Chapter 26Arrhythmias: Nursing Management My Nursing Test Banks

Chapter 26Arrhythmias: Nursing Management

MULTIPLE CHOICE

1.A client is experiencing an alteration in heart rate. The nurse realizes this client is experiencing a disorder of which part of the heart?

1.

Atrioventricular node

2.

Bundle branches

3.

Purkinje fibers

4.

Sinoatrial node

ANS: 4

The sinoatrial node is the dominant pacemaker of the heart. The sinoatrial node has an inherent rate of 60 to 100 bpm. The atrioventricular node has an intrinsic rate of 40 to 60 bpm. The impulse enters the right and left bundle branches and then enters the Purkinje fibers. Impulses at this level are at 15 to 40 times per minute.

PTS: 1 DIF: Analyze REF: Anatomy and Physiology

2.A client is suspected of having cardiac damage. The nurse realizes that which of the following diagnostic tests is most commonly used to help diagnose this clients possible cardiac damage or disease?

1.

12-lead electrocardiogram

2.

Arterial blood gases

3.

Cardiac angiogram

4.

Cardiac enzymes

ANS: 1

A 12-lead electrocardiogram is a quick and accurate diagnostic tool used to evaluate heart damage and disease. The other diagnostic tests require a longer time for results and/or are invasive procedures requiring some preparation.

PTS:1DIF:AnalyzeREF:ECG Monitoring

3.The nurse is analyzing a clients electrocardiogram tracing. Which of the following complexes is not normally seen on an electrocardiogram tracing?

1.

P wave

2.

QRS complex

3.

T wave

4.

U wave

ANS: 4

A U wave is not always seen and can be very small. It can indicate electrolyte imbalance, medication effects, and ischemia. The P wave, QRS complex, and T wave are normally seen in the electrocardiogram tracing.

PTS:1DIF:Analyze

REF: The Normal ECG Complex; Figure 26-1 Conduction System of the Heart

4.The nurse is analyzing a clients electrocardiogram tracing and realizes that each small square on the paper is equal to:

1.

0.04 second.

2.

0.12 second.

3.

0.20 second.

4.

0.40 second.

ANS: 1

The small square on the ECG graph paper equals 0.04 second. The large square equals 0.20 second. The PR interval is 0.12 to 0.20 second. Two large squares would be equal to 0.40 second.

PTS: 1 DIF: Analyze REF: Calculating Heart Rate

5.The nurse is reading an ECG rhythm strip and notes that there are nine QRS complexes in a 6-second strip. The heart rate is:

1.

36.

2.

54.

3.

81.

4.

90.

ANS: 4

A heart rate can be determined by multiplying the QRS complexes in a 6-second strip by 10. The heart rate is 90. This method of calculating the heart rate is the most common method used because it is quick and can be used when the heart rate is irregular.

PTS: 1 DIF: Apply REF: Calculating Heart Rate

6.The nurse notes that on a clients electrocardiogram tracing, there is one P wave for every QRS complex and a delay in the impulse transmission at the AV node. This regular rhythm is identified as:

1.

first-degree AV block.

2.

second-degree AV block type I.

3.

second-degree AV block type II.

4.

complete heart block.

ANS: 1

First-degree atrioventricular (AV) block occurs when there is a delay in the impulse transmission at the AV node. This delay occurs with every impulse and can be seen on every beat on the recorded rhythm strip. Second-degree and complete heart block have differences with the P wave and the associated QRS complexes.

PTS: 1 DIF: Analyze REF: First-Degree Heart Block

7.A client is unresponsive and has no pulse. The nurse notes that the electrocardiogram tracing shows continuous large and bizarre QRS complexes measured greater than 0.12 each. This rhythm is identified as:

1.

premature ventricular complexes.

2.

torsades de pointes.

3.

ventricular fibrillation.

4.

ventricular tachycardia.

ANS: 4

Ventricular tachycardia occurs when the patient experiences sustained consecutive premature ventricular complexes. Torsades de pointes is characterized by a wide-to-narrow pattern of the QRS complexes. Ventricular fibrillation shows a coarse wavy baseline.

PTS: 1 DIF: Analyze REF: Ventricular Tachycardia

8.An elderly client is demonstrating a change in heart rate that occurs with respirations. When planning care for the client, the nurse knows that treatment may include:

1.

Oxygen therapy

2.

Analgesics

3.

Antibiotics

4.

Pacemaker insertion

ANS: 4

A change in heart rate that occurs with respirations defines a sinus arrhythmia. If the client becomes symptomatic during periods of bradycardia, treatment will include atropine sulfate or pacemaker insertion. Treatment for sinus arrhythmia might include oxygen if the client is symptomatic. Treatment for this arrhythmia does not include analgesics or antibiotics.

PTS:1DIF:ApplyREF:Sinus Arrhythmia

9.A clients electrocardiogram tracing shows a sawtooth pattern with F waves. The nurse realizes this client is demonstrating:

1.

atrial flutter.

2.

atrial fibrillation.

3.

premature atrial contractions.

4.

atrial tachycardia.

ANS: 1

Atrial flutter is characterized by F waves that occur in a characteristic sawtooth pattern. Atrial fibrillation is characterized by coarse waves with the baseline between the QRS complexes as being rough and uneven. Premature atrial contractions occur when an electrical impulse is generated in an area of the atria outside of the SA node. Atrial tachycardia is three or more premature atrial contractions. Neither premature atrial contractions or atrial tachycardia have an F wave on the tracing.

PTS:1DIF:AnalyzeREF:Atrial Arrhythmias

10.The electrocardiogram tracing for a client shows premature junctional complexes. Which of the following should the nurse do to assist this client?

1.

Administer oxygen

2.

Increase intravenous fluids

3.

Check on the serum digoxin level

4.

Assist the client to a side-lying position

ANS: 3

The most common cause of premature junctional complexes is digitalis toxicity. The nurse should check on the clients serum digoxin level. Oxygen, intravenous fluids, or position changes will not help treat this rhythm.

PTS: 1 DIF: Apply REF: Premature Junctional Complexes

11.Which of the following should the nurse instruct a client who has been diagnosed with an arrhythmia?

1.

Exercise level

2.

Avoidance of calorie-dense foods

3.

How to take his own pulse

4.

Reasons why fatigue is expected

ANS: 3

Instructions for a client diagnosed with an arrhythmia include symptom management, how to take own pulse, and substances to avoid the onset of an arrhythmia. The nurse may or may not instruct on exercise level. The client does not need to avoid calorie-dense foods. Fatigue is a symptom that should be reported to a health care provider.

PTS:1DIF:Apply

REF:Table 26-2 Nursing Management for the Patient with Arrhythmias

12.A client is diagnosed with supraventricular tachycardia. The nurse should prepare to administer which of the following medications?

1.

Procainamide

2.

Amiodarone

3.

Verapamil

4.

Adenosine

ANS: 4

Adenosine has a short half-life, is given intravenous push, and is used to abruptly stop supraventricular tachycardia. Procainamide is used for tachyarrhythmias and ventricular ectopy. Amiodarone is helpful to treat ventricular fibrillation. Verapamil helps slow the heart rate with atrial fibrillation.

PTS:1DIF:ApplyREFharmacology

13.A client is recovering from insertion of a pacemaker to pace the activity of the ventricles. At which point on the electrocardiogram tracing will the nurse assess pacer spikes?

1.

Before the QRS complex

2.

Before the P wave

3.

After the QRS complex

4.

After the P wave

ANS: 1

If the ventricles are being paced, there will be a pacer spike just prior to the QRS complex. If the atria are being paced, there will be a pacer spike just before the P wave. Pacer spikes that occur after the QRS complex or P wave would indicate pacemaker malfunction and should be addressed immediately.

PTS: 1 DIF: Apply REF: Permanent Pacing; Pacemaker Malfunction

MULTIPLE RESPONSE

1.A client with a heart rate of 40 who is experiencing shortness of breath and nausea is diagnosed with second-degree AV block type II. Which of the following will be included in this clients treatment? (Select all that apply.)

1.

Administer digoxin

2.

Administer antiemetic

3.

Administer atropine sulfate

4.

Insert external pacemaker

5.

Decrease intravenous fluids

6.

Lower the head of the bed

ANS: 3, 4

For second-degree AV block type II, treatment will almost always consist of external pacemaker insertion. Atropine sulfate may be used to increase the heart rate until the pacemaker can be inserted. Digitalis toxicity can cause this heart rhythm so digoxin should not be administered to this client. An antiemetic will not solve the clients underlying problem. The client may or may not need additional fluids. Lowering the head of the bed could compromise this clients respiratory status and should not be done.

PTS: 1 DIF: Apply REF: Second-Degree AV Block Type II

2.A clients electrocardiogram rhythm strip is a straight line. Which of the following should the nurse do to help this client? (Select all that apply.)

1.

Assess for loose leads.

2.

Assess for power to the monitor.

3.

Assess the strip for possible fine ventricular fibrillation.

4.

Begin cardiopulmonary resuscitation once verified the client has no pulse.

5.

Raise the head of the bed.

6.

Stop intravenous fluid infusion.

ANS: 1, 2, 3, 4

The absence of electrical activity will create the rhythm of asystole. The rhythm strip is a straight line. The nurse should confirm that the straight line is not due to another reason such as loose leads, lack of power to the monitor, or fine ventricular fibrillation. Once it is confirmed that the client has no pulse, cardiopulmonary resuscitation should be implemented. Raising the head of the bed or stopping intravenous fluid infusions is not going to help the client experiencing asystole.

PTS: 1 DIF: Apply REF: Asystole

3.The nurse is assessing a client who is diagnosed with pulseless electrical activity. Which of the following will the nurse include in this assessment? (Select all that apply.)

1.

Hypovolemia

2.

Hypoxia

3.

Hypothermia

4.

Tamponade

5.

Thrombosis

6.

Throat pain

ANS: 1, 2, 3, 4, 5

Assessment of pulseless electrical activity includes a review of the 5 Hs and the 5 Ts. The 5 Hs are: hypovolemia, hypoxia, hydrogen ion status, hyperkalemia/hypokalemia, and hypothermia. The 5 Ts include tablets, tamponade, tension pneumothorax, thrombosis coronary, and thrombosis pulmonary. Throat pain does not cause pulseless electrical activity.

PTS: 1 DIF: Apply REF: Pulseless Electrical Activity

4.Which of the following should be implemented to ensure the safe use of a defibrillator? (Select all that apply.)

1.

Do not place over monitoring electrodes.

2.

Do not place over an implanted pacemaker.

3.

Place the paddles at inch from the implanted pacemaker site.

4.

Apply transdermal medication to the chest before using the paddles.

5.

Insert an oral airway before using the paddles.

6.

Have another person hold the clients airway open while using the paddles.

ANS: 1, 2

The safe use of defibrillator paddles include: do not place over monitoring electrodes or implanted devices. Paddles should be at least 1 inch away from an implanted device. Transdermal medication should be removed from the clients chest before using the paddles. An oral airway is not needed before using the paddles. No one should be touching the client when using the paddles.

PTS: 1 DIF: Apply REF: Red Flag: Safe Use of Defibrillator Pads

5.Which of the following interventions would be appropriate for a client recovering from a pacemaker insertion? (Select all that apply.)

1.

Monitor vital signs every 15 minutes until stable.

2.

Assess for chest pain.

3.

Restrict movement of affected extremity.

4.

Monitor electrocardiogram every 8 hours.

5.

Begin intravenous fluid infusion at 150 mL/hr.

6.

Reinforce dressing with excessive bleeding.

ANS: 1, 2, 3

Interventions appropriate for a client recovering from a pacemaker insertion include monitoring vital signs every 15 minutes until stable, assessing for chest pain, restricting movement of the affected extremity, monitoring electrocardiogram ongoing and post a strip every 4 hours, and report excessive bleeding from the surgical site to the health care provider. Intravenous fluids at the rate of 150 mL/hr may or may not be needed.

PTS:1DIF:Apply

REF:Box 26-4 Interventions for Patient with Pacemaker Insertion

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