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Chapter 35. Dysrhythmias Lewis. Medical-Surgical Nursing, 10th Edition Questions with Accurate Answers
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Chapter 35. Dysrhythmias Lewis. Medical-Surgical Nursing, 10th Edition
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Chapter 35. Dysrhythmias Lewis.Medical-Surgical Nursing, 10th Edition
The nurse needs to quickly estimate the heart rate for a patient with a regular heart
rhythm. Which method will be best to use?
a. Count the number of large squares in the R-R interval and divide by 300.
b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS
complexes.
c. Use the 3-second markers to count the number of QRS complexes in 6 seconds and
multiply by 10.
d. Calculate the number of small squares between one QRS complex and the next and
divide into 1500. - answerANS: C
This is the quickest way to determine the ventricular rate for a patient with a regular
rhythm. All the other methods are accurate, but take longer.
DIF: Cognitive Level: Analyze (analysis)
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and
makes the following analysis: no visible P waves, PR interval not measurable,
ventricular rate of 162, R-R interval regular, and QRS complex wide and distorted, and
QRS duration of 0.18 second. The nurse interprets the patient's cardiac rhythm as
a. atrial flutter. c. ventricular fibrillation.
b. sinus tachycardia. d. ventricular tachycardia. - answerANS: D
The absence of P waves, wide QRS, rate greater than 150 beats/min, and the regularity
of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a
narrow QRS configuration, and has flutter waves present representing atrial activity.
Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a
consistent QRS duration.
DIF: Cognitive Level: Apply (application)
The nurse notes that a patient's heart monitor shows that every other beat is earlier than
expected, has no visible P wave, and has a QRS complex that is wide and bizarre in
shape. How will the nurse document the rhythm?
a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
d. Multifocal premature ventricular contractions - answerANS: B
Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and
bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets.
, There is no indication that the premature ventricular contractions are multifocal or that
the R-on-T phenomenon is occurring.
DIF: Cognitive Level: Apply (application)
A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines
that the PR interval is 0.24 seconds. The most appropriate intervention by the nurse
would be to
a. notify the health care provider immediately.
b. document the finding and monitor the patient.
c. give atropine per agency dysrhythmia protocol.
d. prepare the patient for temporary pacemaker insertion. - answerANS: B
First-degree atrioventricular block is asymptomatic and requires ongoing monitoring
because it may progress to more serious forms of heart block. The rate is normal, so
there is no indication that atropine is needed. Immediate notification of the health care
provider about an asymptomatic rhythm is not necessary.
DIF: Cognitive Level: Apply (application)
A patient who was admitted with a myocardial infarction experiences a 45-second
episode of ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98
beats/min. Which action should the nurse take next?
a. Immediately notify the health care provider.
b. Document the rhythm and continue to monitor the patient.
c. Prepare to give IV amiodarone per agency dysrhythmia protocol.
d. Perform synchronized cardioversion per agency dysrhythmia protocol. - answerANS:
C
The burst of sustained ventricular tachycardia indicates that the patient has significant
ventricular irritability, and antidysrhythmic medication administration is needed to
prevent further episodes. The nurse should notify the health care provider after the
medication is started. Cardioversion is not indicated given that the patient has returned
to a sinus rhythm. Documentation and continued monitoring are not adequate
responses to this situation.
DIF: Cognitive Level: Analyze (analysis)
After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree
atrioventricular (AV) block, which finding indicates that the drug has been effective?
a. Increase in the patient's heart rate
b. Increase in strength of peripheral pulses
c. Decrease in premature atrial contractions
d. Decrease in premature ventricular contractions - answerANS: A
Atropine will increase the heart rate and conduction through the AV node. Because the
drug increases electrical conduction, not cardiac contractility, the quality of the
peripheral pulses is not used to evaluate the drug effectiveness. The patient does not
have premature atrial or ventricular contractions.
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