Chapter 22: Arrhythmias and Conduction Problems 1. The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect? a. Pacemaker site infection 2. The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and “sawtooth” P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm? a. Atrial Flutter 3. The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? a. We will be getting rid of our microwave oven so it will not affect my pacemaker." 4. Two nursing students are reading EKG strips. One of the students asks the instructor what the P-R interval represents. The correct response should be which of the following? a. It shows the time needed for the SA node impulse to depolarize the atria and travel through the AV node." 5. A client has been diagnosed with atrial fibrillation and has been prescribed warfarin therapy. What should the nurse prioritize when providing health education to the client? a. The need to have regular blood levels drawn 6. The nurse is proving discharge instructions for a client with a new arrhythmia. Which statement should the nurse include? a. Your family and friends may want to take a CPR class 7. A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? a. “Spike” on the rhythm strip 8. A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client 's monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse's first response? a. Assess the client and monitor leads 9. A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? a. Double-check the monitoring equipment 10. A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder? a. Atrial Flutter 11. The nursing student asks the nurse how to tell the difference between ventricular tachycardia and ventricular fibrillation on an electrocardiogram strip. What is the best response? a. Ventricular fibrillation is irregular with undulating waves and no QRS complex. Ventricular tachycardia is usually regular and fast, with wide QRS complexes." 12. The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? a. The registered nurse administering atropine sulfate intravenously 13. The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document? a. Ventricular Tachycardia 14. The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? a. Hypovolemia 15. A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? a. "I'll keep a log of each time my ICD discharges." 16. The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block? a. Delayed conduction, producing a prolonged PR interval 17. The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment? a. An automatic external defibrillator 18. After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? a. decreased cardiac output and decreased systolic and diastolic blood pressure 19. The nurse is providing teaching to a client with an implanted cardiac device. Which client statement indicates that teaching has been effective? a. “I will not place my cell phone in my chest pocket.” 20. The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? a. The only difference is the heart rate 21. The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer? a. Atropine sulfate 22. The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)? a. Hypokalemia 23. A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client's electrocardiogram (ECG) strip to the spouse? a. "The small box will transmit the heart rhythm to the central monitor all the time." 24. A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client? a. Elective electrical cardioversion 25. The nurse is providing discharge instructions for a client with a newly implanted cardiac defibrillator. What statement made by the client indicates the need for further teaching? a. "I will report if I feel lightheaded and dizzy at my next doctor’s appointment.” 26. The nurse is caring for a client who has premature ventricular contractions. After assessing the client, the nurse will likely need to document which observed sign or symptom? a. Palpitations 27. The nurse knows that what PR interval presents a first-degree heart block? a. 0.24 seconds 28. A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardiogram as an indicator of sinus tachycardia? a. heart rate of 118 bpm 29. The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client? a. alerting the healthcare provider of the third-degree heart block 30. The staff educator is teaching a class in arrhythmias. What statement is correct for defibrillation? a. It is used to eliminate ventricular arrhythmias. 31. A client is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the client's care? a. Diagnose the dysrhythmia 32. The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment? a. A defilbrillator 33. Which ECG waveform characterizes conduction of an electrical impulse through the left ventricle? a. QRS complex 34. The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? a. A client with atrial arrhythmias 35. The nurse cares for a client with a dysrhythmia and understands that the P wave on an electrocardiogram (ECG) represents which phase of the cardiac cycle? a. Atrial depolarization 36. A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? a. Ventricular fibrillation 37. A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? a. internal cardioverter defibrillator insertion 38. When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be a. Captured 39. Which of the following medications does the nurse anticipate administering to a client preparing for cardioversion? a. Diazepam 40. The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe? a. Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers 41. A client has a medical diagnosis of an advanced first-degree atrioventricular block and is symptomatic. What initial treatment will the nurse be prepared to complete? a. administer an IV bolus of atropine 42. The nurse receives a telephone call from a client with an implanted pacemaker who reports a pulse of 68 beats per minute, but the pacemaker rate is set at 72 beats per minute. What is the nurse's best response? a. "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning." 43. Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? a. Monitor vital signs and cardiac rhythm 44. The nurse is admitting a client to a telemetry unit with an atrial dysrhythmia. What symptoms will the nurse further evaluate? a. Chest pain 45. The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse? a. "The rhythm has a normal beat, then a premature beat pattern." 46. The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? a. I should ask for a handheld device search when I go through airport security."
