Exam (elaborations)
cardiac dysrhythmias Questions and Answers 2024
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cardiac dysrhythmias
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Chapter 34. Care of Patients withDysrhythmias
A nurse assesses a client's electrocardiograph tracing and observes that not all QRS
complexes are preceded by a P wave. How should the nurse interpret this observation?
a. The client has hyperkalemia causing irregular QRS complexes.
b. Ventricular tachycardia is overriding the normal atrial rhythm.
c. The client's chest leads are not making sufficient contact with the skin.
d. Ventricular and atrial depolarizations are initiated from different sites. - answerANS: D
Normal rhythm shows one P wave preceding each QRS complex, indicating that all
depolarization is initiated at the sinoatrial node. QRS complexes without a P wave
indicate a different source of initiation of depolarization. This finding on an
electrocardiograph tracing is not an indication of hyperkalemia, ventricular tachycardia,
or disconnection of leads.
A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse
symptoms. Which activity modification should the nurse suggest to avoid further slowing
of the heart rate?
a. "Make certain that your bath water is warm."
b. "Avoid straining while having a bowel movement."
c. "Limit your intake of caffeinated drinks to one a day."
d. "Avoid strenuous exercise such as running." - answerANS: B
Bearing down strenuously during a bowel movement is one type of Valsalva maneuver,
which stimulates the vagus nerve and results in slowing of the heart rate. Such a
response is not desirable in a person who has bradycardia. The other instructions are
not appropriate for this condition.
A nurse is assessing clients on a medical-surgical unit. Which client should the nurse
identify as being at greatest risk for atrial fibrillation?
a. A 45-year-old who takes an aspirin daily
b. A 50-year-old who is post coronary artery bypass graft surgery
c. A 78-year-old who had a carotid endarterectomy
d. An 80-year-old with chronic obstructive pulmonary disease - answerANS: B
Atrial fibrillation occurs commonly in clients with cardiac disease and is a common
occurrence after coronary artery bypass graft surgery. The other conditions do not place
these clients at higher risk for atrial fibrillation.
A nurse assesses a client with atrial fibrillation. Which manifestation should alert the
nurse to the possibility of a serious complication from this condition?
a. Sinus tachycardia
b. Speech alterations
, c. Fatigue
d. Dyspnea with activity - answerANS: B
Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events
includes changes in mentation, speech, sensory function, and motor function. Clients
with atrial fibrillation often have a rapid ventricular response as a result. Fatigue is a
nonspecific complaint. Clients with atrial fibrillation often have dyspnea as a result of the
decreased cardiac output caused by the rhythm disturbance.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which
medication should the nurse expect to find on this client's medication administration
record to prevent a common complication of this condition?
a. Sotalol (Betapace)
b. Warfarin (Coumadin)
c. Atropine (Sal-Tropine)
d. Lidocaine (Xylocaine) - answerANS: B
Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are
treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine,
and lidocaine are not appropriate for this complication.
A nurse administers prescribed adenosine (Adenocard) to a client. Which response
should the nurse assess for as the expected therapeutic response?
a. Decreased intraocular pressure
b. Increased heart rate
c. Short period of asystole
d. Hypertensive crisis - answerANS: C
Clients usually respond to adenosine with a short period of asystole, bradycardia,
hypotension, dyspnea, and chest pain. Adenosine has no conclusive impact on
intraocular pressure.
A telemetry nurse assesses a client with third-degree heart block who has wide QRS
complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment
should the nurse complete next?
a. Pulmonary auscultation
b. Pulse strength and amplitude
c. Level of consciousness
d. Mobility and gait stability - answerANS: C
A heart rate of 40 beats/min or less with widened QRS complexes could have
hemodynamic consequences. The client is at risk for inadequate cerebral perfusion.
The nurse should assess for level of consciousness, light-headedness, confusion,
syncope, and seizure activity. Although the other assessments should be completed,
the client's level of consciousness is the priority.
A nurse cares for a client with an intravenous temporary pacemaker for bradycardia.
The nurse observes the presence of a pacing spike but no QRS complex on the client's
electrocardiogram. Which action should the nurse take next?
a. Administer intravenous diltiazem (Cardizem).
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