CH 26 Dysrhythmias

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d. Avoid sources of electrical interference
Which postimplantation instruction must a nurse provide to a client
with a permanent pacemaker? Rationale: he nurse must instruct the client with a permanent
pacemaker to avoid sources of electrical interference. The nurse
a. Keep the arm on the side of the pacemaker higher than the head should also instruct the client to avoid strenuous movement (es-
b. Delay activities such as swimming and bowling for at least 3 pecially of the arm on the side where the pacemaker is inserted),
weeks to keep the arm on the side of the pacemaker lower than the head
c. Keep moving the arm on the side where the pacemaker is except for brief moments when dressing or performing hygiene,
inserted and to delay for at least 8 weeks activities such as swimming,
d. Avoid sources of electrical interference bowling, tennis, vacuum cleaning, carrying heavy objects, chop-
ping wood, mowing, raking, and shoveling snow.
b. QRS complex
Which ECG waveform characterizes conduction of an electrical
impulse through the left ventricle? Rationale: The QRS complex represents ventricular depolariza-
tion. The P wave is an ECG characteristic reflecting conduction
a. P wave of an electrical impulse through the atria. The PR interval is a
b. QRS complex component of an ECG tracing reflecting conduction of an elec-
c. PR interval trical impulse through the AV node. The QT interval is an ECG
d. QT interval characteristic reflecting the time from ventricular depolarization to
repolarization.
d. Third Degree
When no atrial impulse is conducted through the AV node into the
ventricles, the client is said to be experiencing which type of AV Rationale: In third degree heart block, two impulses stimulate the
block? heart, one impulse stimulates the ventricles and other stimulates
the atria. In first degree heart block, all the atrial impulses are con-
a. First degree ducted through the AV node into the ventricles at a rate slower than
b. Second degree, type I normal. In second degree AV block, type I, all but one of the atrial
c. Second degree, type II impulses are conducted through the AV node into the ventricles. In
d. Third degree second degree AV block, type II, only some of the atrial impulses
are conducted through the AV node into the ventricles.
A client with atrial fibrillation, who does not respond to con-
b. Maze procedure
ventional treatment measures and who is not a candidate for
cardioversion, would have what procedure recommended?
Rationale: Clients who are not candidates for cardioversion and
fail to respond to conventional measures may be candidates for
a. Angiography
a surgical intervention referred to as the Maze procedure. An-
b. Maze procedure
giography, open heart surgery, and heart transplantation are not
c. Open heart surgery
recommended surgeries for these clients.
d. Heart transplantation
A client with an atrial dysrhythmia has come to the clinic for a
follow-up appointment and to talk with the health care provider d. Elective electrical cardioversion
about options to stop this dysrhythmia. What procedure could be
used to treat this client? Rationale: Elective electrical cardioversion is a nonemergency
procedure done by a physician to stop rapid, but not necessarily
a. Elective electrical cardioversion life-threatening, atrial dysrhythmias. Chemical cardioversion is not
b. Chemical cardioversion a procedure; it is drug therapy. A Mace procedure is a distractor
c. Mace procedure for this question. Defibrillation is not an elective procedure.
d. Elective electrical defibrillation
The nurse is placing electrodes for a 12-lead electrocardiogram
(ECG). The nurse would be correct in placing an electrode on a. Right side of sternum, fourth intercostal space
which area for V1?
Rationale: view V1, the electrodes would be placed on the right
a. Right side of sternum, fourth intercostal space side of the sternum, fourth intercostal space. V2 is the left side of
b. Left side of sternum, fourth intercostal space the sternum, fourth intercostal space. V3 is midway between V2
c. Midway between V2 and V4 and V4. V4 is at the mid-clavicular line, fifth intercostal space.
d. Mid-clavicular line, fifth intercostal space
The nurse knows that electrocardiogram (ECG) characteristics of
atrial fibrillation include what? a. Atrial rate of 300 to 400

a. Atrial rate of 300 to 400 Rationale: ECG characteristics of atrial fibrillation include an atrial
b. Normal PR interval
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c. Regular rhythm rate of 300 to 400, a nonmeasurable PR interval, irregular rhythm,
d. P wave resent before each QRS and no discernible P waves.
The nurse is admitting a client to a telemetry unit with an atrial
a. chest pain
dysrhythmia. What symptoms will the nurse further evaluate?
Rationale: Clients with atrial dysrhythmias may have chest pain,
a. chest pain
shortness of breath, and low blood pressure. Leg pain is not com-
b. hypertension
mon with atrial dysrhythmias. Hypocarbia is seen with reduced
c. leg pain
carbon dioxide, not common with chr pulmonary disease.
d. hypocarbia
a. atrial fibrillation
A client has an irregular heart rate of around 100 beats/minute and
a significant pulse deficit. What component of the client's history Rationale: In atrial fibrillation, several areas in the right atrium
would produce such symptoms? initiate impulses resulting in disorganized, rapid activity. The atria
quiver rather than contract, producing a pulse deficit due to irreg-
a. atrial fibrillation ular impulse conduction to the AV node. The ventricles respond to
b. atrial flutter the atrial stimulus randomly, causing an irregular ventricular heart
c. heart block rate, which may be too infrequent to maintain adequate cardiac
d. bundle branch block output. Atrial flutter, heart block, and bundle branch block would
not produce these symptoms.
The nurse is caring for a client who is displaying a third-degree AV d. Alerting the healthcare provider of the third-degree heart block
block on the EKG monitor. What is the priority nursing intervention
for the client? Rationale: The client may experience low cardiac output with
third-degree AV block. The healthcare provider needs to intervene
a. Assessing the client's blood pressure and heart rate frequently to preserve the client's cardiac output. Monitoring the blood pres-
b. Identifying the client's code level status sure and heart rate are important, but not the priority. The iden-
c. Maintaining the client's intravenous fluids tification of a code status during a heart block is not appropriate.
d. Alerting the healthcare provider of the third-degree heart block The IV fluids are not helpful if the heart is not perfusing.
c. sinus dysrhythmia
When the nurse observes that the client's heart rate increases
during inspiration and decreases during expiration, the nurse Rationale: Sinus dysrhythmia occurs when the sinus node creates
reports that the client is demonstrating an impulse at an irregular rhythm. Normal sinus rhythm occurs
when the electrical impulse starts at a regular rate and rhythm in
a. normal sinus rhythm. the SA node and travels through the normal conduction pathway.
b. sinus bradycardia. Sinus bradycardia occurs when the sinus node regularly cre-
c. sinus dysrhythmia. ates an impulse at a slower-than-normal rate. Sinus tachycardia
d. sinus tachycardia. occurs when the sinus node regularly creates an impulse at a
faster-than-normal rate.
The nurse is caring for a client scheduled for a transesophageal
echocardiogram with a diagnosis of atrial fibrillation. The client's
a. "This test will show any blood clots in the heart, and help us
spouse asks the nurse to explain the purpose of the test. What is
determine if it is safe to do a cardioversion."
the nurse's best response?
Rationale: The transesophageal echocardiogram will show if the
a. "This test will show any blood clots in the heart, and help us
client has blood clots and help determine if it is safe to use
determine if it is safe to do a cardioversion."
cardioversion. The transesophageal echocardiogram does not in-
b. "This test will show the specific area causing the atrial fibrillation
dicate which area is causing the atrial fibrillation or the need
and what can be done to stop it."
to evaluate coronary arteries, as with a cardiac catheterization.
c. "This test will show if the client needs a cardiac catheterization."
Hypotension is diagnosed with blood pressure readings.
d. "This test will let the doctor know if the client is at risk for
hypotension."
A nursing instructor is reviewing the parts of an EKG strip with
a group of students. One student asks about the names of all
b. P wave
the EKG cardiac complex parts. Which of the following items
d. P-R interval
are considered a part of the cardiac complex on an EKG strip?
e. T wave
Choose all that apply.
Rationale: The EKG cardiac complex waves include the P wave,
a. QRT wave
the QRS complex, the T wave, and possibly the U wave. The
b. P wave
intervals and segments include the PR interval, the ST segment,
c. S-Q segment
and the QT interval.
d. P-R interval
e. T wave

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The nurse cares for a client with a dysrhythmia and understands
a. Atrial depolarization
that the P wave on an electrocardiogram (ECG) represents which
phase of the cardiac cycle?
Rationale: The P wave represents atrial depolarization. The QRS
complex represents ventricular depolarization. The T wave repre-
a. Atrial depolarization
sents ventricular repolarization. The ST segment represents early
b. Early ventricular repolarization
ventricular repolarization, and lasts from the end of the QRS
c. Ventricular depolarization
complex to the beginning of the T wave.
d. Ventricular repolarization
The nurse is caring for a client with atrial fibrillation. What proce-
dure would be recommended if drug therapies did not control the d. Elective cardioversion
dysrhythmia?
Rationale: Atrial fibrillation also is treated with elective cardiover-
a. Defibrillation sion or digitalis if the ventricular rate is not too slow. Defibrillation is
b. Maze procedure used for a ventricular problem. A Maze procedure is only a distrac-
c. Pacemaker implantation tor for this question. Pacemakers are implanted for bradycardia.
d. Elective cardioversion
b. A defibrillator
The licensed practical nurse is setting up the room for a client ar-
riving at the emergency department with ventricular arrhythmias.
Rationale: The nurse is most correct to place a defibrillator close
The nurse is most correct to place which of the following in the
to the client room if not in the room. The nurse realizes that clients
room for treatment?
with ventricular dysrhythmias are at a high risk for fatal heart
dysrhythmia and death. A suction machine is used to remove
a. A suction machine
respiratory secretions. Cardioversion is used in a planned setting
b. A defibrillator
for atrial dysrhythmias. An ECG machine records tracings of the
c. Cardioversion equipment
heart for diagnostic purposes. Most clients with history of cardiac
d. An ECG machine
disorders have an ECG completed.
d. Ventricular fibrillation
The nurse is working on a monitored unit assessing the cardiac
monitor rhythms. Which waveform pattern needs attention first? Rationale: Ventricular fibrillation is called the rhythm of a dying
heart. It is the rhythm that needs attention first because there is
a. Sustained asystole no cardiac output, and it is an indication for CPR and immediate
b. Supraventricular tachycardia defibrillation. Sustained asystole either is from death, or the client
c. Atrial fibrillation is off of the cardiac monitor. Supraventricular tachycardia and atrial
d. Ventricular fibrillation fibrillation is monitored and reported to the physician but is not
addressed first.
a. Question the client about alcohol and illicit drug use.
A 28-year-old client presents to the emergency department,
Rationale: The client is experiencing sinus tachycardia. Since
stating severe restlessness and anxiety. Upon assessment, the
the client's findings of tachycardia, dilated pupils, restlessness,
client's heart rate is 118 bpm and regular, the client's pupils are
anxiety, and excitability can indicate illicit drug use (cocaine), the
dilated, and the client appears excitable. Which action should the
nurse should question the client about alcohol and illicit drug use.
nurse take next?
This information will direct the client's plan of care. Causes of
tachycardia include medications that stimulate the sympathetic
a. Question the client about alcohol and illicit drug use.
response, stimulants, and illicit drugs. The treatment goals for si-
b. Instruct the client to hold the breath and bear down.
nus tachycardia is usually determined by the severity of symptoms
c. Prepare to administer a calcium channel blocker.
and directed at identifying and abolishing its cause. The other
d. Place the client on supplemental oxygen.
interventions may be implemented, but determining the cause of
the tachycardia is essential.
When the nurse observes an electrocardiogram (ECG) tracing a. Premature ventricular contraction (PVC)
on a cardiac monitor with a pattern in lead II and observes a
bizarre, abnormal shape to the QRS complex, the nurse has likely Rationale: A PVC is an impulse that starts in a ventricle before
observed which of the following ventricular dysrhythmias? the next normal sinus impulse. Ventricular bigeminy is a rhythm
in which every other complex is a PVC. Ventricular tachycardia is
a. Premature ventricular contraction (PVC) defined as three or more PVCs in a row, occurring at a rate ex-
b. Ventricular bigeminy ceeding 100 beats per minute. Ventricular fibrillation is a rapid but
c. Ventricular tachycardia disorganized ventricular rhythm that causes ineffective quivering
d. Ventricular fibrillation of the ventricles.

Which is not a likely origination point for cardiac dysrhythmias? a. bundle of His
a. bundle of His
b. ventricles Rationale: Cardiac dysrhythmias may originate in the atria, atri-
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c. atria oventricular node, or ventricles. They do not originate in the Bundle
d. atrioventricular node of His.
A 43-year-old male came into the emergency department where
you practice nursing and was diagnosed with atrial fibrillation. It's
now 48 hours since his admittance and the dysrhythmia persists.
Which of the following medications will the client's healthcare a. Heparin
provider most likely order?
Rationale: Heparin is generally prescribed initially if the dysrhyth-
a. Heparin mia persists longer than 48 hours.
b. Warfarin (Coumadin)
c. Flecainide (Tambocor)
d. Dabigatran (Pradaxa)
The nurse is instructing on home care after placement of an au-
tomatic implanted cardioverter defibrillator (AICD). Which state-
ment, made by the client, needs clarification by the nurse?
c. "I need to stay away from microwaves."
a. "I need to notify my cardiologist if I feel frequent kicks to the
Rationale: Similar to hand tools, microwaves have shields or are
chest."
grounded, making them safe for clients with AICDs. There is no
b. "I can continue to work with my power tools."
restriction from microwave use. All of the other options are correct.
c. "I need to stay away from microwaves."
d. "I should opt for a hand search at the airport instead of metal
detector scan."
a. "You seem apprehensive about resuming sexual activity."

Rationale: The client treated with an electronic device experi-

The nurse cares for a 56-year-old client who received an im-
ences not only lifestyle and physical changes but also emotional
plantable cardioverter defibrillator (ICD) 2 days prior. The client
changes. At different times during the healing process, the client
tells the nurse "My wife and I can never have sex again now that
may feel angry, depressed, fearful, anxious, or a combination of
I have this ICD." What is the nurse best response by the nurse?
these emotions. It is imperative for the nurse to observe the client's
response to the device and provide the client and family members
a. "You seem apprehensive about resuming sexual activity."
with emotional support and teaching as indicated. Identifying that
b. "Sex is permitted following the implantation of an ICD."
the client appears apprehensive about resuming sexual activity
c. "You really should speak to your wife about your concerns."
acknowledges the client's concerns while allowing for further dis-
d. "I will be sure to share your concerns with the physician."
cussion. The remaining responses ignore the client's feelings and
do not facilitate an ongoing conversation or explore the client's
concern.
A nurse has provided discharge instructions to a client who
received an implantable cardioverter defibrillator (ICD). Which
statement, made by the client, indicates the need for further a. "I need to take a cardiopulmonary resuscitation (CPR) class
teaching? now that I have an ICD."

a. "I need to take a cardiopulmonary resuscitation (CPR) class
now that I have an ICD."
b. "I will document the date and time if my ICD fires."
c. "I can play golf with my son in about 2 or 3 weeks."
d. "I should tell close friends and family members that I have an
ICD."
The nurse is attempting to determine the ventricular rate and
rhythm of a patient's telemetry strip. What should the nurse ex-
amine to determine this part of the analysis?
a. PP interval
b. QT interval
c. RR interval
d. TP interval
Rationale: The client does not need to take a CPR class. However,
it is recommended that the family members and friends of a client
who has an ICD learn CPR. The other statements indicate that the
nurse's teaching was effective.
c. RR interval
Rationale: The rhythm is often identified at the same time the rate
is determined. The RR interval is used to determine ventricular
rhythm and the PP interval to determine atrial rhythm. If the inter-
vals are the same or if the difference between the intervals is less
than 0.8 seconds throughout the strip, the rhythm is called regular.
If the intervals are different, the rhythm is called irregular.

A client with heart failure asks the nurse how dobutamine affects
a. The medication increases the force of the myocardial contrac-
the body's circulation. What is the nurse's best response?
tion.
a. The medication increases the force of the myocardial contrac-
Rationale: A positive inotropic medication increases the force of
tion.
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b. The medication causes the kidneys to retain fluid and increase
the myocardial contraction. The inotropic medication decreases
intravascular volume.
heart rate; it does not cause the kidneys to retain fluid or produce
c. The medication increases the heart rate.
more urine.
d. The medication helps the kidneys produce more urine.

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