Dysrhythmias Questions Answered 100% correct

Dysrhythmias Questions Answered 100% correct patient is in ventricular fibrillation, and cardiopulmonary resuscitation (CPR) is in progress. What is the first step the nurse should take? Turn on the device. Analyze the rhythm. Apply conductive gel pads. Select proper energy setting. Turn on the device. The healthcare team will have to perform defibrillation, and the first step is to turn on the defibrillator or AED. Applying conductive gel pads is always completed after the device has been turned on. Proper energy level selection and rhythm analysis is only completed using a defibrillator; they cannot be done with the AED. The nurse is caring for a patient that has been advised to have a permanent pacemaker implanted. What are indications for a permanent pacemaker? Select all that apply. 1 Cardiomyopathy SA node dysfunction Coronary angioplasty Drug therapy that may cause bradycardia Third-degree atrioventricular (AV) block Cardiomyopathy SA node dysfunction Third-degree atrioventricular (AV) block A permanent pacemaker helps to maintain the normal cardiac pace and is implanted within the body. The power source of such a device is placed subcutaneously, usually over the pectoral muscle on the patient's nondominant side. The permanent pacemaker is used in cardiomyopathy, SA node dysfunction, and third-degree AV block when the dysfunction of the electrical pathways is assumed to be permanent or irreversible. A temporary pacemaker may be required during coronary angioplasty and during drug therapy that may cause bradycardia. To maintain adequate cardiac rhythms during postoperative recovery and as a prophylactic measure after open heart surgery, temporary pacemakers are used. Esmolol is prescribed for some patients with cardiac problems because of what actions it has on the heart's conduction system? Select all that apply. 1 Delays repolarization Accelerates repolarization Decreases automaticity of the SA node Slows the impulse conduction in the AV node Suppresses atrial dysrhythmias through an unknown mechanism Decreases automaticity of the SA node Slows the impulse conduction in the AV node Esmolol is a β-adrenergic blocker that decreases the automaticity of the SA node and slows the impulse conduction in the AV node. Esmolol causes prolonged PR intervals. Potassium channel blockers delay repolarization. Class IB sodium channel blockers accelerate repolarization. Esmolol does not suppress atrial dysrhythmias through an unknown mechanism. A patient with acute coronary syndrome has continuous ECG monitoring in place. The nurse analyzes the patient's rhythm strip and notes a normal atrial rate, regular atrial rhythm, normal-shaped P waves, widened QRS complexes, and 2 P waves preceding every QRS complex. There is no progressive lengthening of PR intervals. What is an appropriate priority intervention? Perform synchronized cardioversion. Administer amiodarone intravenous infusion. Observe for symptoms of decreased cardiac output (CO). Apply a transcutaneous pacemaker. Observe for symptoms of decreased cardiac output (CO). The rhythm is a type II second-degree atrioventricular (AV) block (i.e., Mobitz II). The rhythm is identified by noting P waves that are nonconducted without progressive PR lengthening. This usually occurs when a block in one of the bundle branches is present. On conducted beats, the PR interval is constant. Type II second-degree AV block is a more serious type of block in which a certain number of impulses from the sinoatrial (SA) node are not conducted to the ventricles. This occurs in ratios of 2:1, 3:1, and so on (i.e., two P waves to one QRS complex, three P waves to one QRS complex). The nurse should assess for bradycardia, hypotension, and angina. If the patient becomes symptomatic, atropine or a temporary pacemaker may be needed. A patient states, "I feel tired all the time, and I struggle with activities of daily living." When auscultating the patient's heart rate, the nurse notes disorganization of atrial electrical activity and records a rate of 120 bpm. Which rhythm does the nurse anticipate observing? Asystole Atrial fibrillation Sinus bradycardia Ventricular fibrillation Atrial fibrillation Atrial fibrillation is characterized as irregular. In addition, this rhythm can reduce cardiac output due to the loss of atrial kick and a rapid ventricular rate, causing a reduced exercise tolerance and an elevated heart rate above 100 bpm. The patient will not have a pulse and will not be responsive if the rhythm is ventricular fibrillation or asystole. A patient with sinus bradycardia will have a heart rate less than 60 bpm. A patient that is being tested for syncope has undergone the head-up tilt-test. After 30 minutes of testing, the patient's blood pressure and heart rate did not respond and no clinical symptoms were reproduced. The nurse anticipates that what medication will be given in a low dose intravenously (IV), to provoke a response? Adenosine Midazolam Magnesium Isoproterenol Isoproterenol A head-up tilt-test is a procedure used to determine the cause of fainting spells in a patient. In the head-up tilt-test, the patient is placed on a table supported by a belt across the torso and feet. The electrocardiogram and heart rate are recorded continuously and blood pressure is measured every three minutes throughout the test. If the patient's BP and HR responses are abnormal and faintness is reproduced, the test is considered positive. If after 30 minutes there is no response, the table is returned to the horizontal position and an IV infusion of low-dose isoproterenol is started to provoke a response. IV adenosine is the drug used in the treatment of paroxysmal supraventricular tachycardia. IV midazolam is used to sedate a patient before performing synchronized cardioversion. IV magnesium is used to treat polymorphic ventricular tachycardia with a prolonged baseline QT interval A patient that reports dizziness and shortness of breath is admitted to the emergency department. The following is the patient's electrocardiogram (ECG) tracing. The nurse reviews the patient's plan of care and should question which item that is listed on the plan? - 3rd degree heart block 12-lead ECG Transcutaneous pacing IV adenosine Epinephrine IV adenosine IV adenosine is the drug of choice to convert PSVT to a normal sinus rhythm. Adenosine acts in opposition to adrenaline and would be harmful to a patient in third-degree AV block. The nurse would expect to receive a prescription for a 12-lead ECG. Transcutaneous pacing is used to increase the heart rate until a transvenous or permanent pacemaker can be placed. The use of drugs such as dopamine and epinephrine is a temporary measure to increase HR and support BP until temporary pacing is started. The nurse recalls that cardiac cells enable the conduction system to start an electrical impulse. Which property of heart cells is defined as the ability of the heart to respond mechanically to an impulse? 1 Automaticity 2 Excitability 3 Conductivity 4 Contractility Contractility Contractility enables the cardiac cells to respond mechanically to an impulse. Automaticity provides the ability to initiate an impulse spontaneously and continuously. Excitability enables the cardiac cells to be electrically stimulated. Conductivity allows transmission of an impulse along a membrane in an orderly manner. The nurse is caring for a patient with monomorphic ventricular tachycardia that is clinically stable. What is appropriate to be included on the patient's treatment plan? 1 Perform defibrillation 2 Administer amiodarone 3 Administer a vasopressor 4 Initiate cardiopulmonary resuscitation Administer amiodarone Amiodarone is an antiarrhythmic agent that corrects various atrial and ventricular dysrhythmias. Since the patient is clinically stable, amiodarone can be used. Defibrillation is not indicated for a patient that is clinically stable. There is no need to administer a vasopressor to a clinically stable patient. Cardiopulmonary resuscitation is not needed for a patient with a pulse and that is breathing. The nurse provides teaching to a group of nursing students about radiofrequency catheter ablation therapy and should include what information? 1 The procedure has a high complication rate. 2 The procedure is done before electrophysiological study (EPS). 3 The therapy is considered the nonpharmacologic treatment of choice for severe bradycardic heart rhythms. 4 The therapy uses electrical energy to remove problematic areas of the heart's conduction system. The therapy uses electrical energy to remove problematic areas of the heart's conduction system. Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the conduction system as definitive treatment of tachydysrhythmias. The ablation procedure is successful with a low complication rate. Ablation therapy is done after EPS has identified the source of the dysrhythmia. The therapy is considered the nonpharmacologic treatment of choice for atrial dysrhythmias resulting in rapid ventricular rates and AV nodal recurrent tachycardia refractory to drug therapy. The nurse understands that a pacemaker is used for which type of dysrhythmia? 1 Atrial fibrillation 2 Ventricular fibrillation 3 Ventricular tachycardia 4 Third-degree AV block Third-degree AV block The use of a pacemaker (temporary or permanent) is considered a lifesaving measure for patients who have experienced heart block, particularly third-degree or complete heart block. A temporary pacemaker may be used until the block is resolved through medical interventions or a permanent pacemaker is inserted. In special situations, a pacemaker may be used for ventricular fibrillation or ventricular tachycardia; however, this is more an exception rather than routine. Atrial fibrillation is treated with medication such as diltiazem or synchronized electrical cardioversion. In special situations a ventricular pacemaker may be used for ventricular fibrillation or ventricular tachycardia; however, this is more an exception rather than routine. The nurse observes the rhythm strip of a patient sitting up in bed and talking. The strip shows ventricular tachycardia (VT). What action should the nurse take? V-tach 1 Perform rapid defibrillation. 2 Palpate the patient for a pulse. 3 Take the patient's blood pressure. 4 Start cardiopulmonary resuscitation (CPR). Palpate the patient for a pulse The rhythm strip characterizes ventricular tachycardia (VT). Therefore the first step is to palpate the pulse. The treatment for VT with a pulse differs greatly than for VT without a pulse. If the VT is monomorphic and the patient has a pulse and has preserved left ventricular function, IV drugs are used. VT without a pulse is a life-threatening situation; rapid defibrillation and CPR are the first lines of treatment in this scenario. The nurse can take the patient's blood pressure after the presence of a pulse has been determined. A patient is scheduled to receive IV adenosine. What action should the nurse take while administering the medication? 1 Observe the patient for pallor and hypotension. 2 Give the dose over 1 to 2 minutes and follow with a 20 mL normal saline flush. 3 Monitor the patient carefully for 10 minutes, the length of the drug's half-life. 4 Use an injection site as close to the heart as possible Use an injection site as close to the heart as possible Adenosine has a very short half-life (less than 10 seconds). Therefore, it is imperative that it be given rapidly, within one to two seconds, followed immediately by 20 mL of normal saline bolus flush, and be given via an IV site as close as possible to the heart. The nurse should monitor the patient for flushing, dizziness, chest pain, or palpitations. The drug is to be given rapidly. The drug's half-life is very short. A patient's assessment findings include dizziness, shortness of breath, heart palpitations, and paroxysmal supraventricular tachycardia (PSVT). The nurse obtains a prescription for adenosine. Which statement is true about the medication? 1 It is given as an intravenous push (IVP) over one to two minutes. 2 It must be given through a central venous access device (CVAD). 3 The medication decreases conduction through the AV node. 4 Its half-life is 10 minutes. The medication decreases conduction through the AV node. Adenosine stops PSVT by slowing the conduction through the AV node. A brief period of asystole is common. Adenosine is given as an IVP over one to two seconds and then immediately followed by a rapid 20 mL normal saline flush. It may be given through a peripheral IV, but the site should be as close to the heart as possible because of its short (10 seconds) half-life. A patient who underwent a cardioverter-defibrillator implant (ICD) procedure is being discharged from the health care facility. Which instructions should the nurse give the patient and caregiver? Select all that apply. 1 Keep the incision dry for four days after insertion or as instructed. 2 Exercise the arm on the incision side with full range of motion, as soon as the incision heals. 3 Avoid large magnets and strong electromagnetic fields. 4 Avoid air travel until the cardiologist gives permission. 5 Inform the cardiologist if the implanted ICD fires. Keep the incision dry for four days after insertion or as instructed. Avoid large magnets and strong electromagnetic fields. Inform the cardiologist if the implanted ICD fires. The incision should be kept dry for as many days as instructed by the cardiologist. The patient should avoid metal detectors, large magnets, and strong electromagnetic fields. If the ICD fires, the patient should inform the cardiologist or contact emergency medical service. The patient should not lift the arm on the side of the ICD until approved by the cardiologist. Air travel is not restricted; however, the patient should not drive unless cleared by the cardiologist. A patient is hospitalized for treatment of symptoms associated with a junctional escape rhythm, including a heart rate (HR) of 45 beats/min. What does the nurse expect to be prescribed for this patient? 1 Atropine 2 Propranolol 3 Amiodarone 4 Cardioversion Atropine A junctional escape rhythm is a delayed heartbeat that originates from an ectopic focus somewhere in the atrioventricular junction, not from the atrium. If a patient has symptoms with a junctional escape rhythm, atropine can be used; it will increase the patient's heart rate. Propranolol and amiodarone would not be appropriate for this patient; they cause bradycardia. Cardioversion should not be used for junctional dysrhythmias. A patient is hospitalized with heart failure. The patient has the following electrocardiogram (ECG) tracing, is experiencing chest pain, shortness of breath, and has a blood pressure of 70/40. The nurse anticipates that what will be included on the patient's plan of care? 3rd-degree heart block 1 Lidocaine IV infusion 2 Transcutaneous pacing 3 Trendelenburg position 4 A 500 mL bolus of normal saline Transcutaneous pacing The patient is in a third-degree atrioventricular (AV) block and requires some type of pacemaker. Lidocaine is contraindicated because it further decreases ventricular conduction. Placing the patient in a Trendelenburg position would increase the work of breathing and increase venous return, which could worsen the patient's condition. Administration of fluid boluses in heart failure patients would cause worsening of symptoms. What should a nurse advise a group of caregivers with regards to a patient with an implantable cardioverter-defibrillator (ICD)? Select all that apply. Restrict air travel. If the ICD fires more than once, contact the emergency response system (ERS). Report any signs of infection at incision site. Restrict magnetic resonance imaging (MRI) scan. Restrict the lifting of the arm on the ICD side above the shoulder until approved If the ICD fires more than once, contact the emergency response system (ERS). Report any signs of infection at incision site. Restrict magnetic resonance imaging (MRI) scan. Restrict the lifting of the arm on the ICD side above the shoulder until approved A patient is experiencing atrial flutter. The nurse anticipates that what treatment will be included in the patient's plan of care? 1 Anticholinergic drugs 2 Carotid massage 3 The Maze procedure 4 Radiofrequency catheter ablation Radiofrequency catheter ablation Radiofrequency catheter ablation is the most effective technique for the treatment of atrial flutter. It is performed in the electrophysiology study laboratory and involves the introduction of a catheter in the right atrium. The tissue is targeted and destroyed by the application of low-voltage, high-frequency electrical impulses. The destruction of the tissue results in a normal sinus rhythm. Anticholinergic drugs would increase the heart rate and are not appropriate to treat atrial flutter. Carotid massage is a maneuver for vagal stimulation and is generally used for treating paroxysmal supraventricular tachycardia. The Maze procedure is performed to treat atrial fibrillations that are refractory to drugs, electrical conversion, and radiofrequency catheter ablation. A patient is admitted to a health care facility for placement of a permanent pacemaker. Which cardiac problem does the nurse suspect in this patient? 1 Heart failure 2 Tachydysrhythmias 3 Acute inferior myocardial infarction 4 Complication from open-heart surgery Heart failure A permanent pacemaker is indicated in a patient with heart failure. A temporary pacemaker is indicated in patients recovering from tachydysrhythmias, inferior myocardial infarction, and open-heart surgery. The nurse is caring for a patient that develops atrial fibrillation. Which treatments may be included the patient's treatment plan? Select all that apply. 1 Electrical cardioversion 2 Implantable cardioverter-defibrillator (ICD) 3 Anticoagulation therapy 4 Atropine injection 5 Prepare for radiofrequency catheter ablation Electrical cardioversion Anticoagulation therapy Prepare for radiofrequency catheter ablation Electrical cardioversion converts the atrial fibrillation into normal sinus rhythm. If a patient is in atrial fibrillation for more than 48 hours, anticoagulation therapy with warfarin will be required for three to four weeks. This should commence before the cardioversion and has to be continued for several weeks after successful cardioversion. The ICD is not appropriate for patients with atrial fibrillation. For patients with drug-refractory atrial fibrillation or those who do not respond to electrical conversion, radiofrequency catheter ablation may be done. Atropine increase heart rate and would not be prescribed for a patient with atrial fibrillation. Assessment findings of a patient on a cardiac unit include decreased heart rate (HR), decreased cardiac output (CO), and type I second-degree atrioventricular (AV) block. The nurse identifies that what ECG findings are characteristic of this rhythm and may be responsible for the patient's symptoms? Select all that apply. 1 Regular rhythm Correct 2 Slower ventricular rate 3 Consistent R-R intervals Correct 4 Progressive lengthening of PR intervals Blocked QRS complexes Slower ventricular rate Progressive lengthening of PR interval Blocked QRS complexes Type I second-degree AV block is also called Mobitz I or Wenckebach phenomenon. It is depicted by the ECG as a progressive lengthening of the PR interval until there is a P wave without a QRS complex. Once a ventricular beat is blocked, the cycle repeats itself with progressive lengthening of the PR intervals until another QRS complex is blocked. The atrial rate remains normal, but ventricular rate may be slower, due to blocked QRS complex. This results in bradycardia. The cardiac rhythm is irregular. The R-R intervals are not consistent patient reports a fluttering feeling in the chest. The nurse assesses a rhythm of supraventricular tachycardia (PSVT), a heart rate of 150 beats per minute, and a blood pressure of 120/60 mm Hg. The nurse anticipates that the patient's plan of care will include what treatments? Select all that apply. Intravenous adenosine Intravenous β-blockers Intravenous calcium channel blockers Vagal stimulation Emergent cardioversion Intravenous adenosine Intravenous β-blockers Intravenous calcium channel blockers Vagal stimulation Medications that may be used include adenosine, β-blockers, calcium channel blockers, and amiodarone. These drugs have impact on various phases of action potential. Adenosine decreases conduction through the AV nodes. β-blockers decrease automaticity of the SA node. Treatment for PSVT also includes vagal stimulation. Common vagal maneuvers include Valsalva, carotid massage, and coughing. If the patient becomes hemodynamically unstable and symptomatic, emergent cardioversion is considered. The nurse provides education to a group of nursing students about nonemergent synchronized cardioversion. Which statement made by a student indicates effective learning? "The shock is delivered on the P wave." "Cardioversion is designed to stop the heart very briefly." "Adenosine is given before the procedure for sedation." "After cardioversion, medications to regulate the heart rhythm are no longer needed." Cardioversion is designed to stop the heart very briefly." Synchronized cardioversion is designed to send an electrical shock through the heart on the R wave. This stops the heart momentarily, allowing it to convert back to a normal sinus rhythm. In a nonemergent situation, sedation medicine is given before the procedure because of the pain of the electrical current passing through the chest wall. Postcardioversion, the patient will receive a prescription for cardiac medication to prevent recurrence of the tachyarrhythmia. In nonemergent cases, sedation (e.g., IV midazolam) is given for the patient's comfort. Adenosine is an intravenous medication designed to treat paroxysmal supraventricular tachycardia (PSVT) by slowing the conduction through the AV node, allowing the heart to return to a normal rhythm, but it has no sedative effects. The nurse provides discharge teaching to a patient that underwent pacemaker implantation in the left chest. What should the nurse include in the instructions? Select all that apply. 1 Showering is permitted as long as care is taken to pat dry the incision site. Avoid direct blows to the incision site Raise the left arm above the head frequently, to promote circulation. Monitor pulse and inform the health care provider if the heart rate drops below the predetermined rate. Microwave ovens are safe to use. Avoid direct blows to the incision site Monitor pulse and inform the health care provider if the heart rate drops below the predetermined rate. Microwave ovens are safe to use