C35 - ch 35 test bank PDF

Preview

Summary

ch 35 test bank ...

Description

Chapter 35: Dysrhythmias Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. To determine whether there is a delay in impulse conduction through the ventricles, the nurse

will measure the duration of the patient’s a. P wave. b. Q wave.

c. PR interval. d. QRS complex.

ANS: D

The QRS complex represents ventricular depolarization. The P wave represents the depolarization of the atria. The PR interval represents depolarization of the atria, atrioventricular node, bundle of His, bundle branches, and the Purkinje fibers. The Q wave is the first negative deflection following the P wave and should be narrow and short. DIF: Cognitive Level: Understand (comprehension) REF: 759 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 2. The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm.

Which method will be best to use? a. Count the number of large squares in the R-R interval and divide by 300. b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS

complexes. c. Use the 3-second markers to count the number of QRS complexes in 6 seconds

and multiply by 10. d. Calculate the number of small squares between one QRS complex and the next

and divide into 1500. ANS: C

This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other methods are accurate, but take longer. DIF: Cognitive Level: Analyze (analysis) REF: 759 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 3. A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to

have a heart rate of _____ beats/min. a. 15 to 20 b. 20 to 40

c. 40 to 60 d. 60 to 100

ANS: C

If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60 beats/minute. The slower rates are typical of the bundle of His and Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60 to 100 beats/min. DIF: Cognitive Level: Understand (comprehension) REF: 760 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

4. The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes

the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval regular, and QRS complex wide and distorted, and QRS duration of 0.18 second. The nurse interprets the patient’s cardiac rhythm as a. atrial flutter. c. ventricular fibrillation. b. sinus tachycardia. d. ventricular tachycardia. ANS: D

The absence of P waves, wide QRS, rate greater than 150 beats/min, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration. DIF: Cognitive Level: Apply (application) REF: 764 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 5. The nurse notes that a patient’s heart monitor shows that every other beat is earlier than

expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy c. Ventricular R-on-T phenomenon d. Multifocal premature ventricular contractions ANS: B

Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the premature ventricular contractions are multifocal or that the R-on-T phenomenon is occurring. DIF: Cognitive Level: Apply (application) REF: 768 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 6. A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the

PR interval is 0.24 seconds. The most appropriate intervention by the nurse would be to notify the health care provider immediately. document the finding and monitor the patient. give atropine per agency dysrhythmia protocol. prepare the patient for temporary pacemaker insertion.

a. b. c. d.

ANS: B

First-degree atrioventricular block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary. DIF: Cognitive Level: Apply (application) REF: 767 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 7. A patient who was admitted with a myocardial infarction experiences a 45-second episode of

ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which action should the nurse take next?

a. b. c. d.

Immediately notify the health care provider. Document the rhythm and continue to monitor the patient. Prepare to give IV amiodarone per agency dysrhythmia protocol. Perform synchronized cardioversion per agency dysrhythmia protocol.

ANS: C

The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The nurse should notify the health care provider after the medication is started. Cardioversion is not indicated given that the patient has returned to a sinus rhythm. Documentation and continued monitoring are not adequate responses to this situation. DIF: Cognitive Level: Analyze (analysis) REF: 766 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 8. After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree

atrioventricular (AV) block, which finding indicates that the drug has been effective? Increase in the patient’s heart rate Increase in strength of peripheral pulses Decrease in premature atrial contractions Decrease in premature ventricular contractions

a. b. c. d.

ANS: A

Atropine will increase the heart rate and conduction through the AV node. Because the drug increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The patient does not have premature atrial or ventricular contractions. DIF: Cognitive Level: Apply (application) REF: 763 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 9. A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been

unresponsive to drug therapy for several days. Teaching for this patient would include information about a. anticoagulant therapy. c. emergency cardioversion. b. permanent pacemakers. d. IV adenosine (Adenocard). ANS: A

Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria. Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information does not indicate that the patient has a slow heart rate. DIF: Cognitive Level: Apply (application) REF: 766 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 10. Which information will the nurse include when teaching a patient who is scheduled for a

radiofrequency catheter ablation for treatment of atrial flutter? a. The procedure prevents or minimizes the risk for sudden cardiac death. b. The procedure uses cold therapy to stop the formation of the flutter waves.

c. The procedure uses electrical energy to destroy areas of the conduction system. d. The procedure stimulates the growth of new conduction pathways between the

atria. ANS: C

Radiofrequency catheter ablation therapy uses electrical energy to “burn” or ablate areas of the conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and tachydysrhythmias. All other statements regarding the procedure are incorrect. DIF: Cognitive Level: Apply (application) REF: 765 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 11. The nurse knows that discharge teaching about the management of a new permanent

pacemaker has been most effective when the patient states “It will be several weeks before I can return to my usual activities.” “I will avoid cooking with a microwave oven or being near one in use.” “I will notify the airlines when I make a reservation that I have a pacemaker.” “I won’t lift the arm on the pacemaker side until I see the health care provider.”

a. b. c. d.

ANS: D

The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to avoid displacing the pacemaker leads. The patient should notify airport security about the presence of a pacemaker before going through the metal detector, but there is no need to notify the airlines when making a reservation. Microwave oven use does not affect the pacemaker. The insertion procedure involves minor surgery that will have a short recovery period. DIF: Cognitive Level: Apply (application) REF: 775 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 12. Which intervention by a new nurse who is caring for a patient who has just had an implantable

cardioverter-defibrillator (ICD) inserted indicates a need for more teaching about the care of patients with ICDs? a. The nurse administers amiodarone (Cordarone) to the patient. b. The nurse helps the patient fill out the application for obtaining a Medic Alert device. c. The nurse encourages the patient to do active range of motion exercises for all extremities. d. The nurse teaches the patient that sexual activity can be resumed when the incision is healed. ANS: C

The patient should avoid moving the arm on the ICD insertion site until healing has occurred to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient. DIF: Cognitive Level: Apply (application) REF: 772 TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and Effective Care Environment 13. Which action should the nurse perform when preparing a patient with supraventricular

tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the “off” position.

b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device. ANS: B

When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned “on” for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this patient. DIF: Cognitive Level: Apply (application) REF: 772 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 14. A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a

college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is 114/54 mm Hg, and the student denies any health problems. What action by the nurse is most appropriate? a. Allow the student to participate on the soccer team. b. Refer the student to a cardiologist for further testing. c. Tell the student to stop playing immediately if any dyspnea occurs. d. Obtain more detailed information about the student’s family health history. ANS: A

In an aerobically trained individual, sinus bradycardia is normal. The student’s normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the family’s health history. Dyspnea during an aerobic activity such as soccer is normal. DIF: Cognitive Level: Apply (application) REF: 763 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 15. When analyzing the rhythm of a patient’s electrocardiogram (ECG), the nurse will need to

investigate further upon finding a(n) a. isoelectric ST segment. b. PR interval of 0.18 second.

c. QT interval of 0.38 second. d. QRS interval of 0.14 second.

ANS: D

Because the normal QRS interval is less than 0.12 seconds, the patient’s QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The PR interval and QT interval are within normal range and ST segment should be isoelectric (flat). DIF: Cognitive Level: Apply (application) REF: 761 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 16. A patient has ST segment changes that suggest an acute inferior wall myocardial infarction.

Which lead would be best for monitoring the patient? c. V2 d. V6

a. I b. II

ANS: B

Leads II, III, and AVF reflect the inferior area of the heart and the ST segment changes. Lead II will best capture any electrocardiographic changes that indicate further damage to the myocardium. The other leads do not reflect the inferior part of the myocardial wall and will not provide data about further ischemic changes in that area. DIF: Cognitive Level: Analyze (analysis) REF: 758 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 17. Which laboratory result for a patient with multifocal premature ventricular contractions

(PVCs) is most important for the nurse to communicate to the health care provider? c. Serum sodium of 134 mEq/L d. Serum potassium of 2.9 mEq/L

a. Blood glucose of 243 mg/dL b. Serum chloride of 92 mEq/L ANS: D

Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values are also abnormal, they are not likely to be the etiology of the patient’s PVCs and do not require immediate correction. DIF: Cognitive Level: Analyze (analysis) REF: 768 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 18. A patient’s heart monitor shows a pattern of undulations of varying contours and amplitude

with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which action should the nurse take first? a. Give epinephrine (Adrenalin) IV. b. Perform immediate defibrillation. c. Prepare for endotracheal intubation. d. Ventilate with a bag-valve-mask device. ANS: B

The patient’s rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, begin chest compressions. The other actions may also be appropriate but not first. DIF: Cognitive Level: Analyze (analysis) REF: 771 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 19. A patient’s heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00

AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next? a. Place the transcutaneous pacemaker pads on the patient. b. Give atropine sulfate 1 mg IV per agency dysrhythmia protocol. c. Call the health care provider before giving scheduled metoprolol (Lopressor). d. Document the patient’s rhythm and assess the patient’s response to the rhythm. ANS: C

The patient has progressive first-degree atrioventricular (AV) block, and the b-blocker should be held until discussing the drug with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic. DIF: Cognitive Level: Analyze (analysis) REF: 767 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 20. A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of

80/42 mm Hg, and is complaining of feeling faint. Which action should the nurse take next? Recheck the heart rhythm and BP in 5 minutes. Have the patient perform the Valsalva maneuver. Give the scheduled dose of diltiazem (Cardizem). Apply the transcutaneous pacemaker (TCP) pads.

a. b. c. d.

ANS: D

The patient is experiencing symptomatic bradycardia and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate and the diltiazem should be held. The Valsalva maneuver will further decrease the rate. DIF: Cognitive Level: Apply (application) REF: 775 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 21. A 19-yr-old student comes to the student health center at the end of the semester complaining

that, “My heart is skipping beats.” An electrocardiogram (ECG) shows occasional unifocal premature ventricular contractions (PVCs). What action should the nurse take next? a. Insert an IV catheter for emergency use. b. Start supplemental O2 at 2 to 3 L/min via nasal cannula. c. Ask the patient about current stress level and caffeine use. d. Have the patient taken to the nearest emergency department (ED). ANS: C

In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. The patient is hemodynamically stable, so there is no indication that the patient needs supplemental O2, an IV, or to be seen in the ED. DIF: Cognitive Level: Apply (application) REF: 768 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 22. The nurse has received change-of-shift report about the following patients on the progressive

care unit. Which patient should the nurse see first? a. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin

(Coumadin) due b. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is

dizzy when ambulating c. A patient who is in a sinus rhythm, rate 98 and regular, recovering from an

elective cardioversion 2 hours ago d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and

has a dose of amiodarone (Cordarone) due ANS: D

The frequent firing of the ICD indicates that the patient’s ventricles are very irritable and the priority is to assess the patient and give the amiodarone. The other patients can be seen after the amiodarone is given. DIF: Cognitive Level: Analyze (analysis) REF: 773 OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 23. A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea

and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess th...