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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter26:ManagementofPatientsWithDysrhythmiasand ConductionProblems  1.

ThenurseiscaringforapatientwhohashadanECG.ThenursenotesthatleadsI,II,andIIIdifferfrom oneanotheronthecardiacrhythmstrip.Howshouldthenursebestrespond?

A)

Recognizethattheviewoftheelectricalcurrentchangesinrelationtotheleadplacement.

B)

Recognizethattheelectrophysiologicalconductionoftheheartdifferswithleadplacement.

C)

InformthetechnicianthattheECGequipmenthasmalfunctioned.

D)

Informthephysicianthatthepatientisexperiencinganewonsetofdysrhythmia.

Ans:

A 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.Differencesbetweenleadsarenotnecessarily attributabletoequipmentmalfunctionordysrhythmias.

2.

Thenurseisanalyzingarhythmstrip.WhatcomponentoftheECGcorrespondstotherestingstateof thepatientsheart?

A)

Pwave

B)

Twave

C)

Uwave

D)

QRScomplex

Ans:

B Feedback: TheTwavespecificallyrepresentsventricularmuscledepolarization,alsoreferredtoastherestingstate. VentricularmuscledepolarizationdoesnotresultinthePwave,Uwave,orQRScomplex.

3.

Thenursingeducatorispresentingacasestudyofanadultpatientwhohasabnormalventricular depolarization.ThispathologicchangewouldbemostevidentinwhatcomponentoftheECG?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Pwave

B)

Twave

C)

QRScomplex

D)

Uwave

Ans:

C

510

Feedback: TheQRScomplexrepresentsthedepolarizationoftheventriclesand,assuch,theelectricalactivityof thatventricle. 4.

Anadultpatientwiththird-degreeAVblockisadmittedtothecardiaccareunitandplacedon continuouscardiacmonitoring.WhatrhythmcharacteristicwilltheECGmostlikelyshow?

A)

PPintervalandRRintervalareirregular.

B)

PPintervalisequaltoRRinterval.

C)

FewerQRScomplexesthanPwaves

D)

PRintervalisconstant.

Ans:

C 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.TheotherlistedECGchangesarenotconsistentwiththisdiagnosis.

5.

Thenurseiswritingaplanofcareforapatientwithacardiacdysrhythmia.Whatwouldbethemost appropriategoalforthepatient?

A)

Maintainarestingheartratebelow70bpm.

B)

Maintainadequatecontrolofchestpain.

C)

Maintainadequatecardiacoutput.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Maintainnormalcardiacstructure.

Ans:

C

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Feedback: Forpatientsafety,themostappropriategoalistomaintaincardiacoutputtopreventworsening complicationsasaresultofdecreasedcardiacoutput.Arestingrateoflessthan70bpmisnot appropriateforeverypatient.Chestpainismorecloselyassociatedwithacutecoronarysyndromethan withdysrhythmias.Nursingactionscannotnormallyinfluencethephysicalstructureoftheheart. 6.

Apatienthasreturnedtothecardiaccareunitafterhavingapermanentpacemakerimplantation.For whichpotentialcomplicationshouldthenursemostcloselyassessthispatient?

A)

Chestpain

B)

Bleedingattheimplantationsite

C)

Malignanthyperthermia

D)

Bradycardia

Ans:

B Feedback: Bleeding,hematomas,localinfections,perforationofthemyocardium,andtachycardiaare complicationsofpacemakerimplantations.Thenurseshouldmonitorforchestpainandbradycardia,but bleedingisamorecommonimmediatecomplication.Malignanthyperthermiaisunlikelybecauseitisa responsetoanesthesiaadministration.

7.

Apatientthenurseiscaringforhasapermanentpacemakerimplantedwiththeidentificationcode beginningwithVVI.Whatdoesthisindicate?

A)

Ventricularpaced,ventricularsensed,inhibited

B)

Variablepaced,ventricularsensed,inhibited

C)

Ventricularsensed,ventricularsituated,implanted

D)

Variablesensed,variablepaced,inhibited

Ans:

A Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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TheidentificationofVVIindicatesventricularpaced,ventricularsensed,inhibited. 8.

Thenurseiscaringforanadultpatientwhohasgoneintoventricularfibrillation.Whenassistingwith defibrillatingthepatient,whatmustthenursedo?

A)

Maintainfirmcontactbetweenpaddlesandpatientskin.

B)

Applyalayerofwaterasaconductingagent.

C)

Callallclearoncebeforedischargingthedefibrillator.

D)

Ensurethedefibrillatorisinthesyncmode.

Ans:

A Feedback: Whendefibrillatinganadultpatient,thenurseshouldmaintaingoodcontactbetweenthepaddlesandthe patientsskintopreventarcing,applyanappropriateconductingagent(notwater)betweentheskinand thepaddles,andensurethedefibrillatorisinthenonsyncmode.Clearshouldbecalledthreetimes beforedischargingthepaddles.

9.

Apatientwhoisacandidateforanimplantablecardioverterdefibrillator(ICD)asksthenurseaboutthe purposeofthisdevice.Whatwouldbethenursesbestresponse?

A)

Todetectandtreatdysrhythmiassuchasventricularfibrillationandventriculartachycardia

B)

Todetectandtreatbradycardia,whichisanexcessivelyslowheartrate

C)

Todetectandtreatatrialfibrillation,inwhichyourheartbeatstooquicklyandinefficiently

D)

Toshockyourheartifyouhaveaheartattackathome

Ans:

A Feedback: TheICDisadevicethatdetectsandterminateslife-threateningepisodesofventriculartachycardiaand ventricularfibrillation.Itdoesnottreatatrialfibrillation,MI,orbradycardia.

10. Anurseisprovidinghealtheducationtoapatientscheduledforcryoablationtherapy.Thenurseshould describewhataspectofthistreatment? A)

Peelingawaytheareaofendocardiumresponsibleforthedysrhythmia

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Usingelectricalshocksdirectlytotheendocarduimtoeliminatethesourceofdysrhythmia

C)

Usinghigh-frequencysoundwavestoeliminatethesourceofdysrhythmia

D)

Usingacooledprobetoeliminatethesourceofdysrhythmia

Ans:

D

513

Feedback: Cryoablationtherapyinvolvesusinga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. 11. Thenurseiscaringforapatientwhohasjusthadanimplantablecardioverterdefibrillator(ICD)placed. Whatisthepriorityareaforthenursesassessment? A)

Assessingthepatientsactivitylevel

B)

Facilitatingtransthoracicechocardiography

C)

VigilantmonitoringofthepatientsECG

D)

Closemonitoringofthepatientsperipheralperfusion

Ans:

C Feedback: Afterapermanentelectronicdevice(pacemakerorICD)isinserted,thepatientsheartrateandrhythm aremonitoredbyECG.Thisisapriorityoverperipheralcirculationandactivity.Echocardiographyis notindicated.

12. Duringapatientscareconference,theteamisdiscussingwhetherthepatientisacandidateforcardiac conductionsurgery.Whatwouldbethemostimportantcriterionforapatienttohavethissurgery? A)

Anginapectorisnotresponsivetoothertreatments

B)

Decreasedactivitytolerancerelatedtodecreasedcardiacoutput

C)

Atrialandventriculartachycardiasnotresponsivetoothertreatments

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Ventricularfibrillationnotresponsivetoothertreatments

Ans:

C

514

Feedback: Cardiacconductionsurgeryisconsideredinpatientswhodonotrespondtomedicationsand antitachycardiapacing.Angina,reducedactivitytolerance,andventricularfibrillationarenotcriteria. 13. Anurseiscaringforapatientwhoisexhibitingventriculartachycardia(VT).Becausethepatientis pulseless,thenurseshouldprepareforwhatintervention? A)

Defibrillation

B)

ECGmonitoring

C)

Implantationofacardioverterdefibrillator

D)

Angioplasty

Ans:

A Feedback: AnytypeofVTinapatientwhoisunconsciousandwithoutapulseistreatedinthesamemanneras ventricularfibrillation:Immediatedefibrillationistheactionofchoice.ECGmonitoringisappropriate, butthisisanassessment,notanintervention,andwillnotresolvetheproblem.AnICDandangioplasty donotaddressthedysrhythmia.

14. Apatientconvertsfromnormalsinusrhythmat80bpmtoatrialfibrillationwithaventricularresponse at166bpm.Bloodpressureis162/74mmHg.Respiratoryrateis20breathsperminutewithnormal chestexpansionandclearlungsbilaterally.IVheparinandCardizemaregiven.Thenursecaringforthe patientunderstandsthatthemaingoaloftreatmentiswhat? A)

DecreaseSAnodeconduction

B)

Controlventricularheartrate

C)

Improveoxygenation

D)

Maintainanticoagulation

Ans:

B Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Treatmentforatrialfibrillationistoterminatetherhythmortocontrolventricularrate.Thisisapriority becauseitdirectlyaffectscardiacoutput.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. 15. Thenurseandtheothermembersoftheteamarecaringforapatientwhoconvertedtoventricular fibrillation(VF).ThepatientwasdefibrillatedunsuccessfullyandthepatientremainsinVF.According tonationalstandards,thenurseshouldanticipatetheadministrationofwhatmedication? 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

Ans:

A Feedback: Epinephrineshouldbeadministeredassoonaspossibleafterthefirstunsuccessfuldefibrillationand thenevery3to5minutes.Antiarrhythmicmedicationssuchasamiodaroneandlicocainearegivenif ventriculardysrhythmiapersists.

16. Thenurseisplanningdischargeteachingforapatientwithanewlyinsertedpermanentpacemaker.What isthepriorityteachingpointforthispatient? A)

Startliftingthearmabovetheshoulderrightawaytopreventchestwalladhesion.

B)

Avoidcookingwithamicrowaveoven.

C)

Avoidexposuretohigh-voltageelectricalgenerators.

D)

Avoidwalkingthroughstoreandlibraryantitheftdevices.

Ans:

C 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(e.g., microwaveovens).Theaffectedarmshouldnotberaisedabovetheshoulderfor1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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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interferewithpacemakerfunction. 17. ApatientisbroughttotheEDanddeterminedtobeexperiencingsymptomaticsinusbradycardia.The nursecaringforthispatientisawarethemedicationofchoicefortreatmentofthisdysrhythmiaisthe administrationofatropine.Whatguidelineswillthenursefollowwhenadministeringatropine? A)

Administeratropine0.5mgasanIVbolusevery3to5minutestoamaximumof3.0mg.

B)

Administeratropineasacontinuousinfusionuntilsymptomsresolve.

C)

Administeratropineasacontinuousinfusiontoamaximumof30mgin24hours.

D)

Administeratropine1.0mgsublingually.

Ans:

A Feedback: Atropine0.5mggivenrapidlyasanintravenous(IV)bolusevery3to5minutestoamaximumtotal doseof3.0mgisthemedicationofchoiceintreatingsymptomaticsinusbradycardia.Bythisguideline, theotherlistedoptionsareinappropriate.

18. AnECGhasbeenorderedforanewlyadmittedpatient.Whatshouldthenursedopriortoelectrode placement? A)

Cleantheskinwithprovidone-iodinesolution.

B)

Ensurethattheareaforelectrodeplacementisdry.

C)

Applytinctureofbenzointotheelectrodesitesandwaitforittobecometacky.

D)

Gentlyabradetheskinbyrubbingtheelectrodesiteswithdrygauzeorcloth.

Ans:

D 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.Disinfectingtheskinis unnecessaryandconductiongelisused.

19. Thenurseiscaringforapatientwhohasjustundergonecatheterablationtherapy.Thenurseinthestepdownunitshouldprioritizewhatassessment? A)

Cardiacmonitoring

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Monitoringtheimplanteddevicesignal

C)

Painassessment

D)

Monitoringthepatientslevelofconsciousness(LOC)

Ans:

A

517

Feedback: Followingcatheterablationtherapy,thepatientiscloselymonitoredtoensurethedysrhythmiadoesnot reemerge.ThisisapriorityovermonitoringofLOCandpain,althoughthesearevalidandimportant assessments.Ablationdoesnotinvolvetheimplantationofadevice. 20. TheEDnurseiscaringforapatientwhohasgoneintocardiacarrest.Duringexternaldefibrillation, whatactionshouldthenurseperform? A)

Placegelpadsovertheapexandposteriorchestforbetterconduction.

B)

Ensurenooneistouchingthepatientatthetimeshockisdelivered.

C)

Continuetoventilatethepatientviaendotrachealtubeduringtheprocedure.

D)

Allowatleast3minutesbetweenshocks.

Ans:

B 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patients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.

21. Agroupofnursesareparticipatinginorientationtoatelemetryunit.Whatshouldthestaffeducatortell thisclassaboutSTsegments? A)

TheyarethepartofanECGthatreflectssystole.

B)

TheyarethepartofanECGusedtocalculateventricularrateandrhythm.

C)

TheyarethepartofanECGthatreflectsthetimefromventriculardepolarizationthrough repolarization.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

TheyarethepartofanECGthatrepresentsearlyventricularrepolarization.

Ans:

D

518

Feedback: STsegmentisthepartofanECGthatreflectstheendoftheQRScomplextothebeginningoftheT wave.ThepartofanECGthatreflectsrepolarizationoftheventriclesistheTwave.ThepartofanECG usedtocalculateventricularrateandrhythmistheRRinterval.ThepartofanECGthatreflectsthetime fromventriculardepolarizationthroughrepolarizationistheQTinterval. 22. Thenurseisprovidingcaretoapatientwhohasjustundergoneanelectrophysiologic(EP)study.The patientstatesthatsheisnervousaboutthingsgoingwrongduringtheprocedure.Whatisthenursesbest response? A)

Thisisbasicallyarisk-freeprocedure.

B)

ThousandsofpatientsundergoEPeveryyear.

C)

Rememberthatthisisastepthatwillbringyouclosertoenjoyinggoodhealth.

D)

Thewholeteamwillbemonitoringyouverycloselyfortheentireprocedure.

Ans:

D Feedback: PatientswhoaretoundergoanEPstudymaybeanxiousabouttheprocedureanditsoutcome.A detaileddiscussioninvolvingthepatient,thefamily,andtheelectrophysiologistusuallyoccurstoensure thatthepatientcangiveinformedconsentandtoreducethepatientsanxietyabouttheprocedure.Itis inaccuratetostatethatEPisrisk-freeandstatingthatitiscommondoesnotnecessarilyrelievethe patientsanxiety.CharacterizingEPasasteptowardgoodhealthdoesnotdirectlyaddressthepatients anxiety.

23. Newnursesonthetelemetryunithavebeenpairedwithpreceptors.Onenewnurseasksherpreceptorto explaindepolarization.Whatwouldbethebestanswerbythepreceptor? A)

Depolarizationisthemechanicalcontractionoftheheartmuscles.