MS II Prep U Ch. 26: Management of Patients With
Dysrhythmias and Conduction Problems
A home care nurse is visiting a left-handed client who has an implantable
cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the
nurse how excited he is because he's planning to go rifle hunting with his
grandson. How should the nurse respond?
"Enjoy your time with your grandson."
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the
ICD site."
"Being that close to a rifle might make your ICD fire."
"You'll need to take an extra dose of your antiarrhythmic before you shoot."
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."
The recoil from the rifle can damage the ICD, so the client should be warned against
shooting a rifle with his left hand. Close proximity to a rifle won't cause the ICD to fire
inadvertently. The client shouldn't take an extra dose of his antiarrhythmic.
A nursing student is giving to a client with heart failure a medication with a
positive inotropic effect on the heart. The student asks what a "positive inotropic"
effect is. The correct response would be which of the following?
It increases the force of the myocardial contraction.
It increases the heart rate.
It increases the respiratory rate.
It causes the kidneys to retain fluid and increase intravascular volume.
It increases the force of the myocardial contraction.
A positive inotropic effect increases the force of myocardial contraction. A positive
chronotropic effect increases the heart rate. A positive inotropic effect will usually help
slow respiratory rate and will increase blood flow through the kidneys, so fluid output will
increase.
A nurse and nursing student are caring for a client with coronary heart disease
and providing information about the disease process to the client. When client
care is completed, the student asks the nurse what things stimulate the heart to
beat faster. The correct response would be which of the following?
"Anything that stimulates the sympathetic nervous systerm (positive
chronotropy)"
,"Anything that stimulates the parasympathetic nervous system (negative
chronotropy)"
"Hypothyroidism"
"Beta-adrenergic blocking agents"
"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)"
Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic
stimulation reduces heart rate. Administration of beta-adrenergic blocking agents
decreases stimulation of the sympathetic nervous system and subsequently heart rate.
The nurse caring for a patient with a dysrhythmia understands that the P wave on
an electrocardiogram (ECG) represents what phase of the cardiac cycle?
Atrial depolarization
Early ventricular repolarization
Ventricular depolarization
Ventricular repolarization
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.
A client's Holter monitor strip reveals a heart rate with normal conduction but
with a rate consistently above 105 beats/minute. What other conditions can cause
this response in a healthy heart?
All options are correct.
elevated temperature
shock
strenuous exercise
All options are correct.
There are a variety of causes that can create an elevated heart rate in an otherwise
healthy heart, including fever, shock, and strenuous exercise.
Which diagnostic study best evaluates different medications ability to restore
normal heart rhythm?
Elective electrical cardioversion
Electrocardiogram (ECG)
,Electrophysiology study
Echocardiogram
Electrophysiology study
An electrophysiology study is a procedure that enables the physician to examine the
electrical activity of the heart, produce actual dysrhythmias, and determine the best
method for care. Cardioversion uses synchronized electricity to change the rhythm
pattern. Electrocardiogram and echocardiograms provide diagnostic information.
A nurse is completing a shift assessment on a patient admitted to the telemetry
unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood
pressure of 90/66 mm Hg. The patient is also experiencing dizziness and
shortness of breath. Which of the following medications will the nurse anticipate
administering to the patient based on these clinical findings?
Atropine
Lidocaine
Pronestyl
Cardizem
Atropine
The patient is demonstrating signs and symptoms of symptomatic sinus bradycardia.
Atropine is the medication of choice in treating symptomatic sinus bradycardia.
Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and
ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial
dysrhythmias.
The nurse is caring for a client who has developed junctional tachycardia with a
heart rate (HR) of 80 bpm. Which of the following actions should the nurse
complete?
Request a digoxin level be ordered.
Withhold the patient's oral potassium supplement.
Prepare for emergent electrical cardioversion.
Prepare to administer IV lidocaine.
Request a digoxin level be ordered.
The nurse should request a digoxin level be obtained. Junctional tachycardia generally
does not have any detrimental hemodynamic effect; it may indicate a serious underlying
condition, such as digitalis toxicity, myocardial ischemia, hypokalemia, or chronic
obstructive pulmonary disease (COPD). Potassium supplements do not cause
junctional tachycardia. Lidocaine is indicated for the treatment of premature ventricular
, contractions (PVCs). Because junctional tachycardia is caused by increased
automaticity, cardioversion is not an effective treatment; in fact, it causes an increase in
ventricular rate.
After taking an ECG on a 38-year-old woman, the nurse reports that the PR
interval reflects normal sinus rhythm. The nurse has made this interpretation
based on the PR interval of:
0.05 and 0.1 seconds.
0.12 and 0.2 seconds.
0.15 and 0.3 seconds.
0.25 and 0.4 seconds.
0.12 and 0.2 seconds.
The PR interval is measured from the beginning of the P wave to the beginning of the
QRS complex. It measures the time needed for conduction through the AV node before
ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.
A patient is being examined for medical management of atrial flutter. The nurse
reviews the ECG strip. He expects to see which of the following?
P-to-QRS duration of less than 0.1 seconds
"Sawtooth" pattern to the waveform
Ventricular rate below 70 bpm
PR interval between 0.12 and 0.2 seconds.
"Sawtooth" pattern to the waveform
The "sawtooth pattern" is the classic waveform appearance with atrial flutter. The atrial
rate is faster than the AV node can conduct. Not all atrial impulses stimulate the
ventricle.
A nurse is performing discharge teaching with a client who has an implantable
cardioverter defibrillator (ICD) placed. Which client statement indicates effective
teaching?
"I'll keep a log of each time my ICD discharges."
"I can't wait to get back to my football league."
"I have an appointment for magnetic resonance imaging of my knee scheduled
for next week."
"I need to stay at least 10? away from the microwave."
Dysrhythmias and Conduction Problems
A home care nurse is visiting a left-handed client who has an implantable
cardioverter-defibrillator (ICD) implanted in his left chest. The client tells the
nurse how excited he is because he's planning to go rifle hunting with his
grandson. How should the nurse respond?
"Enjoy your time with your grandson."
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the
ICD site."
"Being that close to a rifle might make your ICD fire."
"You'll need to take an extra dose of your antiarrhythmic before you shoot."
"You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site."
The recoil from the rifle can damage the ICD, so the client should be warned against
shooting a rifle with his left hand. Close proximity to a rifle won't cause the ICD to fire
inadvertently. The client shouldn't take an extra dose of his antiarrhythmic.
A nursing student is giving to a client with heart failure a medication with a
positive inotropic effect on the heart. The student asks what a "positive inotropic"
effect is. The correct response would be which of the following?
It increases the force of the myocardial contraction.
It increases the heart rate.
It increases the respiratory rate.
It causes the kidneys to retain fluid and increase intravascular volume.
It increases the force of the myocardial contraction.
A positive inotropic effect increases the force of myocardial contraction. A positive
chronotropic effect increases the heart rate. A positive inotropic effect will usually help
slow respiratory rate and will increase blood flow through the kidneys, so fluid output will
increase.
A nurse and nursing student are caring for a client with coronary heart disease
and providing information about the disease process to the client. When client
care is completed, the student asks the nurse what things stimulate the heart to
beat faster. The correct response would be which of the following?
"Anything that stimulates the sympathetic nervous systerm (positive
chronotropy)"
,"Anything that stimulates the parasympathetic nervous system (negative
chronotropy)"
"Hypothyroidism"
"Beta-adrenergic blocking agents"
"Anything that stimulates the sympathetic nervous systerm (positive chronotropy)"
Stimulation of the sympathetic nervous system increases heart rate. Parasympathetic
stimulation reduces heart rate. Administration of beta-adrenergic blocking agents
decreases stimulation of the sympathetic nervous system and subsequently heart rate.
The nurse caring for a patient with a dysrhythmia understands that the P wave on
an electrocardiogram (ECG) represents what phase of the cardiac cycle?
Atrial depolarization
Early ventricular repolarization
Ventricular depolarization
Ventricular repolarization
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.
A client's Holter monitor strip reveals a heart rate with normal conduction but
with a rate consistently above 105 beats/minute. What other conditions can cause
this response in a healthy heart?
All options are correct.
elevated temperature
shock
strenuous exercise
All options are correct.
There are a variety of causes that can create an elevated heart rate in an otherwise
healthy heart, including fever, shock, and strenuous exercise.
Which diagnostic study best evaluates different medications ability to restore
normal heart rhythm?
Elective electrical cardioversion
Electrocardiogram (ECG)
,Electrophysiology study
Echocardiogram
Electrophysiology study
An electrophysiology study is a procedure that enables the physician to examine the
electrical activity of the heart, produce actual dysrhythmias, and determine the best
method for care. Cardioversion uses synchronized electricity to change the rhythm
pattern. Electrocardiogram and echocardiograms provide diagnostic information.
A nurse is completing a shift assessment on a patient admitted to the telemetry
unit with a diagnosis of syncope. The patient's heart rate is 55 bpm with a blood
pressure of 90/66 mm Hg. The patient is also experiencing dizziness and
shortness of breath. Which of the following medications will the nurse anticipate
administering to the patient based on these clinical findings?
Atropine
Lidocaine
Pronestyl
Cardizem
Atropine
The patient is demonstrating signs and symptoms of symptomatic sinus bradycardia.
Atropine is the medication of choice in treating symptomatic sinus bradycardia.
Lidocaine treats ventricular dysrhythmias. Pronestyl treats and prevents atrial and
ventricular dysrhythmias. Cardizem is a calcium channel blocker and treats atrial
dysrhythmias.
The nurse is caring for a client who has developed junctional tachycardia with a
heart rate (HR) of 80 bpm. Which of the following actions should the nurse
complete?
Request a digoxin level be ordered.
Withhold the patient's oral potassium supplement.
Prepare for emergent electrical cardioversion.
Prepare to administer IV lidocaine.
Request a digoxin level be ordered.
The nurse should request a digoxin level be obtained. Junctional tachycardia generally
does not have any detrimental hemodynamic effect; it may indicate a serious underlying
condition, such as digitalis toxicity, myocardial ischemia, hypokalemia, or chronic
obstructive pulmonary disease (COPD). Potassium supplements do not cause
junctional tachycardia. Lidocaine is indicated for the treatment of premature ventricular
, contractions (PVCs). Because junctional tachycardia is caused by increased
automaticity, cardioversion is not an effective treatment; in fact, it causes an increase in
ventricular rate.
After taking an ECG on a 38-year-old woman, the nurse reports that the PR
interval reflects normal sinus rhythm. The nurse has made this interpretation
based on the PR interval of:
0.05 and 0.1 seconds.
0.12 and 0.2 seconds.
0.15 and 0.3 seconds.
0.25 and 0.4 seconds.
0.12 and 0.2 seconds.
The PR interval is measured from the beginning of the P wave to the beginning of the
QRS complex. It measures the time needed for conduction through the AV node before
ventricular depolarization. The normal range in adults is 0.12 to 0.2 seconds.
A patient is being examined for medical management of atrial flutter. The nurse
reviews the ECG strip. He expects to see which of the following?
P-to-QRS duration of less than 0.1 seconds
"Sawtooth" pattern to the waveform
Ventricular rate below 70 bpm
PR interval between 0.12 and 0.2 seconds.
"Sawtooth" pattern to the waveform
The "sawtooth pattern" is the classic waveform appearance with atrial flutter. The atrial
rate is faster than the AV node can conduct. Not all atrial impulses stimulate the
ventricle.
A nurse is performing discharge teaching with a client who has an implantable
cardioverter defibrillator (ICD) placed. Which client statement indicates effective
teaching?
"I'll keep a log of each time my ICD discharges."
"I can't wait to get back to my football league."
"I have an appointment for magnetic resonance imaging of my knee scheduled
for next week."
"I need to stay at least 10? away from the microwave."
