Chapter 31: Concepts of Care for Patients
with Dysrhythmias
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse teaches a client who experiences occasional premature atrial contractions
(PACs) accompanied by palpitations that resolve spontaneously without treatment.
Which statement would the nurse include in this client’s teaching?
a. “Minimize or abstain from caffeine.”
b. “Lie on your side until the attack subsides.”
c. “Use your oxygen when you experience PACs.”
d. “Take amiodarone daily to prevent PACs.”
ANS: A
PACs usually have no hemodynamic consequences. For a client experiencing
infrequent PACs, the nurse would explore possible lifestyle causes, such as excessive
caffeine intake and stress. Lying on the side will not prevent or resolve PACs. Oxygen
is not necessary. Although medications may be needed to control symptomatic
dysrhythmias, for infrequent PACs, the client first would try lifestyle changes to
control them.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Cardiac electrical conduction, Health teaching MSC:
Client Needs Category: Health Promotion and Maintenance
,2. 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?” What is the
nurse’s best response?
a. “Substance abuse puts clients at risk for many health issues.”
b. “The hospital requires that I ask you about cocaine use.”
c. “Clients who use cocaine are at risk for fatal dysrhythmias.”
d. “We can provide services for cessation of substance abuse.”
ANS: C
Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal
dysrhythmias. The other responses do not adequately address the client’s question.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Cardiac electrical conduction, Substance abuse MSC:
Client Needs Category: Physiological Integrity: Reduction of Risk Potential
3. A nurse supervises an assistive personnel (AP) applying electrocardiographic
monitoring. Which statement would the nurse provide to the AP related to this
procedure?
a. “Clean the skin and clip hairs if needed.”
b. “Add gel to the electrodes prior to applying them.”
c. “Place the electrodes on the posterior chest.”
d. “Turn off oxygen prior to monitoring the client.”
ANS: A
To ensure the best signal transmission, the skin would be clean and hairs clipped.
Electrodes would be placed on the anterior chest, and no additional gel is needed.
Oxygen has no impact on electrocardiographic monitoring.
DIF: Understanding TOP: Integrated Process: Communication and
Documentation KEY: Cardiac electrical conduction, Delegation
, MSC: Client Needs Category: Safe and Effective Care Environment:
Management of Care
4. A nurse assesses a client’s electrocardiogram (ECG) and observes the reading shown
below:
How would the nurse document this client’s ECG strip?
a. Ventricular tachycardia
b. Ventricular fibrillation
c. Sinus rhythm with premature atrial contractions (PACs)
d. Sinus rhythm with premature ventricular contractions (PVCs)
ANS: D
Sinus rhythm with PVCs has an underlying regular sinus rhythm with ventricular
depolarization that sometimes precede atrial depolarization. The PVC would exhibit
as a widened QRS without a preceding p wave. Ventricular tachycardia and
ventricular fibrillation rhythms would not have sinus beats present. Premature atrial
contractions are atrial contractions initiated from another region of the atria before the
sinus node initiates atrial depolarization.
DIF: Analyzing TOP: Integrated Process: Communication and Documentation
KEY: Cardiac electrical conduction, Documentation MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
5. A nurse cares for a client who is on a cardiac monitor. The monitor displayed the
rhythm shown below:
with Dysrhythmias
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse teaches a client who experiences occasional premature atrial contractions
(PACs) accompanied by palpitations that resolve spontaneously without treatment.
Which statement would the nurse include in this client’s teaching?
a. “Minimize or abstain from caffeine.”
b. “Lie on your side until the attack subsides.”
c. “Use your oxygen when you experience PACs.”
d. “Take amiodarone daily to prevent PACs.”
ANS: A
PACs usually have no hemodynamic consequences. For a client experiencing
infrequent PACs, the nurse would explore possible lifestyle causes, such as excessive
caffeine intake and stress. Lying on the side will not prevent or resolve PACs. Oxygen
is not necessary. Although medications may be needed to control symptomatic
dysrhythmias, for infrequent PACs, the client first would try lifestyle changes to
control them.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Cardiac electrical conduction, Health teaching MSC:
Client Needs Category: Health Promotion and Maintenance
,2. 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?” What is the
nurse’s best response?
a. “Substance abuse puts clients at risk for many health issues.”
b. “The hospital requires that I ask you about cocaine use.”
c. “Clients who use cocaine are at risk for fatal dysrhythmias.”
d. “We can provide services for cessation of substance abuse.”
ANS: C
Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal
dysrhythmias. The other responses do not adequately address the client’s question.
DIF: Understanding TOP: Integrated Process: Nursing Process: Assessment
KEY: Cardiac electrical conduction, Substance abuse MSC:
Client Needs Category: Physiological Integrity: Reduction of Risk Potential
3. A nurse supervises an assistive personnel (AP) applying electrocardiographic
monitoring. Which statement would the nurse provide to the AP related to this
procedure?
a. “Clean the skin and clip hairs if needed.”
b. “Add gel to the electrodes prior to applying them.”
c. “Place the electrodes on the posterior chest.”
d. “Turn off oxygen prior to monitoring the client.”
ANS: A
To ensure the best signal transmission, the skin would be clean and hairs clipped.
Electrodes would be placed on the anterior chest, and no additional gel is needed.
Oxygen has no impact on electrocardiographic monitoring.
DIF: Understanding TOP: Integrated Process: Communication and
Documentation KEY: Cardiac electrical conduction, Delegation
, MSC: Client Needs Category: Safe and Effective Care Environment:
Management of Care
4. A nurse assesses a client’s electrocardiogram (ECG) and observes the reading shown
below:
How would the nurse document this client’s ECG strip?
a. Ventricular tachycardia
b. Ventricular fibrillation
c. Sinus rhythm with premature atrial contractions (PACs)
d. Sinus rhythm with premature ventricular contractions (PVCs)
ANS: D
Sinus rhythm with PVCs has an underlying regular sinus rhythm with ventricular
depolarization that sometimes precede atrial depolarization. The PVC would exhibit
as a widened QRS without a preceding p wave. Ventricular tachycardia and
ventricular fibrillation rhythms would not have sinus beats present. Premature atrial
contractions are atrial contractions initiated from another region of the atria before the
sinus node initiates atrial depolarization.
DIF: Analyzing TOP: Integrated Process: Communication and Documentation
KEY: Cardiac electrical conduction, Documentation MSC:
Client Needs Category: Physiological Integrity: Physiological Adaptation
5. A nurse cares for a client who is on a cardiac monitor. The monitor displayed the
rhythm shown below:
