Nclex Style EKG Practice

Nclex Style EKG Practice Leave the first rating Terms in this set (16) Save

• Normal Sinus Rhythm

measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second, respectively.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
• Tightly Secured Cable

Connections 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. Electrode placement over bony prominences also should be avoided. Signal interference can also occur with electrode removal and cable disconnection.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?A.Frequent movement of the client

• Tightly secured cable connections
• Leads applied over hairy areas
• Leads applied to the limbs

• Ventricular Tachycardia

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 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
• Administer amiodarone

(Cordarone) intravenously 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). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia).Defibrillation is used with pulseless ventricular tachycardia. Epinephrine would stimulate and already excitable ventricle and is contraindicated 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

• Inhale deeply and cough

forcefully every 1 to 3 seconds.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 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

A.Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and, if frequent enough, to decreased cardiac output. The client may be asymptomatic or may feel palpitations. PVCs can be caused by cardiac disorders or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by the intake of caffeine, alcohol, or nicotine.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

• A continuous and totally

unpredictable irregularity In atrial fibrillation, multiple ectopic foci stimulate the atria to contract.The AV node is unable to transmit all of these impulses to the ventricles, resulting in a pattern of highly irregular ventricular contractions.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

B.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 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:

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

A.The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. 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 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