Exam 1: Dysrhythmias NCLEX

Exam 1: Dysrhythmias (NCLEX)

Questions and answers A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second.

The nurse interprets this rhythm is:

• Normal sinus rhythm
• Sinus bradycardia
• Sinus tachycardia
• Sinus dysrhythmia - ANSWER A

A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is

most concerned with this dysrhythmia because:

• It is uncomfortable for the client, giving a sense of impending doom.
• It produces a high cardiac output that quickly leads to cerebral and myocardial

ischemia.

• It is almost impossible to convert to a normal sinus rhythm.
• It can develop into ventricular fibrillation at any time. - ANSWER D

Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with antidysrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time.The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia.Which monitoring by the nurse is necessary with this drug? Select all that apply.

• Respiratory rate
• QT interval
• Heart rate and rhythm
• Magnesium level
• Urine output - ANSWER BCD

Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia.Antidysrhythmic medications cause changes in cardiac rhythm and rate; therefore monitoring of heart rate and rhythm is needed.Electrolyte depletion, specifically potassium and magnesium, may predispose to further dysrhythmia. Although it is always important to monitor vital signs and urine output, these assessments are not specific to amiodarone.The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication? 1 / 2

Exam 1: Dysrhythmias (NCLEX)

Questions and answers

• ST segment
• Heart rate
• Troponin
• Myoglobin - ANSWER B

The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand. ST segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS but does not address needed monitoring related to metoprolol.The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer?

• Heparin
• Atropine
• Dobutamine
• Magnesium sulfate - ANSWER A

Clients with atrial fibrillation are prone to blood pooling in the atrium, clotting, then embolizing. Heparin is used to prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke).The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60; a P wave precedes each QRS complex, and the PR interval is 0.24 second.Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. The following medications are available on the medication record.What action should the nurse take?

• Administer atropine.
• Administer digoxin.
• Administer clonidine.
• Continue to monitor. - ANSWER D

The client is displaying sinus rhythm with first-degree atrioventicular heart block; this is usually asymptomatic and does not require treatment. Atropine is used in emergency treatment of symptomatic bradycardia. This client has normal vital signs. Digoxin is used in the treatment of atrial fibrillation, which is, by definition, an irregular rhythm.Clonidine is used in the treatment of hypertension; a side effect is bradycardia.You are the charge nurse on the telemetry unit and are responsible for making client assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit?

• The 64-year-old admitted for weakness who has a first-degree heart block with a

heart rate of 58 beats/min

• / 2