Chapter 26: Arrhythmias: Nursing Management(questions with complete solutions.)

A client is experiencing an alteration in heart rate. The nurse realizes this client is experiencing a disorder of which part of the heart? 1. Atrioventricular node 2. Bundle branches 3. Purkinje fibers 4. Sinoatrial node 4. Sinoatrial node The sinoatrial node is the dominant pacemaker of the heart. The sinoatrial node has an inherent rate of 60 to 100 bpm. The atrioventricular node has an intrinsic rate of 40 to 60 bpm. The impulse enters the right and left bundle branches and then enters the Purkinje fibers. Impulses at this level are at 15 to 40 times per minute. A client is suspected of having cardiac damage. The nurse realizes that which of the following diagnostic tests is most commonly used to help diagnose this client's possible cardiac damage or disease? 1. 12-lead electrocardiogram 2. Arterial blood gases 3. Cardiac angiogram 4. Cardiac enzymes 1. 12-lead electrocardiogram A 12-lead electrocardiogram is a quick and accurate diagnostic tool used to evaluate heart damage and disease. The other diagnostic tests require a longer time for results and/or are invasive procedures requiring some preparation. 00:41 01:14 The nurse is analyzing a client's electrocardiogram tracing. Which of the following complexes is not normally seen on an electrocardiogram tracing? 1. P wave 2. QRS complex 3. T wave 4. U wave 4. U wave A U wave is not always seen and can be very small. It can indicate electrolyte imbalance, medication effects, and ischemia. The P wave, QRS complex, and T wave are normally seen in the electrocardiogram tracing. The nurse is analyzing a client's electrocardiogram tracing and realizes that each small square on the paper is equal to: 1. 0.04 second. 2. 0.12 second. 3. 0.20 second. 4. 0.40 second. 1. 0.04 second The small square on the ECG graph paper equals 0.04 second. The large square equals 0.20 second. The PR interval is 0.12 to 0.20 second. Two large squares would be equal to 0.40 second. The nurse is reading an ECG rhythm strip and notes that there are nine QRS complexes in a 6-second strip. The heart rate is: 1. 36. 2. 54. 3. 81. 4. 90. 4. 90 A heart rate can be determined by multiplying the QRS complexes in a 6-second strip by 10. The heart rate is 90. This method of calculating the heart rate is the most common method used because it is quick and can be used when the heart rate is irregular. The nurse notes that on a client's electrocardiogram tracing, there is one P wave for every QRS complex and a delay in the impulse transmission at the AV node. This regular rhythm is identified as: 1. first-degree AV block. 2. second-degree AV block type I. 3. second-degree AV block type II. 4. complete heart block. 1. first-degree AV block First-degree atrioventricular (AV) block occurs when there is a delay in the impulse transmission at the AV node. This delay occurs with every impulse and can be seen on every beat on the recorded rhythm strip. Second-degree and complete heart block have differences with the P wave and the associated QRS complexes. A client is unresponsive and has no pulse. The nurse notes that the electrocardiogram tracing shows continuous large and bizarre QRS complexes measured greater than 0.12 each. This rhythm is identified as: 1. premature ventricular complexes. 2. torsades de pointes. 3. ventricular fibrillation. 4. ventricular tachycardia. 4. ventricular tachycardia Ventricular tachycardia occurs when the patient experiences sustained consecutive premature ventricular complexes. Torsades de pointes is characterized by a wide-to-narrow pattern of the QRS complexes. Ventricular fibrillation shows a coarse wavy baseline. An elderly client is demonstrating a change in heart rate that occurs with respirations. When planning care for the client, the nurse knows that treatment may include: 1. Oxygen therapy 2. Analgesics 3. Antibiotics 4. Pacemaker insertion 4. Pacemaker insertion A change in heart rate that occurs with respirations defines a sinus arrhythmia. If the client becomes symptomatic during periods of bradycardia, treatment will include atropine sulfate or pacemaker insertion. Treatment for sinus arrhythmia might include oxygen if the client is symptomatic. Treatment for this arrhythmia does not include analgesics or antibiotics. A client's electrocardiogram tracing shows a sawtooth pattern with F waves. The nurse realizes this client is demonstrating: 1. atrial flutter. 2. atrial fibrillation. 3. premature atrial contractions. 4. atrial tachycardia. 1. atrial flutter Atrial flutter is characterized by F waves that occur in a characteristic sawtooth pattern. Atrial fibrillation is characterized by coarse waves with the baseline between the QRS complexes as being rough and uneven. Premature atrial contractions occur when an electrical impulse is generated in an area of the atria outside of the SA node. Atrial tachycardia is three or more premature atrial contractions. Neither premature atrial contractions or atrial tachycardia have an F wave on the tracing. The electrocardiogram tracing for a client shows premature junctional complexes. Which of the following should the nurse do to assist this client? 1. Administer oxygen 2. Increase intravenous fluids 3. Check on the serum digoxin level 4. Assist the client to a side-lying position 3. Check on the serum digoxin level The most common cause of premature junctional complexes is digitalis toxicity. The nurse should check on the client's serum digoxin level. Oxygen, intravenous fluids, or position changes will not help treat this rhythm. Which of the following should the nurse instruct a client who has been diagnosed with an arrhythmia? 1. Exercise level 2. Avoidance of calorie-dense foods 3. How to take his own pulse 4. Reasons why fatigue is expected 3. How to take his own pulse Instructions for a client diagnosed with an arrhythmia include symptom management, how to take own pulse, and substances to avoid the onset of an arrhythmia. The nurse may or may not instruct on exercise level. The client does not need to avoid calorie-dense foods. Fatigue is a symptom that should be reported to a health care provider. A client is diagnosed with supraventricular tachycardia. The nurse should prepare to administer which of the following medications? 1. Procainamide 2. Amiodarone 3. Verapamil 4. Adenosine 4. Adenosine Adenosine has a short half-life, is given intravenous push, and is used to abruptly stop supraventricular tachycardia. Procainamide is used for tachyarrhythmias and ventricular ectopy. Amiodarone is helpful to treat ventricular fibrillation. Verapamil helps slow the heart rate with atrial fibrillation.