NSG 201H – Cardiac Dysrhythmia Care

NSG 201H – Cardiac Dysrhythmia Care

NSG 201H – Cardiac Dysrhythmia Care

Chapter 29: Coordinating Care for Patients With Cardiac Dysrhythmia

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____     1.   A patient’s heart rate is 48 beats per minute. Which structure is most likely generating this heart rate?

1)	Purkinje fibers
2)	Sinoatrial node
3)	Atrioventricular node
4)	Ventricular pacer cells

 

____     2.   The nurse is concerned that a patient is at risk for pulseless electrical activity. What information from the assessment did the nurse use to make this clinical decision?

1)	Blood pH 7.30
2)	Temperature 100.5°F
3)	Serum glucose level 170 mg/dL
4)	Serum potassium level 4.1 mEq/L

 

____     3.   A patient asks why cardiac leads are being placed on the chest. What should the nurse respond to this patient?

1)	“It shows where the heart vessels are blocked.”
2)	“It is used to evaluate the effectiveness of dietary changes.”
3)	“It provides a graphic picture of the heart’s electrical activity.”
4)	“It determines which medications are needed to improve heart function.”

 

____     4.   When analyzing a patient’s electrocardiogram, the nurse notes that the P wave is normal. What criteria did the nurse use to make this decision?

1)	Pointed and skinny in width
2)	Small and rounded in lead II
3)	Upright and rounded in lead II
4)	Length 0.10 seconds and height 2.5 mm

 

NSG 201H – Cardiac Dysrhythmia Care

____     5.   A patient is being evaluated for a blockage in the cardiac ventricles. On which part of the electrocardiogram should the nurse focus as evidence of this blockage?

1)	T wave
2)	U wave
3)	PR interval
4)	QRS interval

 

____     6.   The nurse is observed marching out the rhythm on a patient’s cardiac monitor tracing. What is this nurse assessing?

1)	Rate
2)	Polarity
3)	Regularity
4)	Amplitude

 

____     7.   A patient with shortness of breath has a heart rhythm of 46 beats per minute. Which medication should the nurse anticipate being prescribed for this patient?

1)	Atropine sulfate
2)	Atenolol (Tenormin)
3)	Diltiazem (Cardizem)
4)	Adenosine (Adenocard)

 

____     8.   A patient with atrial fibrillation has a heart rate of 90 beats per minute. Which manifestation should the nurse expect to assess in this patient?

1)	Headache
2)	Chest pain
3)	Palpitations
4)	Hypotension

 

____     9.   A patient with atrial fibrillation is being considered for cardioversion. Which diagnostic test should the nurse anticipate being prescribed prior to this procedure being completed?

1)	Chest x-ray
2)	CT scan of the chest
3)	12-lead electrocardiogram
4)	Transesophageal echocardiogram (TEE)

 

NSG 201H – Cardiac Dysrhythmia Care

____   10.   A patient is experiencing supraventricular tachycardia. What should be done before determining this patient’s treatment?

1)	Assess for thyroid disease
2)	Identify the underlying rhythm
3)	Evaluate serum electrolyte values
4)	Study lifestyle and behavioral habits

 

____   11.   A patient is admitted for treatment for a low junctional rhythm. Where should the nurse expect to assess the P wave on this patient’s electrocardiogram?

1)	Prior to the QRS wave
2)	Buried within the QRS wave
3)	At the tail end of the QRS wave
4)	Superimposed over the previous T wave

 

____   12.   A patient’s cardiac rhythm has no identifiable P or QRS waves. What action should the nurse take first?

1)	Apply oxygen
2)	Assess a radial pulse
3)	Insert an intravenous line
4)	Begin chest compressions

 

____   13.   A patient is in normal sinus rhythm with prolonged PR intervals. What treatment should the nurse expect to be prescribed for this patient?

1)	Continue to monitor
2)	Anticipate defibrillating
3)	Prepare for cardioversion
4)	Prepare for pacemaker insertion

 

____   14.   The nurse notes that PR intervals are getting progressively longer before a QRS complex is dropped on a patient’s cardiac rhythm strip. Which health problem should the nurse realize this patient is experiencing?

1)	Mobitz I
2)	Mobitz II
3)	First-degree AV block
4)	Third-degree AV block

 

____   15.   A patient is being prepared for a transvenous pacemaker. What should the nurse include when explaining this pacemaker to the family?

1)	“It is inserted using an internal jugular vein.”
2)	“It is done by placing defibrillator pads on the torso using an anterior/posterior position.”
3)	“It is done by placing a pacer wire in the atrium or the ventricle and fed out through the skin, where it is attached to an external pacemaker.”
4)	“It is inserted by placing pacer wires in the atrium, ventricle, or both and attached to a small pacemaker generator placed under the skin near the clavicle.”

 

____   16.   A patient is diagnosed with third-degree AV block. For which type of pacemaker should the nurse prepare this patient?

1)	Transvenous
2)	Biventricular
3)	Transthoracic
4)	Transcutaneous

 

NSG 201H – Cardiac Dysrhythmia Care

____   17.   The nurse is preparing to defibrillate a patient. Which setting should the nurse use for this treatment?

1)	50 J
2)	100 J
3)	150 J
4)	200 J

 

____   18.   A patient is being cardioverted for symptomatic atrial fibrillation. At which point of the cardiac cycle will the electric impulse occur?

1)	At the end of the P wave
2)	Before the QRS complex
3)	At the peak of the R wave
4)	After the QRS complex but before the T wave

 

____   19.   The nurse notes that a patient with a cardiac dysrhythmia is developing shortness of breath. What is the pathophysiological reason for this manifestation?

1)	Decreased oxygen in the brain
2)	Stimulation of the sympathetic nervous system
3)	Imbalance in myocardial oxygen demand and supply
4)	Increase in oxygenation because of a drop in cardiac output

 

____   20.   A patient with a cardiac dysrhythmia is experiencing nausea and vomiting. What is the reason for this to occur?

1)	Poor contractile function
2)	Altered electrolyte levels
3)	Blood shunted away from nonessential organ systems
4)	An imbalance in myocardial oxygen supply and demand

 

____   21.   A patient with a cardiac dysrhythmia asks why it is important to recognize the signs of a stroke. What should the nurse respond to this patient?

1)	“So you can respond quickly and prevent adverse effects.”
2)	“To encourage you to take your medication as prescribed.”
3)	“So that you can recognize the signs of stroke in a family member.”
4)	“Most people with a heart arrhythmia develop strokes as a side effect.”

 

____   22.   During a home visit the nurse learns that a patient has been skipping doses of antiarrhythmic medication. What should the nurse include when counseling this patient?

1)	Taking the medication as prescribed reduces the occurrence of side effects
2)	Skipping doses increases the risk of developing chest pain and diaphoresis.
3)	Adequate medication level decreases the adverse effects of the dysrhythmia.
4)	Insufficient amounts of medication in the blood stream affect pacemaker functioning.

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____   23.   An older client is being evaluated for a new onset of a cardiac dysrhythmia. What should the nurse consider as being the cause for this abnormal heart rhythm? Select all that apply.

1)	Advanced age
2)	Protein malnutrition
3)	Fat deposits around the SA node
4)	Fewer pacemaker cells in the SA node
5)	Calcification around the SA node and valves

 

NSG 201H – Cardiac Dysrhythmia Care

____   24.   A patient becomes unresponsive without a palpable pulse despite showing bradycardia on the rhythm strip. What action should the nurse take immediately? Select all that apply.

1)	Auscultate heart sounds
2)	Begin cardiac compressions
3)	Adjust cardiac monitor leads
4)	Prepare for chest tube insertion
5)	Place epinephrine at the bedside

 

____   25.   A patient has a heart rate of 132 beats per minute. What should the nurse assess to help determine the reason for this rate? Select all that apply.

1)	Muscle tone
2)	Temperature
3)	Urine output
4)	Bowel sounds
5)	Blood pressure

 

____   26.   The nurse is caring for a patient with a potentially life-threatening cardiac dysrhythmia. What should be included in this patient’s plan of care? Select all that apply.

1)	Document frequency of dysrhythmia
2)	Administer antiarrhythmic medications
3)	Maintain continuous cardiac monitoring
4)	Prepare to administer advanced cardiac life support
5)	Complete preoperative checklist for pacemaker insertion

 

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Completion

Complete each statement.

 

27. The nurse reviews the cardiac electrical cycle with a patient scheduled for pacemaker insertion surgery. In which order should the nurse explain this process? (Enter the number of each step in the proper sequence; do not use punctuation or spaces. Example: 1234)

P wave

T wave

QRS complex

Firing of the SA node

Ventricular contraction

Ventricular repolarization

 

28. When calculating a patient’s heart rate using the cardiac rhythm strip, the nurse notes the presence of four large boxes between the two R waves. What is this patient’s heart rate? Record your answer as a whole number. ______