Med-Surge Nursing Cardio Prep U ch 26
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When no atrial impulse is conducted through the AV node into the ventricles, the
client is said to be experiencing which type of AV block? - -Third degree
In third degree heart block, two impulses stimulate the heart, one impulse stimulates
the ventricles and other stimulates the atria. In first degree heart block, all the atrial
impulses are conducted through the AV node into the ventricles at a rate slower than
normal. In second degree AV block, type I, all but one of the atrial impulses are
conducted through the AV node into the ventricles. In second degree AV block, type
II, only some of the atrial impulses are conducted through the AV node into the
ventricles.
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The staff educator is teaching a class in dysrhythmias. What statement is correct for
defibrillation? - -It is used to eliminate ventricular dysrhythmias.
The only treatment for a life-threatening ventricular dysrhythmia is immediate
defibrillation, which has the exact same effect as cardioversion, except that
defibrillation is used when there is no functional ventricular contraction. It is an
emergency procedure performed during resuscitation. The client is not sedated but is
unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than
cardioversion.
A nurse is caring for a client who has been admitted to have a cardioverter
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defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are
used in which clients? - -Clients with recurrent life-threatening
tachydysrhythmias
The automatic implanted cardioverter defibrillator (AICD) is an internal electrical
device used for selected clients with recurrent life-threatening tachydysrhythmias.
Therefore, options A, B, and C are incorrect.
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The nurse recognizes that Premature ventricular contractions (PVCs) are considered
precursors of ventricular tachycardia (VT) when they: - -occur at a rate of more
than six per minute
When PVCs occur at a rate of more than six per minute, they indicate increasing
ventricular irritability and are considered forerunners of VT. PVCs are dangerous
when they occur on the T wave. PVCs are dangerous when they are multifocal (have
different shapes). A PVC that is paired with a normal beat is termed bigeminy.
The nurse cares for a client with a dysrhythmia and understands that the P wave on
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an electrocardiogram (ECG) represents which phase of the cardiac cycle? -
-Atrial depolarization
,The P wave represents atrial depolarization. The QRS complex represents
ventricular depolarization. The T wave represents ventricular repolarization. The ST
segment represents early ventricular repolarization, and lasts from the end of the
QRS complex to the beginning of the T wave.
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The nurse is caring for a client who has premature ventricular contractions. What
sign or symptom is observed in this client? - -Fluttering
Premature ventricular contractions usually cause a flip-flop sensation in the chest,
sometimes described as "fluttering." Associated signs and symptoms include pallor,
nervousness, sweating, and faintness. Symptoms of premature ventricular
contractions are not nausea, hypotension, and fever.
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
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practical nurse confirms the monitor reading. When consulting with the registered
nurse, which of the following is anticipated? - -The registered nurse
administering atropine sulfate intravenously
The licensed practical nurse and registered nurse both identify that client's
bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously
(IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the
pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate
increases without nursing intervention or administering additional medications until
the imminent concern is addressed.
A client is unconscious on arrival to the emergency department. The nurse in the
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emergency department identifies that the client has a permanent pacemaker due to
which characteristic? - -"Spike" on the rhythm strip
Confirmation that the client has a permanent pacemaker is the characteristic "spike"
identified by a thin, straight stroke on the rhythm strip. The scar on the chest is
suggestive of pacer implantation but not definitive. There should be no change in
pulse quality, and no vibration under the skin.
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Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P
waves? - -Atrial flutter
Atrial flutter occurs in the atrium and creates impulses at a regular atrial rate
between 250 and 400 times per minute. The P waves are saw-toothed in shape.
Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial
, musculature. Ventricular fibrillation is a rapid, disorganized ventricular rhythm that
causes ineffective quivering of the ventricles. Ventricular tachycardia is defined as
three or more PVCs in a row, occurring at a rate exceeding 100 beats per minute.
A client has been diagnosed with atrial fibrillation and has been prescribed warfarin
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therapy. What should the nurse prioritize when providing health education to the
client? - -The need to have regular blood levels drawn
One drawback of warfarin therapy is the need to have blood levels drawn on a
regular basis. The medication does not need to be taken on an empty stomach, and
the client does not have to sit upright. Adequate fluid intake is useful in a general
way, but the need for fluids is not increased by taking warfarin.
After evaluating a client for hypertension, a health care provider orders atenolol, 50
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mg P.O. daily. Which therapeutic effect should atenolol have in treating
hypertension? - -Decreased cardiac output and decreased systolic and
diastolic blood pressure
As a long-acting, selective beta1-adrenergic blocker, atenolol decreases cardiac
output and systolic and diastolic blood pressure; however, like other beta-adrenergic
blockers, it increases peripheral vascular resistance at rest and with exercise.
Atenolol may cause bradycardia, not tachycardia.
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Which postimplantation instruction must a nurse provide to a client with a permanent
pacemaker? - -Avoid sources of electrical interference
The nurse must instruct the client with a permanent pacemaker to avoid sources of
electrical interference. The nurse should also instruct the client to avoid strenuous
movement (especially of the arm on the side where the pacemaker is inserted), to
keep the arm on the side of the pacemaker lower than the head except for brief
moments when dressing or performing hygiene, and to delay for at least 8 weeks
activities such as swimming, bowling, tennis, vacuum cleaning, carrying heavy
objects, chopping wood, mowing, raking, and shoveling snow.
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Which nursing intervention must a nurse perform when administering prescribed
vasopressors to a client with a cardiac dysrhythmia? - -Monitor vital signs and
cardiac rhythm
The nurse should monitor the client's vital signs and cardiac rhythm for effectiveness
of the medication and for side effects and should always have emergency life
support equipment available when caring for an acutely ill client. The side effects of
vasopressor drugs are hypertension, dysrhythmias, pallor, and oliguria. It is not
necessary to place a client flat during or after vasopressor administration. When
administering cholinergic antagonists, documentation of the heart rate is necessary.
