A Nurse Is Reviewing the Ecg Rhythm Strip of a Client Who Is Receiving Telemetry

A client's cardiac status is beingness observed by telemetry monitoring. The nurse observes a P wave that changes shape in lead Two. What conclusion does the nurse make about the P wave? a. Information technology originates from an ectopic focus. b. The P wave was replaced by U waves. c. It is from the sinoatrial (SA) node. d. Multiple P waves are present.

A: If the P wave is firing consistently from the SA node, the P moving ridge volition take a consistent shape in a given lead. If the impulse is from an ectopic focus, then the P wave volition vary in shape in that lead

The nurse is assessing the client's electrocardiography (ECG). What does the P moving ridge on the ECG tracing represent? a. Wrinkle of the atria b. Contraction of the ventricles c. Depolarization of the atria d. Depolarization of the ventricles

C: The ECG tracing of a P wave represents electrical changes caused by atrial depolarization.

A nurse notes that the PR interval on a customer's electrocardiograph (ECG) tracing is 0.14 2nd. What action does the nurse accept? a. Assess serum cardiac enzymes. b. Administer ane mg epinephrine IV. c. Administer oxygen via nasal cannula. d. Document the finding in the client's chart.

D: The PR interval usually ranges from 0.12 to 0.20 second. This is a normal finding, so the nurse only documents this. No further activity is required.

When analyzing a client's electrocardiograph (ECG) tracing, the nurse observes that not all QRS complexes are preceded past a P wave. What is the nurse's interpretation of this observation? a. The customer has hyperkalemia causing irregular QRS complexes. b. Ventricular tachycardia is overriding the normal atrial rhythm. c. The customer'southward breast leads are not making sufficient contact with the skin. d. Ventricular and atrial depolarizations are initiated from different sites.

D: Normal rhythm shows one P wave preceding each QRS, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P moving ridge bespeak a different source of initiation of depolarization.

The nurse observes a prominent U moving ridge on the client'southward electrocardiograph (ECG) tracing. What is the most advisable action for the nurse to take? a. Document the finding every bit a normal variant. b. Review the customer's daily electrolyte results. c. Movement the crash cart closer to the client's room. d. Call for an immediate electrocardiogram.

B: Prominent U waves may be the result of hypokalemia. The nurse should review the customer's daily electrolyte results. Although documentation is important, this is not a normal variant. Moving the crash cart closer to the room may or may non exist warranted. The client does not need an immediate ECG.

The customer's center charge per unit increases slightly during inspiration and decreases slightly during expiration. What action does the nurse have? a. Evaluate for a respirator disorder. b. Assess the client for chest pain. c. Document the finding in the chart. d. Administer antidysrhythmic drugs.

C: Sinus dysrhythmia is noted when the centre rate increases slightly during inspiration and decreases slightly during expiration. Sinus dysrhythmia is a variant of normal sinus rhythm that is frequently observed in healthy children and adults. No other actions are needed.

A client with tachycardia is experiencing clinical manifestations. Which manifestation requires immediate intervention by the nurse? a. Mid-sternal chest hurting b. Increased urine output c. Mild orthostatic hypotension d. P wave touching the T wave

A: Chest pain, peradventure angina, indicates that tachycardia may be increasing the client's myocardial workload and oxygen demand to such an extent that normal oxygen commitment cannot keep pace. This results in myocardial hypoxia and pain.

A customer is experiencing sinus bradycardia with hypotension and dizziness. What medication does the nurse administer? a. Atropine (Atropine) b. Digoxin (Lanoxin) c. Lidocaine (Xylocaine) d. Metoprolol (Lopressor)

A: Atropine is a cholinergic antagonist that inhibits parasympathetically-induced hyperpolarization of the sinoatrial node. This inhibition results in an increased middle charge per unit. The other medications are non appropriate.

A client experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. What instruction does the nurse include in the client's education programme? a. "Minimize or abjure from caffeine." b. "Lie on your side until the attack subsides." c. "Utilise your oxygen when you lot experience PACs." d. "Take quinidine (Cardioquin) daily to prevent PACs."

A: PACs unremarkably have no hemodynamic consequences. For a client experiencing infrequent bouts of PACs, the nurse should explore possible lifestyle causes, such every bit excessive caffeine intake and stress. Lying on the side will non forbid or resolve PACs. Oxygen is not necessary. Although medications may be needed to command symptomatic dysrhythmias, for infrequent PACs, the client first should try lifestyle changes to control them.

The nurse identifies a client's rhythm to be a sustained supraventricular tachycardia. What medication does the nurse administer? a. Atropine (Atropine) b. Epinephrine (Adrenalin) c. Lidocaine (Xylocaine) d. Diltiazem (Cardizem)

D: Diltiazem, a calcium channel blocker, slows depolarization through the conduction system and is commonly used as an agent to terminate a sustained episode of supraventricular tachycardia.

A client has a heart rate averaging 56 beats/min with no adverse symptoms. What activity modifications does the nurse propose to avert further slowing of the heart rate? a. "Brand certain that your bath water is warm (100° F)." b. "Avert bearing downwards or straining while having a bowel movement." c. "Avert strenuous do, such every bit running, during the tardily afternoon." d. "Limit your intake of caffeinated drinks to no more than than 2 cups per day."

B: Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in slowing of the middle rate. Such a response is not desirable in a person who has bradycardia. The other instructions are not advisable for this status.

The nurse is assessing clients at a community clinic. Which customer does the nurse assess most carefully for atrial fibrillation? a. Middle-aged client who takes an aspirin daily b. Client who is dismissed afterwards coronary artery bypass surgery c. Older adult client later on a carotid endarterectomy d. Customer with chronic obstructive pulmonary disease

B: Atrial fibrillation occurs commonly in clients with cardiac affliction and is a common occurrence after coronary artery bypass graft (CABG) surgery. The other conditions practice not place a client at higher risk for atrial fibrillation.

The nurse is caring for a client on a cardiac monitor. The monitor shows a rapid rhythm with a "saw tooth" configuration. What physical cess findings does the nurse await? a. Presence of a split S1 and wheezing b. Anorexia and gastric distress c. Shortness of breath and feet d. Hypertension and mental status changes

C: The rhythm described is atrial flutter with a rapid ventricular response. Rapid atrial flutter may manifest with palpitations, shortness of jiff, and anxiety. Syncope, angina, and evidence of heart failure also may be present.

The nurse is caring for a client with atrial fibrillation. What manifestation nigh alerts the nurse to the possibility of a serious complication from this status? a. Sinus tachycardia b. Oral communication alterations c. Fatigue d. Dyspnea with activity

B: Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes in mentation, oral communication, sensory office, and motor part. Clients with atrial fibrillation often have a rapid ventricular response as a upshot. Fatigue is a nonspecific complaint. Clients with atrial fibrillation ofttimes have dyspnea as a result of the decreased cardiac output acquired by the rhythm disturbance.

The nurse is caring for a client with chronic atrial fibrillation. Which drug does the nurse expect to administrate to forestall a common complexity of this condition? a. Sotalol (Betapace) b. Warfarin (Coumadin) c. Atropine (Atropine) d. Lidocaine (Xylocaine)

B: Atrial fibrillation puts clients at hazard for developing emboli. Clients at risk for emboli are treated with anticoagulants, such equally heparin, enoxaparin, or warfarin. The other drugs are non appropriate for this complexity.

The nurse is caring for a client admitted for myocardial infarction. The customer's monitor shows frequent premature ventricular contractions (PVCs). What dysrhythmia does the nurse remain alert for? a. Sinus tachycardia b. Rapid atrial palpitate c. Ventricular tachycardia d. Atrioventricular junctional rhythm

C: With an astute myocardial infarction (MI), the onset of PVCs may be considered every bit a alert that could herald the onset of ventricular tachycardia or ventricular fibrillation.

A customer with myocardial ischemia is having frequent early, wide ventricular complexes seen on the cardiac monitor. Which medication does the nurse administer? a. Lanoxin (Digoxin) b. Amiodarone (Cordarone) c. Dobutamine (Dobutamine) d. Atropine sulfate (Atropisol)

B: Early, broad ventricular complexes are premature ventricular contractions (PVCs). Amiodarone, an antidysrhythmic, is the handling of choice for frequent PVCs. The other medications are not appropriate for this condition.

The nurse has administered adenosine (Adenocard). What is the expected therapeutic response? a. Increased intraocular pressure b. A cursory tonic-clonic seizure c. A curt period of asystole d. Hypertensive crunch

C: Clients usually respond to this medication with a brusk period of asystole, bradycardia, hypotension, dyspnea, and chest pain.

A client's electrocardiograph (ECG) tracing shows a run of sustained ventricular tachycardia. What is the nurse'south start action? a. Appraise airway, animate, and level of consciousness. b. Administer an amiodarone bolus followed by a drip. c. Cardiovert the client with a biphasic defibrillator. d. Brainstorm cardiopulmonary resuscitation (CPR).

A: The outset action that the nurse should take when ventricular tachycardia is observed is to assess the client's airway, breathing, and level of consciousness. If the client is unconscious or has experienced respiratory arrest, defibrillation and CPR are begun.

A client with unstable ventricular tachycardia is receiving amiodarone by intravenous infusion. The nurse notes that the client's heart charge per unit has decreased from 68 to 50 beats/min. The customer is asymptomatic. What is the nurse's priority intervention? a. Cease the infusion and flush the IV. b. Boring the amiodarone infusion rate. c. Administer a precordial thump. d. Place the client in a side-lying position.

B: Iv administration of amiodarone may cause bradycardia and atrioventricular (AV) cake. The right action for the nurse to have at this time is to irksome the infusion, because the client is asymptomatic and no evidence reveals AV block that might require pacing. Abruptly ceasing the medication could permit fatal dysrhythmias to occur. A precordial thump is non required at this time considering the client nevertheless has a centre rate. A side-lying position will not increase the client's centre rate.

A client with ischemic middle disease has an electrocardiograph (ECG) tracing that shows a PR interval of 0.24 2nd. What is the nurse's best action? a. Document the finding in the chart. b. Mensurate blood pressure level. c. Notify the wellness care provider. d. Administrate oxygen.

A: This prolonged PR interval indicates a showtime-degree center block. First-degree eye block in a stable client requires no intervention.

The physician is about to perform carotid sinus massage on a customer with supraventricular tachycardia. What equipment is nigh important for the nurse to have ready? a. Emesis basin b. Magnesium sulfate c. Resuscitation cart d. Padded tongue blade

C: Complications of this procedure include bradydysrhythmias, asystole, ventricular fibrillation, and cerebral damage. The resuscitation cart, complete with defibrillator, should be available whenever this procedure is initiated. The other equipment is not needed

The nurse is caring for a client with a consummate centre block (tertiary-caste atrioventricular [AV] cake). What is the nurse's priority intervention? a. Perform a cardioversion. b. Assist with carotid massage. c. Begin external pacing. d. Administrate adenosine (Adenocard) IV.

C: The nurse would look the client with complete eye block or third-degree AV cake to be paced externally until the customer tin be scheduled for a permanent pacemaker.

A client with 3rd-caste heart block is admitted to the telemetry unit. The nurse observes broad QRS complexes on the monitor with a heart charge per unit of 35 beats/min. What priority assessment does the nurse perform? a. Pulmonary auscultation b. Pulse strength and amplitude c. Level of consciousness d. Mobility and gait stability

C: A heart rate of twoscore beats/min or less, with widened QRS complexes, could have hemodynamic consequences, and the client is at take a chance for inadequate cognitive perfusion. The nurse should assess for level of consciousness, lightheadedness, confusion, syncope, and seizure action.

The nurse is caring for a client with a temporary pacemaker. The client'south bedside monitor shows a spike followed by a QRS circuitous. What is the nurse's best action? a. Remove the pacemaker; it is not needed. b. Decrease the threshold of the pacemaker. c. Certificate the finding in the client's chart. d. Fix the pacemaker to the synchronous mode.

C: A spike followed by a QRS complex indicates "capture," meaning that the pacemaker has successfully depolarized or captured the ventricle. No action other than documentation of this finding is necessary.

A client with ventricular tachycardia (VT) is unresponsive and has no pulse. The nurse calls for assistance and a defibrillator. What is the nurse's priority intervention while waiting for the defibrillator to arrive? a. Perform a pericardial thump. b. Initiate cardiopulmonary resuscitation. c. Start an eighteen-estimate Iv in the antecubital. d. Inquire the client'due south family almost lawmaking status.

B: A client with pulseless VT should exist defibrillated immediately. If the defibrillator is not available, the nurse should initiate cardiopulmonary resuscitation (CPR) and then should defibrillate as soon as possible. Basic life support (BLS) is the basis of emergency cardiac care; if the customer does not have an Four already, this can wait until others have arrived to help. Providing good quality CPR is vital. The client should take already been assessed for code status.

A customer has an epicardial pacemaker. The nurse observes the presence of a pacing fasten just no QRS complex on the client's electrocardiograph (ECG) tracing. How does the nurse interpret this event? a. Loss of capture b. Ventricular fibrillation c. Failure to sense d. A normal tracing

A: In epicardial 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.

The nurse is assisting with resuscitation of a client. What priority intervention does the nurse perform earlier defibrillating a client? a. Make sure the defibrillator is set to the synchronous mode. b. Deliver a precordial thump to the upper portion of the sternum. c. Test the equipment by delivering a smaller shock at 100 J. d. Ensure that all personnel are clear of contact with the client and the bed.

D: 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 thumb can be delivered when no defibrillator is available. Equipment should not be tested before a client is defibrillated because this is an emergency procedure; equipment should be checked on a routine basis. Defibrillation is done in asynchronous style.

The nurse is recovering a customer later insertion of an implantable cardioverter-defibrillator (ICD). What complication must the nurse intervene for immediately? a. 2/four bilateral peripheral edema b. Heart rate of 56 beats/min c. Temperature of 96° F (35.five° C) d. Deadened heart sounds

D: In the postimplantation flow, the nurse should exist warning for complications of cardiac tamponade, bleeding, and dysrhythmias. Muffled heart sounds are a manifestation of cardiac tamponade. Edema and a lower temperature would non be indicative of a complication of this procedure. Bradycardia might need intervention, just this client's center charge per unit is not critically low.

A customer was admitted for a permanent pacemaker insertion. What priority pedagogy does the nurse include in the customer'southward discharge education? a. "Practise not submerge your pacemaker, have simply showers." b. "Report pulse rates lower than your pacemaker setting." c. "If y'all experience weak, apply pressure over your generator." d. "Have your pacemaker turned off before having an MRI."

B: The client should be instructed to report changes in heart rate or rhythm, such as rates lower than the pacemaker setting or greater than 100 beats/min

The nurse is providing discharge instructions for a client with an implantable cardioverter-defibrillator (ICD). What argument by the customer indicates a good agreement of the instructions? a. "I should wear a snug-fitting shirt over the ICD." b. "I will avoid sources of strong electromagnetic fields." c. "I tin can't perform activities that increase my eye rate." d. "Now I can discontinue my antidysrhythmic medication."

B: 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. The client should non appoint in strenuous activities that cause the heart charge per unit to meet or exceed the ICD cutoff betoken because the ICD can discharge inappropriately. The client should continue all prescribed medications.

The nurse is assessing a client's ECG. What is the nurse's interpretation of the following ECG strip? a. Sinus rhythm with premature ventricular contractions (PVCs) b. Ventricular tachycardia c. Ventricular fibrillation d. Sinus rhythm with premature atrial contractions (PACs)

A: Sinus rhythm with PVCs has an underlying regular sinus rhythm with ventricular depolarization that sometime precedes atrial depolarization.

The nurse notes the post-obit rhythm on a customer'south telemetry monitor. How does the nurse interpret these findings? a. Ventricular tachycardia b. Second-degree center block c. Supraventricular tachycardia d. Premature ventricular contractions

A: Ventricular tachycardia occurs with repetitive firing of an irritable ventricular ectopic focus, unremarkably at a rate of 140 to 180 beats/min or more.

A nurse assesses the following ECG strip from a customer's telemetry monitor. What does the nurse exercise next? a. Mensurate hourly urine output. b. Assess the client's vital signs. c. Administer 0.5 mg atropine Iv. d. Gear up for external pacing.

B: Assessing the client's vital signs allows the nurse to determine if he or she is stable or unstable and symptomatic with the bradycardia. The client's stability with the bradycardia volition determine the need for specific interventions.

The nurse is alerted to a client's telemetry monitor. After assessing the following ECG, what is the nurse's priority intervention? a. Starting time a big-bore IV. b. Administer atropine. c. Ready for intubation. d. Perform defibrillation.

D: The client's rhythm is ventricular fibrillation. This is a lethal rhythm that is best treated with immediate defibrillation. If the client does not already have an IV , other members of the team can insert one afterward defibrillation. Besides, intubation can occur later if necessary. Atropine is not given for ventricular fibrillation.

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