Question 1

The cardiac monitor alarm goes off for a patient being monitored in the coronary care unit,and the nurse notes a cardiac pattern of undulations of varying contours and amplitude with no measurable ECG pattern.The patient is unconscious,with no pulse or respirations.After calling for assistance,what should the nurse do?

Accepted Answer

The undulations with no measurable ECG pattern indicate asystole, which requires immediate initiation of basic cardiopulmonary resuscitation (CPR) to attempt to restore the patient's pulse and respirations. Administering a bolus dose of epinephrine, preparing for endotracheal intubation, or waiting for the defibrillator will not be effective in treating asystole.

Question 2

The nurse determines that a patient has ventricular bigeminy when the rhythm strip indicates which of the following changes?

Accepted Answer

Ventricular bigeminy is a type of arrhythmia in which every other QRS complex is wide and starts prematurely. It is called "bigeminy" because there is a repeating pattern of every other beat being abnormal, resulting in pairs of beats. Conduction origin and ventricular rate are not specific criteria for ventricular bigeminy, and the SA node rhythm with long pauses between every two beats is not related to ventricular bigeminy.

Question 3

During the change-of-shift report,the nurse learns that a patient with a large MI has been having frequent PVCs.What will the nurse check when monitoring the patient for the effects of PVCs?

Accepted Answer

PVCs can affect the heart rate, so checking the apical-radial heart rate can help assess if the PVCs are causing a pulse deficit or affecting cardiac output.

Question 4

The nurse is doing discharge teaching with a patient who is going home with an implantable cardioverter-defibrillator (ICD).Which of the following instructions should the nurse give the patient?

Accepted Answer

Patients with an ICD should have routine checks every 2 to 3 months to ensure the device is functioning properly.

Question 5

A patient is seen in the emergency department after experiencing dizziness and shortness of breath for several days.During cardiac monitoring in the ED,the nurse notes the following findings: atrial rate 82 beats/min,P-P interval regular;ventricular rate 42 beats/min,R-R interval regular;PR interval variable with no relationship between P and QRS;and QRS complex 0.06 second with normal contour.The following ECG tracing was obtained: 
The nurse interprets this cardiac rhythm as which of the following?

Accepted Answer

The ECG tracing shows a complete dissociation between the atrial and ventricular rhythms with no relationship between P and QRS complexes. Atrial rate is regular, but the ventricular rate is significantly slower, indicating third-degree heart block. Premature atrial contractions and PVCs would show irregularities in the atrial and ventricular rhythms, respectively. Paroxysmal supraventricular tachycardia would show a narrow QRS complex and a fast heart rate.

Question 6

The nurse obtains a monitor strip on a patient admitted to the coronary care unit with a myocardial infarction (MI)and makes the following analysis: P wave not apparent;ventricular rate 142 beats/min,R-R interval regular;PR interval not measurable;and QRS complex wide and distorted,greater than 0.14 second.The nurse interprets this patient's cardiac rhythm as which of the following?

Accepted Answer

The absence of P waves suggests that the patient is not in normal sinus rhythm. The wide and distorted QRS complex greater than 0.14 second suggests a ventricular origin for the rhythm. The fast ventricular rate and regular R-R interval are consistent with ventricular tachycardia. The PR interval cannot be measured because there is no identifiable P wave. Therefore, option D) is the best choice as it accurately describes the patient's rhythm.

Question 7

In analyzing a patient's electrocardiogram (ECG)rhythm strip,the nurse uses the knowledge that the time of the conduction of an impulse through the Purkinje fibres is represented by which of the following changes?

Accepted Answer

The answer of In analyzing a patient's electrocardiogram (ECG)rhythm strip,the...

Question 8

How would the nurse document a dysrhythmia pattern that has a sawtooth-shape P wave,a variable PR interval,and a normal QRS complex?

Accepted Answer

The sawtooth-shape P wave and variable PR interval are characteristic of atrial flutter. Atrial fibrillation would have an irregularly irregular rhythm, and junctional rhythms and sinus bradycardia would have different P wave morphologies.

Question 9

A patient has received instruction on the management of her permanent pacemaker before discharge from the hospital.The nurse recognizes that teaching has been effective when the patient makes which of the following statements?

Accepted Answer

The patient should avoid lifting the arm on the pacemaker side above shoulder level until cleared by a doctor to prevent dislodging the pacemaker leads.

Question 10

A patient who has been successfully resuscitated twice following sudden cardiac death has a transvenous ICD implanted for management of ventricular dysrhythmias.When performing discharge teaching with the patient,what is most important for the nurse to instruct the patient and family about?

Accepted Answer

It is important to inform the patient and family that if the ICD fires and the patient loses consciousness, they should immediately call 911. This is because the ICD may not always restore normal rhythm and the patient may require further medical attention. The other options are incorrect because the patient may still need to take medications to control dysrhythmias even with an ICD, family members should still learn CPR as the ICD may not always be effective, and there may be some travel restrictions as the ICD can set off airport security alarms.

Question 11

A patient who is complaining of a "racing" heart and nervousness comes to the emergency department.The patient's blood pressure (BP)is 102/68 mm Hg.The nurse places the patient on a cardiac monitor and obtains the following ECG tracing: 
Which action should the nurse take next?

Accepted Answer

The ECG tracing shows sinus tachycardia, which is a fast heart rate originating from the sinoatrial (SA) node. Before administering any medication, the nurse should obtain further information about possible causes for the tachycardia, such as anxiety, fever, pain, hypovolemia, or hyperthyroidism. The Valsalva manoeuvre (choice A) may be used to slow down a supraventricular tachycardia, but not sinus tachycardia. Electrical cardioversion (choice C) is not indicated for sinus tachycardia. Beta-blockers (choice B) can be used to slow down the heart rate, but only after identifying and treating the underlying cause.

Question 12

A patient has a normal cardiac rhythm strip,except that the PR interval is 0.34 seconds.What is the appropriate nursing intervention?

Accepted Answer

A PR interval of 0.34 seconds falls within the normal range (0.12-0.20 seconds), so there is no need for immediate intervention or notification of the physician. The appropriate nursing intervention is to document the finding and continue to monitor the patient for any changes.

Question 13

Which classification of antidysrhythmia drugs has no effect on ECG?

Accepted Answer

The answer of Which classification of antidysrhythmia drugs has no...

Question 14

A patient has a sinus arrest with a junctional escape rhythm.What would the nurse expect the patient's pulse rate to be?

Accepted Answer

In the case of a sinus arrest with a junctional escape rhythm, the atrioventricular (AV) node or junction takes over as the pacemaker of the heart. The typical rate of a junctional escape rhythm is 40 to 60 beats per minute, which is slower than the normal sinus rhythm but faster than ventricular escape rhythms.

Question 15

What is the most accurate way to calculate the heart rate from an ECG?

Accepted Answer

Counting the number of QRS complexes in 1 minute provides the most accurate heart rate calculation from an ECG.

Question 16

A patient has a dysrhythmia that requires careful monitoring of atrial activity.Which lead will be best to use for continuous monitoring?

Accepted Answer

MCL1 (Modified Chest Lead 1) is a lead that can be obtained by placing the negative electrode on the right side of the sternum and the positive electrode on the left side of the chest just below the clavicle. This lead provides a good view of atrial activity as it is close to the atrium. Other leads, such as AVF, V6, and I, may not provide as clear of a view of atrial activity.

Question 17

A patient with myocardial damage develops a type I,second-degree AV block.The nurse administers IV atropine as prescribed.The nurse determines that the medication has been effective on finding which of the following changes?

Accepted Answer

Atropine is a medication that stimulates the sympathetic nervous system by blocking the action of acetylcholine. This leads to an increase in heart rate by increasing the firing rate of the sinoatrial (SA) node. Therefore, an increase in the patient's heart rate would be the expected finding after administering atropine. Options A and B are not necessarily relevant to the administration of atropine for AV block, and option D may not always be a reliable indicator of medication effectiveness.

Question 18

The nurse retrieves data from the cardiac monitor that indicates that a patient with an MI experienced a 45-second episode of ventricular tachycardia before a normal sinus rhythm and a heart rate of 98 were re-established.What is the most appropriate initial nursing action?

Accepted Answer

The answer of The nurse retrieves data from the cardiac...

Question 19

A patient with diabetes mellitus is admitted unresponsive to the emergency department (ED).Initial laboratory findings are serum potassium 2.8 mmol/L,serum sodium 138 mmol/L,serum chloride 90 mmol/L,and blood glucose 34.9 mmol/L (628 mg/dL).Cardiac monitoring shows multifocal premature ventricular contractions (PVCs).What does the nurse understand that the patient's PVCs are most likely caused by?

Accepted Answer

The patient's PVCs are most likely caused by hypokalemia, as the serum potassium level is 2.8 mmol/L, which is below the normal range (typically 3.5 to 5.0 mmol/L). Low potassium levels can lead to cardiac rhythm abnormalities, including PVCs.

Question 20

A patient has a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response.The nurse recognizes that the pacemaker is used for the patient to do which of the following?

Accepted Answer

Pacemakers are designed to discharge an electrical stimulus to prompt ventricular depolarization if the heart's natural electrical activity is too slow or absent, ensuring a stable heart rate and rhythm.

Quiz 38: Nursing Management: Dysrhythmias