Cardiac Rhythms and Dysrhythmias Comprehensive
Question and Answer Session with a Perfect 100%
Accuracy, 2024
The nurse provides discharge teaching to a patient that underwent pacemaker
implantation in the left chest. What should the nurse include in the instructions?
Select all that apply:
1) Showering is permitted as long as care is taken to pat dry the incision site
2) Avoid direct blows to the incision site
3) Raise the left arm above the head frequently, to promote circulation
4) Monitor pulse and inform the health care provider if the heart rate drops below
the predetermined rate
5) Microwave ovens are safe to use
2) Avoid direct blows to the incision site
4) Monitor pulse and inform the health care provider if the heart rate drops below the
predetermined rate
5) Microwave ovens are safe to use
The patient should avoid direct blows to the incision site for safety reasons. The patient
should monitor the pulse and inform the cardiologist if it drops below the predetermined
rate. Microwave ovens are safe to use and do not interfere with the functioning of the
pacemaker. Also, the incision site should be kept dry for four days after implantation, so
showering should be avoided. The patient should avoid lifting the arm above the
shoulder until approved by the cardiologist, because it might affect the functioning of the
pacemaker.
The nurse that is monitoring the electrocardiogram (ECG) of a patient with
hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial
rate 250 beats/minute. How should the nurse document this pattern?
1) Sinus bradycardia
2) Sinus tachycardia
3) Atrial flutter
4) Atrial fibrillation
3) Atrial flutter
Atrial flutter is an atrial tachydysrhythmia identified by flutter (F) waves, a sawtoothed
pattern, with a 200-350 beats/minute atrial rate. In sinus bradycardia, the heart rate is
less than 60 beats/minute, with regular rhythm and normal P waves. Sinus tachycardia
is identified by 101 to 200 beats/minute, with regular rhythm and normal P waves. In
atrial fibrillation, atrial rate is 350 to 600 beats/minute, with irregular rhythm, and fibrillary
(f) waves
,A patient with a newly inserted pacemaker receives discharge instructions from
the nurse. Which patient statement indicates that further teaching is required?
1) "I should avoid using microwave ovens."
2) "I should avoid standing near antitheft devices."
3) "I should avoid direct blows to the pacemaker site."
4) "I should avoid close proximity to high-output electric generators."
1) "I should avoid using microwave ovens."
Microwaves do not interfere with a pacemaker's function and can be used safely.
Electric signals from antitheft devices can affect pacemaker functioning. The patient
should avoid direct blows to the pacemaker site to reduce pressure at the site. Electric
signals from high-output electric generators can move the pacemaker from its position
and affect its functioning.
Which ECG characteristic is consistent with a diagnosis of ventricular
tachycardia (VT)?
1) Unmeasurable rate and rhythm
2) Rate 150 beats/minute; inverted P wave
3) Rate 200 beats/minute; P wave not visible
4) Rate 125 beats/minute; normal QRS complex
3) Rate 200 beats/minute; P wave not visible
VT is associated with a rate of 150 to 250 beats/minute; the P wave normally is not
visible. Rate and rhythm are not measurable in ventricular fibrillation. P wave inversion
and a normal QRS complex are not associated with VT.
The nurse is monitoring a patient on a wireless electrocardiogram (ECG) monitor.
Which observation is a cause for concern?
1) Upright P wave
2) Flat ST segment
3) Prolonged QT interval
4) Upright T wave
3) Prolonged QT interval
Prolonged QT interval is a cause for concern. QT disturbance may be caused by drugs,
electrolyte imbalances, and changes in heart rate. Upright P wave, flat ST segment, and
upright T wave are normal findings.
Which action does flecainide have on the heart?
1) Decreases automaticity
2) Accelerates depolarization
3) Decreases impulse conduction
4) Reduces myocardial contractility
3) Decreases impulse conduction
, Flecainide is a class IC sodium channel blocker; it decreases impulse conduction in
patients. Mexiletine is a class IB sodium channel blocker that accelerates
depolarization. B-adrenergic blockers like esmolol decrease the automaticity of the
sinoatrial node. Myocardial contractility is reduced with diltiazem, a calcium channel
blocker.
A patient has sought care following a syncopal episode of unknown etiology. The
nurse anticipates that what will be included in the patient's treatment plan?
1) A head-up tilt-test
2) Intravenous (IV) B-adrenergic blocker
3) Pacemaker insertion
4) Antiplatelet therapy
1) A head-up tilt-test
In patients without structural heart disease, the head-up tilt-test is a common
component of the diagnostic workup following episodes of syncope. IV B-blockers are
not indicated, although an IV infusion of low-dose isoproterenol may be started in an
attempt to provoke a response if the head-up tilt-test did not produce a response.
Addressing pacemakers is premature and inappropriate at this stage of diagnosis.
There is no data to support the initiation of anti platelet therapy.
The nurse teaches a group of nursing students about telemetry monitoring. The
nurse should provide information that the steps for applying electrodes should
be performed in what order?
-Affix the electrodes
-Clip excessive hair with scissors
-Monitor for artifact
-Gently rub the skin with dry gauze
1) Clip excessive hair with scissors
2) Gently rub the skin with dry gauze
3) Affix the electrodes
4) Monitor for artifact
The first stop during the measurement of an ECG is to remove excess hair on the skin.
The presence of hair may not facilitate the proper adherence of electrodes to the skin.
This could interfere with the recording of the cardiac impulses. It is followed by wiping
the skin with alcohol to remove dirt and oil, and gently rubbing with gauze until the skin
becomes pale pink. Wiping of the skin is followed by attaching the electrodes to the
patient at the designated areas. Artifact may occur for various reasons. This indicates
deformity of baseline and waveforms on electrocardiograph.
What is a disadvantage of a centralized monitoring system?
1) It cannot diagnose dysrhythmias
2) It measures the patients' heart rate remotely
3) It cannot rapidly detect myocardial ischemia
4) It requires continuous observation of patients' ECGs
Question and Answer Session with a Perfect 100%
Accuracy, 2024
The nurse provides discharge teaching to a patient that underwent pacemaker
implantation in the left chest. What should the nurse include in the instructions?
Select all that apply:
1) Showering is permitted as long as care is taken to pat dry the incision site
2) Avoid direct blows to the incision site
3) Raise the left arm above the head frequently, to promote circulation
4) Monitor pulse and inform the health care provider if the heart rate drops below
the predetermined rate
5) Microwave ovens are safe to use
2) Avoid direct blows to the incision site
4) Monitor pulse and inform the health care provider if the heart rate drops below the
predetermined rate
5) Microwave ovens are safe to use
The patient should avoid direct blows to the incision site for safety reasons. The patient
should monitor the pulse and inform the cardiologist if it drops below the predetermined
rate. Microwave ovens are safe to use and do not interfere with the functioning of the
pacemaker. Also, the incision site should be kept dry for four days after implantation, so
showering should be avoided. The patient should avoid lifting the arm above the
shoulder until approved by the cardiologist, because it might affect the functioning of the
pacemaker.
The nurse that is monitoring the electrocardiogram (ECG) of a patient with
hyperthyroidism observes regular, sawtooth-shaped flutter waves with an atrial
rate 250 beats/minute. How should the nurse document this pattern?
1) Sinus bradycardia
2) Sinus tachycardia
3) Atrial flutter
4) Atrial fibrillation
3) Atrial flutter
Atrial flutter is an atrial tachydysrhythmia identified by flutter (F) waves, a sawtoothed
pattern, with a 200-350 beats/minute atrial rate. In sinus bradycardia, the heart rate is
less than 60 beats/minute, with regular rhythm and normal P waves. Sinus tachycardia
is identified by 101 to 200 beats/minute, with regular rhythm and normal P waves. In
atrial fibrillation, atrial rate is 350 to 600 beats/minute, with irregular rhythm, and fibrillary
(f) waves
,A patient with a newly inserted pacemaker receives discharge instructions from
the nurse. Which patient statement indicates that further teaching is required?
1) "I should avoid using microwave ovens."
2) "I should avoid standing near antitheft devices."
3) "I should avoid direct blows to the pacemaker site."
4) "I should avoid close proximity to high-output electric generators."
1) "I should avoid using microwave ovens."
Microwaves do not interfere with a pacemaker's function and can be used safely.
Electric signals from antitheft devices can affect pacemaker functioning. The patient
should avoid direct blows to the pacemaker site to reduce pressure at the site. Electric
signals from high-output electric generators can move the pacemaker from its position
and affect its functioning.
Which ECG characteristic is consistent with a diagnosis of ventricular
tachycardia (VT)?
1) Unmeasurable rate and rhythm
2) Rate 150 beats/minute; inverted P wave
3) Rate 200 beats/minute; P wave not visible
4) Rate 125 beats/minute; normal QRS complex
3) Rate 200 beats/minute; P wave not visible
VT is associated with a rate of 150 to 250 beats/minute; the P wave normally is not
visible. Rate and rhythm are not measurable in ventricular fibrillation. P wave inversion
and a normal QRS complex are not associated with VT.
The nurse is monitoring a patient on a wireless electrocardiogram (ECG) monitor.
Which observation is a cause for concern?
1) Upright P wave
2) Flat ST segment
3) Prolonged QT interval
4) Upright T wave
3) Prolonged QT interval
Prolonged QT interval is a cause for concern. QT disturbance may be caused by drugs,
electrolyte imbalances, and changes in heart rate. Upright P wave, flat ST segment, and
upright T wave are normal findings.
Which action does flecainide have on the heart?
1) Decreases automaticity
2) Accelerates depolarization
3) Decreases impulse conduction
4) Reduces myocardial contractility
3) Decreases impulse conduction
, Flecainide is a class IC sodium channel blocker; it decreases impulse conduction in
patients. Mexiletine is a class IB sodium channel blocker that accelerates
depolarization. B-adrenergic blockers like esmolol decrease the automaticity of the
sinoatrial node. Myocardial contractility is reduced with diltiazem, a calcium channel
blocker.
A patient has sought care following a syncopal episode of unknown etiology. The
nurse anticipates that what will be included in the patient's treatment plan?
1) A head-up tilt-test
2) Intravenous (IV) B-adrenergic blocker
3) Pacemaker insertion
4) Antiplatelet therapy
1) A head-up tilt-test
In patients without structural heart disease, the head-up tilt-test is a common
component of the diagnostic workup following episodes of syncope. IV B-blockers are
not indicated, although an IV infusion of low-dose isoproterenol may be started in an
attempt to provoke a response if the head-up tilt-test did not produce a response.
Addressing pacemakers is premature and inappropriate at this stage of diagnosis.
There is no data to support the initiation of anti platelet therapy.
The nurse teaches a group of nursing students about telemetry monitoring. The
nurse should provide information that the steps for applying electrodes should
be performed in what order?
-Affix the electrodes
-Clip excessive hair with scissors
-Monitor for artifact
-Gently rub the skin with dry gauze
1) Clip excessive hair with scissors
2) Gently rub the skin with dry gauze
3) Affix the electrodes
4) Monitor for artifact
The first stop during the measurement of an ECG is to remove excess hair on the skin.
The presence of hair may not facilitate the proper adherence of electrodes to the skin.
This could interfere with the recording of the cardiac impulses. It is followed by wiping
the skin with alcohol to remove dirt and oil, and gently rubbing with gauze until the skin
becomes pale pink. Wiping of the skin is followed by attaching the electrodes to the
patient at the designated areas. Artifact may occur for various reasons. This indicates
deformity of baseline and waveforms on electrocardiograph.
What is a disadvantage of a centralized monitoring system?
1) It cannot diagnose dysrhythmias
2) It measures the patients' heart rate remotely
3) It cannot rapidly detect myocardial ischemia
4) It requires continuous observation of patients' ECGs
