Chapter 27- Management of Patients With Dysrhythmias and Conduction
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Chapter 27- Management of Patients With Dysrhythmias and Conduction

Course: NRSG 1, Spring 2012

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Brunner: Medical-Surgical Nursing, 11th Edition Test Bank Chapter 27: Management of Patients With Dysrhythmias and Conduction Problems Multiple Choice 1. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip because: A) The view of the electrical current changes in relation to the lead placement. B) Conduction of the heart differs with lead placement. C) Electrocardiogram...

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Medical-Surgical Brunner: Nursing, 11th Edition Test Bank Chapter 27: Management of Patients With Dysrhythmias and Conduction Problems Multiple Choice 1. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip because: A) The view of the electrical current changes in relation to the lead placement. B) Conduction of the heart differs with lead placement. C) Electrocardiogram (ECG) equipment has malfunctioned. D) The circadian rhythm has changed. Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: D-4 Feedback: Each lead offers a different reference point to view the electrical activity of the heart. The lead displays the configuration of electrical activity of the heart. 2. The nurse evaluating a rhythm strip notes that the wave forms that move to the top of the strip indicate: A) The heart rate B) A negative deflection C) An isoelectric wave D) A positive deflection Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Patient Needs: D-4 Feedback: When an ECG wave form moves to the top of the strip, it is referred to as a positive deflection; when it moves to the bottom of the strip, it is then referred to as a negative deflection. 3. While analyzing a rhythm strip, the nurse identifies the resting state of the heart by looking at the: A) P wave B) T wave C) U wave D) QRS complex Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Patient Needs: D-4 Feedback: The T wave represents ventricular muscle depolarization, also referred to as the resting state. 4. An adult patient has damage to the electrical conduction of the ventricles of the heart. The nurse would expect to see changes in the: A) P wave B) T wave C) QRS complex D) U wave Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-4 Feedback: The QRS complex represents the depolarization of the ventricles, and as such, the electrical activity of that ventricle. 5. To find the heart rate from an ECG strip of a patient with a normal sinus rhythm, the nurse counts 20 small boxes between two R waves. The heart rate would be: A) 75 beats/min B) 80 beats/min C) 60 beats/min D) 140 beats/min Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-1 Feedback: The calculation to determine the heart rate on an ECG strip counting the number of small boxes between R waves is 1500 divided by the number of R waves (1500 divided by 20 equals 75). 6. An adult patient being assessed in the emergency room is anxious about his health status. The ECG rhythm strip shows a heart rate of 120 beats/min. Characteristics of a sinus tachycardia rhythm are: A) P:QRS ratio of 2:1 B) P:QRS ratio of 1:1 C) Ventricular and atrial rhythm are irregular D) Atrial rhythm regular, ventricular rhythm irregular Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Patient Needs: D-4 Feedback: Anxiety can cause a patient to experience sinus tachycardia. The characteristics of this rhythm are a P:QRS ratio of 1:1, with regular atrial and ventricular rhythm. 7. An adult patient with third-degree AV block is on continuous cardiac monitoring. The EKG will show which of the following rhythm characteristics? A) B) C) D) PP interval and RR intervals are irregular PP interval equal to RR interval Fewer QRS complexes than P waves PR interval constant Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: D-4 Feedback: In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. 8. A patient reports feeling palpitations, light-headedness, and weakness. The nurse finds a pulse deficit when doing the assessment. This may be an indicator of: A) Atrial fibrillation B) Sinus tachycardia C) Premature atrial complex D) Junctional rhythm Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-4 Feedback: Signs and symptoms of atrial fibrillation include palpitations, light-headedness, weakness, and a pulse deficit. 9. When caring for a patient with a cardiac dysrhythmia, the most appropriate goal for the patient is to maintain: A) Nutritional intake B) Fluid intake C) Cardiac output D) Social contacts Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: D-4 Feedback: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. 10. A stable patient with atrial flutter is symptomatic from the arrhythmia. The physician administers amiodarone IV in an attempt to: A) Convert the arrhythmia to a sinus rhythm B) Slow the ventricular rate C) Block the conduction of the AV node D) Slow the conduction through the AV node Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-2 Feedback: Amiodarone is used to promote conversion to sinus rhythm, while medications such as diltiazem, verapamil, and digitalis are used to slow the ventricular rate. 11. A nursing intervention to assess the hemodynamic effects of a dysrhythmia on a patient would be to: A) Obtain an ECG rhythm strip B) Obtain a blood level of drugs administered C) Assess the patient's level of anxiety D) Assess the patient's BP and pulse rate Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: D-1 Feedback: BP and pulse rate are indicators of the hemodynamic effect of dysrhythmias on a patient and are nursing measures that do not require a physician's order. Obtaining an ECG or drug levels requires a physician's order. 12. An adult patient experiences premature atrial complex (PAC) on occasion (once every couple of hours) but remains hemodynamically stable. The patient expresses concern over the arrhythmia developing into a more fatal arrhythmia in the future. The most appropriate nursing diagnosis for this patient is: A) Decreased cardiac output B) Alteration in comfort C) Anxiety related to fear of unknown D) Potential for injury Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: C-1 Feedback: The patient is stable, and PAC is not uncommon; therefore, it does not require treatment. The patient is fearful of the possibility of worsening arrhythmias. 13. The nurse notes that the ECG strip of a patient who has had a temporary pacemaker inserted indicates loss of capture. The priority nursing intervention upon identification of this problem is to: A) Change the generator B) Increase sensitivity C) Change the battery D) Turn the patient to the left side Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 6 Patient Needs: D-3 Feedback: The most appropriate action to take initially when there is loss of capture is to turn the patient to the left side before changing the battery or generator or adjusting the sensitivity. 14. The nurse should assess for which of the following potential complications in a postoperative patient with permanent pacemaker implantation? A) Decreased urinary output B) Bleeding at the generator implantation site C) Decreased respiratory rate D) Decreased pulse rate Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Patient Needs: D-3 Feedback: Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. 15. A patient has a permanent pacemaker implanted with the identification code beginning with VVI, which indicates: A) Ventricular paced, ventricular sensed, inhibited B) Atrial paced, ventricular sensed, inhibited C) Ventricular sensed, ventricular paced, inhibited D) Atrial sensed, atrial paced, inhibited Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Patient Needs: D-4 Feedback: The identification of VVI indicates ventricular paced, ventricular sensed, inhibited. 16. An adult patient is in ventricular fibrillation; when defibrillating the patient, the nurse must: A) B) C) D) Maintain good contact between paddles and patient skin. Use ultrasound gel as a conducting agent. Call all clear once before discharging the defibrillator. Ensure the defibrillator is in the sync mode. Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Patient Needs: D-3 Feedback: When defibrillating an adult patient, the nurse should maintain good contact between the paddles and the patient's skin to prevent arcing, apply an appropriate conducting agent between the skin and the paddles, and ensure the defibrillator is in the non-sync mode. All clear should be called 3 times before discharging the paddles. 17. An adult patient who has undergone an implantable cardioverter defibrillator (ICD) procedure asks about the purpose of this device. The nurse's best response would be: A) To detect and treat ventricular fibrillation and ventricular tachycardia B) To detect and treat bradycardia C) To detect and treat atrial fibrillation D) To shock your heart if you have a heart attack at home Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/learning Objective: 9 Patient Needs: D-4 Feedback: The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. 18. The nurse is aware that cryoablation therapy involves: A) Peeling away the area of endocardium responsible for the dysrhythmia B) Using electrical shocks directly to endocardium to eliminate the source of dysrhythmia C) Using high-frequency sound waves to eliminate the source of dysrhythmia D) Using a probe cooled to a temperature of -60C (-76 F) to eliminate the source of dysrhythmia Register to View AnswerChapter: 27 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 10 Patient Needs: D-4 Feedback: Cryoablation therapy involves using the cooled probe to create a small scar on the endocardium to eliminate the source of the dysrhythmias. Endocardium resection involves peeling away a specified area of the endocardium. Electrical ablation involves using shocks to eliminate the area causing the dysrhythmias. Radio frequency ablation uses high-frequency sound waves to destroy the area causing the dysrhythmias. 19. The nurse is caring for a patient receiving lidocaine IV. Which factor is most relevant to administration of this medication? A) Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter B) Increase in systemic blood pressure C) Presence of premature ventricular contractions (PVCs) on cardiac monitor D) Increase in intracranial pressure (ICP) Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-2 Feedback: Lidocaine drips are commonly used to treat patients whose arrhythmias haven't been controlled with oral medication and who are having PVCs that are visible on the cardiac monitor. SaO2, blood pressure, and ICP are important factors but aren't as significant as PVCs in this situation. 20. A patient would be considered for cardiac conduction surgery if which of the following are present? A) Sinus bradycardia not responsive to other treatments B) Functional rhythms not responsive to other treatments C) Atrial and ventricular tachycardias not responsive to other treatments D) Ventricular fibrillation not responsive to other treatments Register to View AnswerChapter: 27 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 10 Patient Needs: D-4 Feedback: Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing. 21. The nurse caring for a patient on the telemetry floor who is experiencing symptomatic sinus bradycardia is aware the medication of choice for treatment of this dysrhythmia is atropine. What guidelines will the nurse following when administering atropine? A) Administer atropine 0.5 mg rapidly as an IV bolus every 3 to 5 minutes to a maximum total dose of 3 mg. B) Administer atropine 0.5 mg slowly as an IV bolus every minute to a maximum total dose of 3 mg. C) Administer atropine 1.0 mg rapidly as an IV bolus every 3 to 5 minutes to a maximum total dose of 3 mg. D) Administer atropine 1.0 mg slowly as an IV bolus every minute to a maximum total dose of 3 mg. Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: D-2 Feedback: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3 mg is the medication of choice in treating symptomatic sinus bradycardia. 22. A patient presenting to the emergency room is experiencing atrial flutter. The initial management of atrial flutter in a stable patient with a narrow QRS and regular R-R interval is: A) Rapid IV administration of adenosine 6 mg, followed by a 20-mL saline flush and elevation of the arm B) IV administration of a beta-blocker C) Rapid IV administration of adenosine 12 mg, repeating the drug administration if needed D) IV administration of magnesium Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: D-2 Feedback: If the patient with atrial flutter is stable, the QRS is narrow, and the R-R interval is regular, 6 mg of adenosine may be rapidly administered followed by a 20-mL saline flush and elevation of the arm. If the rhythm does not convert to sinus rhythm within 1 to 2 minutes, a 12mg bolus may be administered and repeated, if needed, within 1 to 2 minutes. If the adenosine fails to convert the rhythm or if the R-R interval is irregular, then magnesium, diltiazem, or betablockers may be administered. 23. An unstable patient exhibiting atrioventricular nodal reentry tachycardia (AVNRT) has not responded to vagal maneuvers or drug therapy. What will the nurse anticipate as the next step in the management of this patient's dysrhythmia? A) Cardioversion B) Carotid sinus massage C) Defibrillation D) Cardiac bypass surgery Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing 4 Patient Process Objective: Needs: D-4 Feedback: A patient with AVNRT who is unstable or does not respond to vagal maneuvers will require cardioversion. Carotid sinus massage is an example of a vagal maneuver. Defibrillation should never be attempted on a patient with a pulse. Cardiac bypass surgery is indicated for a patient with blocked coronary arteries. 24. The nurse is caring for a patient in the critical care unit who experiences ventricular tachycardia (VT). What is the drug of choice for this dysrhythmia? A) Amiodarone B) Lidocaine C) Adenosine D) Clonidine Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-2 Feedback: Amiodarone-administered IV is the antidysrhythmic medication of choice for a stable patient with VT. Other medications that may be used are procainamide and sotalol. Although lidocaine has been the medication most commonly used for immediate, short-term therapy, it has no proven short- or long-term efficacy in cardiac arrest. 25. A patient is exhibiting ventricular tachycardia with an irregular rhythm. The nurse should expect which dysrhythmia as the cause of the ventricular tachycardia? A) Atrial fibrillation B) Atrial flutter C) Premature ventricular complex D) Sinus bradycardia Register to View AnswerChapter: 27 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-4 Feedback: Atrial fibrillation should be suspected as the cause of a ventricular tachycardia with an irregular rhythm and it should be treated appropriately. 26. The critical care nurse has responded to a cardiac arrest on a medical-surgical unit. The continuous electrocardiogram monitoring indicates that the patient is experiencing ventricular fibrillation. After the initial defibrillations, the next step in the management of this patient is: A) Administration of medications until an electrical rhythm is obtained B) 5 cycles of CPR alternating with a rhythm check and defibrillation C) Continuous defibrillation until an electrical rhythm is obtained D) Continuous CPR until an electrical rhythm is obtained Register to View Answer Chapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-1 Feedback: After the initial defibrillation, 5 cycles of CPR alternating with a rhythm check and defibrillation are the treatments used to convert ventricular fibrillation (VF) to an electrical rhythm that produces a pulse. 27. A patient who has been transported to the emergency room after a motor vehicle accident is experiencing ventricular asystole. Management of ventricular asystole focuses on : A) Continuous defibrillation until an electrical rhythm is obtained B) High-quality CPR with minimal interruptions C) Cessation at resuscitation attempts after 2 minutes D) Administration of medications until an electrical rhythm is obtained Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Patient Needs: D-1 Feedback: Ventricular asystole is treated the same as pulseless electrical activity (PEA), focusing on high-quality CPR with minimal interruptions and identifying the underlying and/or contributing factors. 28. The nurse who is caring for a patient in ICU on a ventilator assesses a need for suctioning and is aware that the most common cardiac arrhythmia occurring during endotracheal suctioning is: A) Sinus tachycardia B) Ventricular tachycardia C) Paroxysmal supraventricular tachycardia D) Sinus bradycardia Register to View AnswerChapter: 27 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-1 Feedback: Vagal stimulation such as vomiting, suctioning, severe pain, and extreme emotions may cause sinus bradycardia when the sinus node creates an impulse at a slower-than-normal rate. Sinus bradycardia has a ventricular and atrial rate less than 60. The treatment of choice is to block vagal stimulation, thus allowing a normal rate to occur. Sinus tachycardia occurs when the sinus node creates an impulse at a faster-than-normal rate resulting from physiologic or psychological stress. Ventricular tachycardia is associated with coronary artery disease 29. The nurse is caring for a patient who converts from normal sinus rhythm at 72/min to atrial fibrillation with a ventricular response at 164/min. Blood pressure is 160/76. Respiratory rate is 20/min with normal chest expansion and clear lungs bilaterally. IV heparin and cardizem are given. The nurse understands that the goal is to: A) Decrease SA node conduction B) Control ventricular rate C) Improve oxygenation D) Maintain anticoagulation Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: D-1 Feedback: Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice followed by anticoagulation with heparin and then coumadin. 30. The nurse is caring for a patient who converted to ventricular fibrillation (VF) and was defibrillated at 200 joules, 300 joules, and 360 joules respectively. The patient remains in VF. According to national standards, the nurse is aware that the following medication should be used: A) Epinephrine 1 mg IV push B) Lidocaine 100 mg IV push C) Amiodarone 300 mg IV push D) Sodium bicarbonate 1 amp IV push Register to View Answer Chapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Patient Needs: D-1 Feedback: Epinephrine is administered after three consecutive defibrillations to make it easier to convert the dysrhythmia to a normal sinus rhythm with defibrillation. Epinephrine may also increase cerebral and coronary artery blood flow. Antiarrythmic medications such as amiodarone and lidocaine are given if ventricular dysrhythmia persists. 31. A 12-lead EKG performed on a patient 4 hours after onset of chest pain reveals ST segment elevation. The nurse recognizes that this finding indicates: A) Transient ischemia typical of unstable angina B) Lack of permanent damage to myocardial cells C) Myocardial infarction associated with prolonged and complete coronary thrombosis D) Myocardial infarction associated with transient or incomplete artery occlusion Register to View AnswerChapter: 27 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-1 Feedback: The ST segment represents early ventricular repolarization. It is analyzed to identify whether it is above or below the isoelectric line, which may be a sign of cardiac ischemia. 32. The nurse is caring for a patient who develops pulseless electrical activity. Upon confirmation, the nurse would immediately: A) Start CPR B) Administer epinephrine C) Notify the physician STAT D) Start an IV of NSS wide-open rate Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: D-1 Feedback: During asystole or pulseless electrical activity, CPR must be initiated immediately to maintain minimal cardiac output and oxygenation, followed by intubation, and then administration of epinephrine. 33. The nurse is caring for a patient who requires transcutaneous pacing. She sets the rate to 80/min. She knows that the milliamperage setting is adequate when: A) She sees the pacemaker spike at a rate of 80/min. B) The milliamperage reaches 40. C) There is evidence of a paced QRS. D) Oxygenation has improved. Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Patient Needs: D-1 Feedback: The appropriate ECG complex should immediately follow the pacing spike; therefore, a QRS complex should follow a ventricular pacing spike. 34. The nurse is caring for a patient who suddenly develops bradycardia. The patient is breathing but with a decreased level of consciousness and decreased blood pressure. Which of the following treatments would be done by the nurse first? A) Begin CPR B) Administer atropine IV C) Application of a transcutaneous pacemaker D) Discontinue cardioversion Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: D-1 Feedback: If a patient suddenly develops bradycardia, emergency pacing may be started with a transcutaneous pacemaker, which most defibrillators are now able to perform. If the patient is alert, sedation and analgesia should be used. CPR would not be initiated because the patient has a pulse and is breathing. 35. The nurse doing discharge teaching on a patient with a newly inserted permanent pacemaker teaches the patient to: A) Start lifting the arm above the shoulder right away to prevent shoulder restriction B) Avoid cooking with a microwave oven C) Avoid exposure to high-voltage electrical generators D) Avoid walking through store and library antitheft devices Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Patient Needs: D-3 Feedback: High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (eg, microwave ovens). The affected arm should not be raised above the shoulder for one week following placement of the pacemaker. Antitheft alarms may be triggered, so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function. 36. The nurse caring for a patient with a tachydysrhythmia would teach and prepare him for which of the following procedures: A) Catheter ablation therapy B) Transubcutaneous pacemaker C) Cardioversion D) Implantable cardiac device Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 10 Patient Needs: D-1 Feedback: Catheter ablation therapy uses radiofrequency energy to ablate or burn accessory pathways or ectopic sites in the atria, AV node, or ventricles that cause tachyarrhythmias. 37. The nurse caring for a patient with an arrhythmia who develops a sudden drop in blood pressure, chest pain, and decreased mentation identifies which of the following conditions related to the arrhythmia: A) Hepatomegaly B) Right-sided heart failure C) Decreased cardiac output D) Left-sided heart failure Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Patient Needs: D-1 Feedback: Symptoms of decreased cardiac output related to cardiac arrhythmias include a sudden drop in blood pressure and symptoms of hypoxemia, such as decreased mentation, chest pain and dyspnea. Right-sided heart failure include jugular vein distention, edema, and hepatomegaly. Left-sided failure symptoms include dyspnea pulmonary crackles and decreased blood pressure and S3, S4 heart sounds. 38. The nurse is caring for a patient 1 hour postoperative pacemaker implantation. Upon assessing the patient's ECG, spikes appear within the QRS complex and ST segment. This is described as: A) Failure to sense B) Failure to capture C) Pacemaker failure D) Demand pacing Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Patient Needs: D-1 Feedback: Failure to sense is when the pacemaker is unable to detect an electrically conducted signal produced by the heart such as a P wave or QRS complex. It is seen as spikes on the QRS complex and ST segment. Failure to capture is no response of the ventricle of the heart to the electrical conducting system. 39. The nurse is preparing a patient for an ECG. Which of the following should be done prior to electrode placement? A) Cleaning the skin with povidone-iodine solution prior to applying the electrodes B) Ensuring that the area for electrode placement is dry C) Applying tincture of benzoin to the electrode sites and waiting for it to become tacky D) Abrading the skin by rubbing the electrode sites briskly with a rough surface such as a clean, dry gauze or washcloth Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Patient Needs: D-1 Feedback: An ECG is obtained by slightly abrading the skin with a clean, dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. 40. The nurse is performing external defibrillation. Which of the following is a vital step in the procedure? A) Gel pads are placed anterior over the apex and posterior for better conduction. B) No one is to be touching the patient at the time shock is delivered. C) Continue to ventilate the patient via endotracheal tube during the procedure. D) Second shock cannot be administered for 1 minute to allow recharging. Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Patient Needs: A-2 Feedback: In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patient's skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation. 41. A nurse is assessing an ECG rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second. The overall heart rate is 60 beats/min. The nurse assesses the cardiac rhythm as: A) Normal sinus rhythm B) Sinus bradycardia C) Sick sinus syndrome D) Heart Block Register to View AnswerChapter: 27 Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-1 Feedback: Normal sinus rhythm appears as a regular rhythm with a rate of 60 to 100 beats per minute. The PR and QRS measurements are normal according to normal sinus rhythm. 42. A nurse is caring for a patient on a cardiac monitor and whose rhythm suddenly changes. There are no P waves; instead she observes wavy lines. The QRS complexes measure 0.08 second and are irregular. The patient's heart rate is 120 beats/minute. The nurse interprets that this rhythm is: A) Sinus tachycardia B) Atrial fibrillation C) Ventricular tachycardia D) Ventricular fibrillation Register to View AnswerChapter: 27 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Patient Needs: D-1 Feedback: Atrial fibrillation is seen as a loss of P waves with a wavy baseline. QRS can be normal, but the heart rate ranges from 100 to 160 beats/min.
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