A nurse assesses a client's electrocardiograph tracing and observes that not all QRS complexes are
preceded by a P wave. How should the nurse interpret this observation?
Ventricular and atrial depolarizations are initiated from different sites
Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarization is
initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation
of depolarization.
A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which
activity modification should the nurse suggest to avoid further slowing of the heart rate?
"Avoid straining while having a bowel movement."
Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates
the vagus nerve and results in slowing of the heart rate. Such a response is not desirable in a person who
has bradycardia.
A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at
greatest risk for atrial fibrillation?
A 50-year-old who is post coronary artery bypass graft surgery
Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after
coronary artery bypass graft surgery.
A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the
possibility of a serious complication from this condition?
Speech alterations
Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes
in mentation, speech, sensory function, and motor function. Clients with atrial fibrillation often have a
rapid ventricular response as a result. Clients with atrial fibrillation often have dyspnea as a result of the
decreased cardiac output caused by the rhythm disturbance.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the
nurse expect to find on this client's medication administration record to prevent a common complication
of this condition?
Warfarin (Coumadin)
Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with
anticoagulants, such as heparin, enoxaparin, or warfarin.
A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse
assess for as the expected therapeutic response?
,Short period of asystole
Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea,
and chest pain.
A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a
heart rate of 35 beats/min on the cardiac monitor. Which assessment should the nurse complete next?
Level of consciousness
A heart rate of 40 beats/min or less with widened QRS complexes could have hemodynamic
consequences. The client is at risk for inadequate cerebral perfusion. The nurse should assess for level of
consciousness, light-headedness, confusion, syncope, and seizure activity.
A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes
the presence of a pacing spike but no QRS complex on the client's electrocardiogram. Which action
should the nurse take next?
vital signs and level of consciousness
In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the
chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen
without subsequent QRS complexes imply loss of capture. If there is no capture, then there is no
ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and
level of consciousness.
A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention
should the nurse perform prior to defibrillating this client?
Ensure that everyone is clear of contact with the client and the bed
To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and
ensures their compliance before delivery of the shock. A precordial thump can be delivered when no
defibrillator is available.
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the
client's understanding. Which statement by the client indicates a correct understanding of the teaching?
"I will avoid sources of strong electromagnetic fields."
The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields.
Clients should avoid tight clothing, which could cause irritation over the ICD generator.
A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily
living. What interventions should the nurse implement to address this client's concerns?
Schedule periods of exercise and rest during the day
, Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing
activities of daily living. The nurse should schedule periods of exercise and rest during the day to
decrease fatigue.
A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action
should the nurse take prior to the initiation of cardioversion?
Turn off oxygen therapy
For safety during cardioversion, the nurse should turn off any oxygen therapy to prevent fire.
A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care
services. Which priority information should be communicated to the home health nurse upon discharge?
Medication reconciliation
The home health nurse needs to know current medications the client is taking to ensure assessment,
evaluation, and further education related to these medications.
A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention
by the nurse?
Mid-sternal chest pain
Chest pain, possibly angina, indicates that tachycardia may be increasing the client's myocardial
workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This
results in myocardial hypoxia and pain.
A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied
by palpitations that resolve spontaneously without treatment. Which statement should the nurse
include in this client's teaching?
"Minimize or abstain from caffeine."
PACs usually have no hemodynamic consequences. For a client experiencing infrequent PACs, the nurse
should explore possible lifestyle causes, such as excessive caffeine intake and stress.
The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client
asks, "Why do you want to know if I use cocaine?" How should the nurse respond?
"Clients who use cocaine are at risk for fatal dysrhythmias."
Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias.
A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring.
Which statement should the nurse provide to the UAP related to this procedure?
"Clean the skin and clip hairs if needed."
preceded by a P wave. How should the nurse interpret this observation?
Ventricular and atrial depolarizations are initiated from different sites
Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarization is
initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation
of depolarization.
A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which
activity modification should the nurse suggest to avoid further slowing of the heart rate?
"Avoid straining while having a bowel movement."
Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates
the vagus nerve and results in slowing of the heart rate. Such a response is not desirable in a person who
has bradycardia.
A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at
greatest risk for atrial fibrillation?
A 50-year-old who is post coronary artery bypass graft surgery
Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after
coronary artery bypass graft surgery.
A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the
possibility of a serious complication from this condition?
Speech alterations
Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes
in mentation, speech, sensory function, and motor function. Clients with atrial fibrillation often have a
rapid ventricular response as a result. Clients with atrial fibrillation often have dyspnea as a result of the
decreased cardiac output caused by the rhythm disturbance.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the
nurse expect to find on this client's medication administration record to prevent a common complication
of this condition?
Warfarin (Coumadin)
Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with
anticoagulants, such as heparin, enoxaparin, or warfarin.
A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse
assess for as the expected therapeutic response?
,Short period of asystole
Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea,
and chest pain.
A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a
heart rate of 35 beats/min on the cardiac monitor. Which assessment should the nurse complete next?
Level of consciousness
A heart rate of 40 beats/min or less with widened QRS complexes could have hemodynamic
consequences. The client is at risk for inadequate cerebral perfusion. The nurse should assess for level of
consciousness, light-headedness, confusion, syncope, and seizure activity.
A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes
the presence of a pacing spike but no QRS complex on the client's electrocardiogram. Which action
should the nurse take next?
vital signs and level of consciousness
In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the
chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen
without subsequent QRS complexes imply loss of capture. If there is no capture, then there is no
ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and
level of consciousness.
A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention
should the nurse perform prior to defibrillating this client?
Ensure that everyone is clear of contact with the client and the bed
To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and
ensures their compliance before delivery of the shock. A precordial thump can be delivered when no
defibrillator is available.
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the
client's understanding. Which statement by the client indicates a correct understanding of the teaching?
"I will avoid sources of strong electromagnetic fields."
The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields.
Clients should avoid tight clothing, which could cause irritation over the ICD generator.
A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily
living. What interventions should the nurse implement to address this client's concerns?
Schedule periods of exercise and rest during the day
, Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing
activities of daily living. The nurse should schedule periods of exercise and rest during the day to
decrease fatigue.
A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action
should the nurse take prior to the initiation of cardioversion?
Turn off oxygen therapy
For safety during cardioversion, the nurse should turn off any oxygen therapy to prevent fire.
A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care
services. Which priority information should be communicated to the home health nurse upon discharge?
Medication reconciliation
The home health nurse needs to know current medications the client is taking to ensure assessment,
evaluation, and further education related to these medications.
A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention
by the nurse?
Mid-sternal chest pain
Chest pain, possibly angina, indicates that tachycardia may be increasing the client's myocardial
workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This
results in myocardial hypoxia and pain.
A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied
by palpitations that resolve spontaneously without treatment. Which statement should the nurse
include in this client's teaching?
"Minimize or abstain from caffeine."
PACs usually have no hemodynamic consequences. For a client experiencing infrequent PACs, the nurse
should explore possible lifestyle causes, such as excessive caffeine intake and stress.
The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client
asks, "Why do you want to know if I use cocaine?" How should the nurse respond?
"Clients who use cocaine are at risk for fatal dysrhythmias."
Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias.
A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring.
Which statement should the nurse provide to the UAP related to this procedure?
"Clean the skin and clip hairs if needed."
