome. Which ECG characteristics would be most suggestive of myocardial ischemia?

• Sinus rhythm with a pathologic Q wave
• Sinus rhythm with an elevated ST segment
• Sinus rhythm with a depressed ST segment
• Sinus rhythm with premature atrial contractions

assessing the patient's response to the dysrhythmia.The ECG monitor of a patient in the cardiac care unit after an MI indicates ventricular bigeminy with a rate of 50 beats/min. The nurse would anticipate

• performing defibrillation.
• treating with IV amiodarone.
• inserting a temporary transvenous pacemaker.
• assessing the patient's response to the dysrhythmia.

patients should be sedated if cardioversion is done on a nonemergency basis.The nurse prepares a patient for synchronized cardioversion knowing that cardioversion differs from defibrillation in that

• defibrillation requires a lower dose of electrical energy.
• cardioversion is indicated to treat atrial bradydysrhythmias.
• defibrillation is synchronized to deliver a shock during the QRS complex.
• patients should be sedated if cardioversion is done on a nonemergency basis.

b,c,d

• Which patient teaching points should the nurse include when providing discharge instructions to a patient with a new permanent pacemaker

and the caregiver (SATA)?

• Avoid or limit air travel.
• Take and record a daily pulse rate.
• Obtain and wear a Medic Alert ID device at all times.
• Avoid lifting arm on the side of the pacemaker above shoulder.
• Avoid microwave ovens because they interfere with pacemaker function.

the procedure will destroy areas of the conduction system that are causing rapid heart rhythms.Important teaching for the patient scheduled for a radiofrequency catheter ablation procedure includes explaining that

• ventricular bradycardia may be induced and treated during the procedure.
• a catheter will be placed in both femoral arteries to allow double-catheter use.
• the procedure will destroy areas of the conduction system that are causing rapid heart rhythms.
• a general anesthetic will be given to prevent the awareness of any "sudden cardiac death" experiences.

The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers Which statement best describes the electrical activity of the heart represented by measuring the PR interval on the electrocardiogram (ECG)?

• The length of time it takes to depolarize the atrium
• The length of time it takes for the atria to depolarize and repolarize
• The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers
• The length of time it takes for the electrical impulse to travel from the sinoatrial (SA) node to the atrioventricular (AV) node

Assessing the incision for any redness, swelling, or discharge The nurse is caring for a patient who is 24 hours postpacemaker insertion. Which nursing intervention is most appropriate at this time?

• Reinforcing the pressure dressing as needed
• Encouraging range-of-motion exercises of the involved arm
• Assessing the incision for any redness, swelling, or discharge
• Applying wet-to-dry dressings every 4 hours to the insertion site

Ventricular fibrillation The nurse prepares to defibrillate a patient. For which dysrhythmia has the nurse observed in this patient?

• Ventricular fibrillation
• Third-degree AV block
• Uncontrolled atrial fibrillation
• Ventricular tachycardia with a pulse

Epinephrine and/or vasopressin (Normally, the patient in asystole cannot be successfully resuscitated. However, administration of epinephrine or vasopressin may prompt the return of depolarization and ventricular contraction. Lidocaine and amiodarone are used for ventricular tachycardia or ventricular fibrillation.Digoxin and procainamide are used for ventricular rate control. β-adrenergic blockers are used to slow heart rate, and dopamine is used to increase heart rate.) The nurse observes a flat line on the patient's monitor and the patient is unresponsive without pulse. What medications does the nurse prepare to administer?

• Lidocaine and amiodarone
• Digoxin and procainamide
• Epinephrine and/or vasopressin
• β-adrenergic blockers and dopamine

First-degree AV block (In first-degree atrioventricular (AV) block, there is prolonged duration of AV conduction that lengthens the PR interval above 0.20 sec. In type I second-degree AV block, the PR interval continues to increase in duration until a QRS complex is blocked. In type II, the PR interval may be normal or prolonged, the ventricular rhythm may be irregular, and the QRS is usually greater than 0.12 sec. PACs cause an irregular rhythm with a different-shaped P wave than the rest of the beats, and the PR interval may be shorter or longer. PVCs cause an irregular rhythm, and the QRS complex is wide and distorted in shape.) The patient has a potassium level of 2.9 mEq/L, and the nurse obtains the following measurements on the rhythm strip: Heart rate of 86 with a regular rhythm, the P wave is 0.06 seconds (sec) and normal shape, the PR interval is 0.24 sec, and the QRS is 0.09 sec. How should the nurse document this rhythm?

• First-degree AV block
• Second-degree AV block
• Premature atrial contraction (PAC)
• Premature ventricular contraction (PVC)

Adenosine (IV adenosine is the first drug of choice to convert supraventricular tachycardia to a normal sinus rhythm. Adenosine is administered IV rapidly (over 1 or 2 seconds) followed by a rapid, normal saline flush. The nurse should monitor the patient's electrocardiogram continuously because a brief period of asystole after adenosine administration is common and expected. Atropine sulfate increases heart rate, whereas lanoxin and metoprolol slow the heart rate.) A patient reports dizziness and shortness of breath and is admitted with a dysrhythmia. Which medication, if ordered, requires the nurse to carefully monitor the patient for asystole?

• Digoxin
• Adenosine
• Metoprolol
• Atropine sulfate

d, f (The expected PR interval is 0.12 to 0.20 seconds and is measured from the beginning of the P wave to the beginning of the QRS complex. The T wave is 0.16 seconds, the QRS interval is <0>

• 0.16 seconds
• <0>
• 0.06 to 0.12 seconds
• 0.12 to 0.20 seconds
• Time of depolarization and repolarization of ventricles
• Measured from beginning of P wave to beginning of QRS complex

induces dysrhythmias that may require cardioversion or defibrillation to correct.(Electrophysiologic testing involves electrical stimulation to various areas of the atrium and ventricle to determine the inducibility of dysrhythmias and frequently induces ventricular tachycardia or ventricular fibrillation. The patient may have "near-death" experiences and requires emotional support if this occurs. Dye and anticoagulants are used for coronary angiograms.) The nurse plans close monitoring for the patient during electrophysiologic testing because this test

• requires the use of dyes that irritate the myocardium.
• causes myocardial ischemia, resulting in dysrhythmias.
• involves the use of anticoagulants to prevent thrombus and embolism.
• induces dysrhythmias that may require cardioversion or defibrillation to correct.