Deck 29: Coordinating Care for Patients With Cardiac Dysrhythmia

Question 1

The nurse monitors for which clinical manifestation in the patient with atrial fibrillation at a heart rate of 90 beats per minute. Which manifestation should the nurse expect to assess in this patient?
1)Headache
2)Chest pain
3)Palpitations
4)Hypotension

Answer 1

3

Question 2

Once ventricular fibrillation has been confirmed in a patient, which action is the priority?
1)Assessing vital signs
2)Opening the airway
3)Beginning rescue breathing
4)Starting chest compressions

Answer 2

4

Question 3

The nurse provides care to a patient who is undergoing cardioversion. Which is the priority nursing action before initiating the shock?
1)Documenting the vital signs
2)Telling the patient what to expect
3)Setting the defibrillation to 100 joules
4)Stating, "I am clear, you are clear, we are all clear."

Answer 3

4

Question 4

In preparing a patient with atrial fibrillation for cardioversion, the nurse prepares the patient for which diagnostic before the cardioversion?
1)Chest x-ray examination
2)Computed tomography (CT) scan of the chest 3.12-lead electrocardiogram
4)Transesophageal echocardiogram (TEE)

Question 5

A patient is in normal sinus rhythm with prolonged PR intervals. What prescribed treatment does the nurse plan for this patient?
1)Continue to monitor
2)Prepare for defibrillation
3)Prepare for cardioversion
4)Prepare for pacemaker insertion

Question 6

When analyzing a patient's electrocardiogram, the nurse correlates which information as descriptive of a normal P wave?
1)Represents conduction through the atrioventricular (AV) node
2)Represents ventricular depolarization
3)The height of the P wave is 4 mm
4)The P length is 0.10 seconds

Question 7

A patient is being cardioverted for symptomatic atrial fibrillation. At which point of the cardiac cycle will the electric impulse occur?
1)At the end of the P wave
2)Before the QRS complex
3)At the peak of the R wave
4)After the QRS complex but before the T wave

Question 8

The nurse notes that PR intervals are getting progressively longer before a QRS complex is dropped on a patient's cardiac rhythm strip. The nurse interprets this as which cardiac dysrhythmia?
1)First-degree atrioventricular (AV) block
2)Second-degree AV block, Mobitz I
3)Secondary-degree AV block, Mobitz II
4)Third-degree AV block

Question 9

The nurse correlates the P wave on the electrocardiogram (ECG) tracing to which cardiac action?
1)Repolarization of the Purkinje fibers
2)Repolarization of the ventricles
3)Depolarization of the atria
4)Depolarization of the ventricles

Question 10

The nurse is monitoring the electrocardiogram (ECG) of a patient who has an internal ventricular pacemaker. Which pacer spike indicates the pacemaker is functioning properly?
1)The pacer spike occurs before the P wave
2)The pacer spike occurs before the QRS
3)Two pacer spikes occur before the QRS
4)Two pacer spikes occur before the T wave

Question 11

The nurse develops the nursing diagnosis "Decreased Cardiac Output related to impaired conduction as evidenced by consistent PR intervals and dropped QRS complexes" for which cardiac dysrhythmia?
1)First-degree atrioventricular (AV) block
2)Second-degree AV block type I
3)Second-degree AV block type II
4)Third-degree AV block

Question 12

The nurse is concerned that a patient is at risk for pulseless electrical activity. What information from the assessment did the nurse use to make this clinical decision?
1)Blood pH 7.30
2)Temperature 100.5°F
3)Serum glucose level 170 mg/dL
4)Serum potassium level 4.1 mEq/L

Question 13

A patient is being prepared for a transvenous pacemaker. What should the nurse include when explaining this pacemaker to the family?
1)"It is inserted using an internal jugular vein."
2)"It is done by placing defibrillator pads on the torso using an anterior/posterior position."
3)"It is done by placing a pacer wire in the atrium or the ventricle and fed out through the skin, where it is attached to an external pacemaker."
4)"It is inserted by placing pacer wires in the atrium, ventricle, or both and attached to a small pacemaker generator placed under the skin near the clavicle."

Question 14

The nurse prepares to administer which prescribed medication to the patient with shortness of breath and a heart rhythm of 46 beats per minute.
1)Atropine sulfate
2)Atenolol (Tenormin)
3)Diltiazem (Cardizem)
4)Adenosine (Adenocard)

Question 15

A patient's heart rate is 48 beats per minute. The nurse correlates this heart rate to the inherent rate of which structure?
1)Purkinje fibers
2)Sinoatrial node
3)Atrioventricular node
4)Ventricular pacer cells

Question 16

The nurse is observed marching out the rhythm on a patient's cardiac monitor tracing. What is this nurse assessing?
1)Rate
2)Polarity
3)Regularity
4)Amplitude

Question 17

The nurse is preparing to defibrillate a patient and selects which setting before the first shock?
1)50 J
2)100 J
3)150 J
4)200 J

Question 18

A patient is being evaluated for a blockage in the cardiac ventricles. The nurse assesses which part of the electrocardiogram as evidence of this blockage?
1)T wave
2)U wave
3)PR interval
4)QRS interval

Question 19

The nurse notes that the patient with atrial fibrillation has hypotension and correlates this to decreased cardiac output secondary to which factor?
1)Loss of atrial kick
2)Decreased atrioventricular (AV) node conduction
3)Increased atrial contraction
4)Resistance to ventricular filling

Question 20

The nurse provides care to a patient who is prescribed intravenous (IV) adenosine (Adenocard). Which is the priority nursing action before administering the medication?
1)Monitoring respirations
2)Palpating the patient's pulse
3)Teaching the patient to avoid caffeine intake
4)Ensuring a transcutaneous pacemaker is available

Question 21

A patient becomes unresponsive without a palpable pulse despite showing bradycardia on the rhythm strip. What action should the nurse take immediately? Select all that apply.
1)Auscultating heart sounds
2)Beginning cardiac compressions
3)Adjusting cardiac monitor leads
4)Obtaining blood samples for electrolytes
5)Placing epinephrine at the bedside

Question 22

An older adult patient is being evaluated for a new onset of a cardiac dysrhythmia. What should the nurse consider as being the cause for this abnormal heart rhythm? Select all that apply.
1)Advanced age
2)Protein malnutrition
3)Fat deposits around the sinoatrial (SA) node
4)Fewer pacemaker cells in the SA node
5)Calcification around the AV node and valves

Question 23

The nurse working on the telemetry unit correlates which data to normal electrocardiogram (ECG) parameters. Select all that apply.
1)The sinoatrial (SA) node is located in the right upper wall of the right atrium.
2)The inherent rate of the SA node is 60 to 100 bpm.
3)The inherent rate of the atrioventricular (AV) node is 20 to 40 bpm.
4)Impulses from the AV node travel through the ventricular pathways.
5)The inherent rate of the Purkinje fibers is 40 bpm or less.

Question 24

The nurse counts eight QRS complexes in a 6-second period on the patient's electrocardiogram (ECG) strip. The nurse documents the patient's pulse as ____________________ bpm.

Question 25

A patient with a cardiac dysrhythmia asks why it is important to recognize the signs of a stroke. What is the best response by the nurse?
1)"To help you to respond quickly to these signs and symptoms."
2)"To encourage you to take your medication as prescribed."
3)"Although stroke is very rare in patients with cardiac dysrhythmias, this is important information."
4)"Most people with heart dysrhythmias develop strokes"

Question 26

A patient with a cardiac dysrhythmia is experiencing nausea and vomiting. What is the reason for this?
1)Poor contractile function
2)Altered electrolyte levels
3)Blood shunted away from nonessential organ systems
4)An imbalance in myocardial oxygen supply and demand

Question 27

The nurse counts 20 small boxes between two R waves. The nurse documents the patient's heart rate as ____________________ bpm.

Question 28

In assessing a patient with a heart rate of 132 beats per minute, the nurse assesses for which causes of this elevated heart rate? Select all that apply.
1)Blood pressure 80/40
2)Fever
3)Blood glucose 60 mg/dL
4)Urine specific gravity 1.003
5)Hemoglobin 9 g/dL

Question 29

In assessing a patient diagnosed with complete heart block (CHB), which data require an immediate intervention? Select all that apply.
1)Skin that this dry and intact.
2)Serum potassium of 4 mEq/L.
3)Capillary refill greater than 3 seconds.
4)A decreased blood pressure noted from baseline.
5)A baseline heart rate of 88 bpm that is unchanged.

Question 30

When calculating a patient's heart rate using the cardiac rhythm strip, the nurse notes the presence of four large boxes between the two R waves. What is this patient's heart rate? Record your answer as a whole number. ______