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Cardiac dysrhythmias

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are abnormal rhythms of the heart's electrical system that can affect its ability to effectively pump oxygenated blood throughout the body.

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The electrophysiologic properties of those cells regulate heart rate and rhythm and possess unique properties:

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automaticity, excitability, conductivity, and contractility.

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automaticity

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The ability of a cell to initiate an impulse spontaneously and repetitively; in cardiac electrophysiology, the ability of primary pacemaker cells (SA node, AV junction) to generate an electrical impulse.

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excitability

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The ability of a cell to respond to a stimulus by initiating an impulse; also called "depolarization." In cardiac electrophysiology, it is the ability of non-pacemaker myocardial cells to respond to an electrical impulse generated from pacemaker cells and to depolarize.

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conductivity

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The ability of a cell to transmit an electrical stimulus from cell membrane to cell membrane.

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contractility

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The ability of a cell to contract in response to an impulse. In cardiac electrophysiology, the ability of atrial and ventricular muscle cells to shorten their fiber length in response to electrical stimulation, generating sufficient pressure to propel blood forward. Contractility is the mechanical activity of the heart.

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The SA node is the heart's primary

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pacemaker. It can spontaneously and rhythmically generate electrical impulses at a rate of 60 to 100 beats per minute and therefore has the greatest degree of automaticity.

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electrocardiogram (ECG)

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A graphic recording of the electrical current generated by the heart. The ECG provides information about cardiac dysrhythmias, myocardial ischemia, site and extent of myocardial infarction, cardiac hypertrophy, electrolyte imbalances, and effectiveness of cardiac drugs. It is a routine part of cardiovascular evaluation and is a valuable diagnostic test.

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For continuous ECG monitoring, the electrodes are not placed on

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the limbs because movement of the extremities causes "noise," or motion artifact, on the ECG signal.

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The clarity of continuous ECG monitor recordings is affected by

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skin preparation and electrode quality.

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Electrodes cannot be placed on

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irritated skin or over scar tissue.

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The P wave

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is a deflection representing atrial depolarization. The shape of the P wave may be a positive, negative, or biphasic (both positive and negative) deflection, depending on the lead selected. When the electrical impulse is consistently generated from the sinoatrial (SA) node, the P waves have a consistent shape in a given lead. If an impulse is then generated from a different (ectopic) focus, such as atrial tissue, the shape of the P wave changes in that lead, indicating that an ectopic focus has fired.

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The PR segment

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is the isoelectric line from the end of the P wave to the beginning of the QRS complex, when the electrical impulse is traveling through the atrioventricular (AV) node, where it is delayed. It then travels through the ventricular conduction system to the Purkinje fibers.

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The PR interval

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is measured from the beginning of the P wave to the end of the PR segment. It represents the time required for atrial depolarization as well as the impulse delay in the AV node and the travel time to the Purkinje fibers. It normally measures from 0.12 to 0.20 second (five small blocks).

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The QRS complex

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represents ventricular depolarization. The shape of the QRS complex depends on the lead selected. The Q wave is the first negative deflection and is not present in all leads. When present, it is small and represents initial ventricular septal depolarization. When the Q wave is abnormally present in a lead, it represents myocardial necrosis (cell death). The R wave is the first positive deflection. It may be small, large, or absent, depending on the lead. The S wave is a negative deflection following the R wave and is not present in all leads.

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The QRS duration

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represents the time required for depolarization of both ventricles. It is measured from the beginning of the QRS complex to the J point (the junction where the QRS complex ends and the ST segment begins). It normally measures from 0.04 to 0.10 second (up to three small blocks).

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The ST segment

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is normally an isoelectric line and represents early ventricular repolarization. It occurs from the J point to the beginning of the T wave. Its length varies with changes in the heart rate, the administration of medications, and electrolyte disturbances. It is normally not elevated more than 1 mm or depressed more than 0.5 mm from the isoelectric line. Its amplitude is measured at a point 1.5 to 2 mm after the J point. ST elevation or depression can be caused by myocardial injury, ischemia or infarction, conduction abnormalities, or the administration of medications.

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The T wave

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follows the ST segment and represents ventricular repolarization. It is usually positive, rounded, and slightly asymmetric. If an ectopic stimulus excites the ventricles during this time, it may cause ventricular irritability, lethal dysrhythmias, and possible cardiac arrest in the vulnerable heart. This is known as the R-on-T phenomenon. T waves may become tall and peaked, inverted (negative), or flat as a result of myocardial ischemia, potassium or calcium imbalances, medications, or autonomic nervous system effects.

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The U wave,

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when present, follows the T wave and may result from slow repolarization of ventricular Purkinje fibers. It is of the same polarity as the T wave, although generally it is smaller. It is not normally seen in all leads and is more common in lead V3. An abnormal U wave may suggest an electrolyte abnormality (particularly hypokalemia) or other disturbance. Correct identification is important so that it is not mistaken for a P wave. If in doubt, notify the health care provider and request that a potassium level be obtained.

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The QT interval

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represents the total time required for ventricular depolarization and repolarization. The QT interval is measured from the beginning of the QRS complex to the end of the T wave. This interval varies with the patient's age and gender and changes with the heart rate, lengthening with slower heart rates and shortening with faster rates. It may be prolonged by certain medications, electrolyte disturbances, Prinzmetal's angina, or subarachnoid hemorrhage. A prolonged QT interval may lead to a unique type of ventricular tachycardia called torsades de pointes.

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Artifact

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is interference seen on the monitor or rhythm strip, which may look like a wandering or fuzzy baseline. It can be caused by patient movement, loose or defective electrodes, improper grounding, or faulty ECG equipment, such as broken wires or cables. Some artifact can mimic lethal dysrhythmias like ventricular tachycardia (with tooth brushing) or ventricular fibrillation (with tapping on the electrode). Assess the patient to differentiate artifact from actual lethal rhythms! Do not rely only on the ECG monitor.

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Analysis of an ECG rhythm strip requires a systematic approach using a six-step method facilitated by use of a measurement tool called an ECG caliper:

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1 Determine the heart rate. 2 Determine the heart rhythm. 3 Analyze the P waves. 4 Measure the PR interval 5 Measure the QRS duration. 6 Interpret the rhythm.

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Normal sinus rhythm (NSR) is the rhythm originating from the sinoatrial (SA) node (dominant pacemaker) that meets these ECG criteria:

answer

• Rate: Atrial and ventricular rates of 60 to 100 beats/min • Rhythm: Atrial and ventricular rhythms regular • P waves: Present, consistent configuration, one P wave before each QRS complex • PR interval: 0.12 to 0.20 second and constant • QRS duration: 0.04 to 0.10 second and constant

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Sinus arrhythmia is a variant of NSR. It results from

answer

changes in intrathoracic pressure during breathing. In this context, the term arrhythmia does not mean an absence of rhythm, as the term suggests. Instead, the heart rate increases slightly during inspiration and decreases slightly during exhalation. This irregular rhythm is frequently observed in healthy children as well as adults.

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Sinus arrhythmia has all the characteristics of NSR except for its irregularity.

answer

• Rate: Atrial and ventricular rates between 60 and 100 beats/min • Rhythm: Atrial and ventricular rhythms irregular, with the shortest PP or RR interval varying at least 0.12 second from the longest PP or RR interval • P waves: One P wave before each QRS complex; consistent configuration • PR interval: Normal, constant • QRS duration: Normal, constant

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Dysrhythmias result from:

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• A disturbance in the relationship between electrical conductivity and the mechanical response of the myocardium • A disturbance in impulse formation (either from an abnormal rate or from an ectopic focus) • A disturbance in impulse conduction (delays and blocks) • The combination of several mechanisms

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Tachydysrhythmias are

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heart rates greater than 100 beats per minute.

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Tachydysrhythmias are serious because they:

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• Shorten the diastolic time and therefore the coronary perfusion time (the amount of time available for blood to flow through the coronary arteries to the myocardium). • Initially increase cardiac output and blood pressure. However, a continued rise in heart rate decreases the ventricular filling time because of a shortened diastole, decreasing the stroke volume. Consequently, cardiac output and blood pressure will begin to decrease, reducing aortic pressure and therefore coronary perfusion pressure. • Increase the work of the heart, increasing myocardial oxygen demand.

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The patient with a tachydysrhythmia may have:

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• Palpitations • Chest discomfort (pressure or pain from myocardial ischemia or infarction) • Restlessness and anxiety • Pale, cool skin • Syncope ("blackout") from hypotension

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Bradydysrhythmias occur when

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the heart rate is less than 60 beats per minute.

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Bradydysrhythmias can also be significant because:

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• Myocardial oxygen demand is reduced from the slow heart rate, which can be beneficial. • Coronary perfusion time may be adequate because of a prolonged diastole, which is desirable. • Coronary perfusion pressure may decrease if the heart rate is too slow to provide adequate cardiac output and blood pressure; this is a serious consequence.

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premature complex

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In the electrocardiogram, an early complex that occurs when a cardiac cell or cell group other than the sinoatrial node becomes irritable and fires an impulse before the next sinus impulse is generated. After the premature complex, there is a pause before the next normal complex, which creates an irregularity in the rhythm.

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bigeminy

answer

A type of premature complex that exists when normal complexes and premature complexes occur alternately in a repetitive two-beat pattern, with a pause occurring after each premature complex so that complexes occur in pairs.

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trigeminy

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A type of premature complex consisting of a repetitive three-beat pattern; usually occurs as two sequential normal complexes followed by a premature complex and a pause, with the same pattern repeating itself in triplets.

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quadrigeminy

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A type of premature complex consisting of a repetitive four-beat pattern; usually occurs as three sequential normal complexes followed by a premature complex and a pause, with the same pattern repeating itself in a four-beat pattern.

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When the rate of SA node discharge is more than 100 beats per minute, the rhythm is called

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sinus tachycardia

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For patients with sinus tachycardia, assess for

answer

fatigue, weakness, shortness of breath, orthopnea, decreased oxygen saturation, and decreased blood pressure. Also assess for restlessness and anxiety from decreased cerebral perfusion and for decreased urine output from impaired renal perfusion. The patient may also have anginal pain and palpitations. The ECG pattern may show T-wave inversion or ST-segment elevation or depression in response to myocardial ischemia.

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When the sinus node discharge rate is less than 60 beats/min, the rhythm is called

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sinus bradycardia

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The patient with sinus bradycardia may be asymptomatic except for the decreased pulse rate. At times, however, the rhythm may not be well tolerated. Assess the patient for:

answer

• Syncope ("blackouts" or fainting) • Dizziness and weakness • Confusion • Hypotension • Diaphoresis (excessive sweating) • Shortness of breath • Chest pain

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The most common atrial dysrhythmias are:

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• Premature atrial complexes • Supraventricular tachycardia • Atrial fibrillation

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A premature atrial complex (PAC) occurs when

answer

atrial tissue becomes irritable. This ectopic focus fires an impulse before the next sinus impulse is due. The premature P wave may not always be clearly visible because it can be hidden in the preceding T wave. Examine the T wave closely for any change in shape, and compare with other T waves. A PAC is usually followed by a pause.

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The causes of atrial irritability include:

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• Stress • Fatigue • Anxiety • Inflammation • Infection • Caffeine, nicotine, or alcohol • Drugs such as epinephrine, sympathomimetics, amphetamines, digitalis, or anesthetic agents

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Supraventricular tachycardia (SVT)

answer

involves the rapid stimulation of atrial tissue at a rate of 100 to 280 beats/min in adults. During SVT, P waves may not be visible, especially if there is a 1:1 conduction with rapid rates, because the P waves are embedded in the preceding T wave. SVT may occur in healthy young people, especially women.

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paroxysmal supraventricular tachycardia (PSVT) is used when

answer

the rhythm is intermittent. It is initiated suddenly by a premature complex such as a PAC and terminated suddenly with or without intervention.

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atrial fibrillation (AF)

answer

A cardiac dysrhythmia in which multiple rapid impulses from many atrial foci, at a rate of 350 to 600 times per minute, depolarize the atria in a totally disorganized manner, with no P waves, no atrial contractions, a loss of the atrial kick, and an irregular ventricular response.

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For patients with AF Assess the patient for

answer

fatigue, weakness, shortness of breath, dizziness, anxiety, syncope, palpitations, chest discomfort or pain, and hypotension. Some patients may be asymptomatic.

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cardioversion

answer

A synchronized countershock that may be performed in emergencies for hemodynamically unstable ventricular or supraventricular tachydysrhythmias or electively for stable tachydysrhythmias that are resistant to medical therapies. The shock depolarizes a critical mass of myocardium simultaneously during intrinsic depolarization and is intended to stop the re-entry circuit and allow the sinus node to regain control of the heart.

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maze procedure

answer

An open chest surgical technique often performed with coronary artery bypass grafting for patients in atrial fibrillation with decompensation.

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The most common or life-threatening ventricular dysrhythmias include:

answer

• Premature ventricular complexes • Ventricular tachycardia • Ventricular fibrillation • Ventricular asystole

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Premature ventricular complexes (PVCs), also called premature ventricular contractions,

answer

result from increased irritability of ventricular cells and are seen as early ventricular complexes followed by a pause. When multiple PVCs are present, the QRS complexes may be unifocal or uniform, meaning that they are of the same shape or multifocal or multiform, meaning that they are of different shapes

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Three or more successive PVCs are usually called

answer

nonsustained ventricular tachycardia (NSVT).

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Ventricular tachycardia (VT), sometimes referred to as "V tach,"

answer

occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min or more (Fig. 36-11). VT may result from increased automaticity or a re-entry mechanism. It may be intermittent (nonsustained VT) or sustained, lasting longer than 15 to 30 seconds.

question

People with more than 5000 PVCs in a 24-hour period are usually placed on

answer

beta blockers.

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Ventricular fibrillation (VF), sometimes called "V fib,"

answer

is the result of electrical chaos in the ventricles and is life threatening! Impulses from many irritable foci fire in a totally disorganized manner so that ventricular contraction cannot occur. There are no recognizable ECG deflections. The ventricles merely quiver, consuming a tremendous amount of oxygen. There is no cardiac output or pulse and therefore no cerebral, myocardial, or systemic perfusion. This rhythm is rapidly fatal if not successfully ended within 3 to 5 minutes.

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Ventricular asystole, sometimes called ventricular standstill,

answer

is the complete absence of any ventricular rhythm. There are no electrical impulses in the ventricles and therefore no ventricular depolarization, no QRS complex, no contraction, no cardiac output, and no pulse, respirations, or blood pressure. The patient is in full cardiac arrest.

question

If asystole occurs,

answer

call for assistance and begin high-quality CPR immediately (unless there is a do-not-resuscitate [DNR] order). Check another ECG lead to ensure the rhythm is asystole and not fine VF, which requires immediate defibrillation. Do NOT shock asystole!

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Nonsurgical management of dysrhythmias includes

answer

oxygen therapy, drug therapy, temporary pacing, cardioversion, CPR, defibrillation, and catheter ablation.

question

What is usually a first-line agent in all cardiac arrests?

answer

Epinephrine (Adrenalin)

question

In carotid sinus massage,

answer

the physician massages over one carotid artery for a few seconds, observing for a change in cardiac rhythm.

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temporary pacing

answer

A nonsurgical intervention for cardiac dysrhythmia that provides a timed electrical stimulus to the heart when either the impulse initiation or the intrinsic conduction system of the heart is defective.

question

noninvasive temporary pacing (NTP)

answer

Cardiac pacing that is accomplished through the application of two large external electrodes attached to an external pulse generator; used as an emergency measure to provide demand ventricular pacing in a profoundly bradycardic or asystolic patient until invasive pacing can be instituted or the patient's intrinsic rate returns to normal.

question

invasive temporary pacemaker

answer

A cardiac pacing system consisting of an external battery-operated pulse generator and pacing electrodes, or lead wires, that attach to the generator on one end and are in contact with the heart on the other end. Electrical pulses are emitted from the negative terminal of the generator, flow through a lead wire, and stimulate the cardiac cells to depolarize. The current seeks ground by returning through the other lead wire to the positive terminal of the generator, thus completing a circuitous route.

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Monitor for these complications of invasive temporary pacing, which may be serious and include:

answer

• Infection or hematoma at the pacemaker wire insertion site • Ectopic complexes (usually premature ventricular complexes [PVCs]) caused by irritability from the pacing wire in the ventricle, use of high current, or undersensing with pacemaker competition • Loss of capture, noted by the presence of a pacing stimulus or spike but no QRS complex • Undersensing or pacemaker competition, noted when pacing stimuli occur at a fixed rate in the presence of an adequate intrinsic rhythm • Oversensing, noted when the pacemaker fails to fire in the presence of an inadequate intrinsic rhythm • Electromagnetic interference, noted by altered generator variables • Stimulation of the chest wall or diaphragm, noted by rhythmic contraction of the chest wall muscles or hiccups with the use of high current or from lead wire perforation, which could cause cardiac tamponade

question

Complications of CPR include:

answer

• Rib fractures • Fracture of the sternum • Costochondral separation • Lacerations of the liver and spleen • Pneumothorax • Hemothorax • Cardiac tamponade • Lung contusions • Fat emboli

question

cardioversion

answer

A synchronized countershock that may be performed in emergencies for hemodynamically unstable ventricular or supraventricular tachydysrhythmias or electively for stable tachydysrhythmias that are resistant to medical therapies. The shock depolarizes a critical mass of myocardium simultaneously during intrinsic depolarization and is intended to stop the re-entry circuit and allow the sinus node to regain control of the heart.

question

Nursing care after cardioversion includes:

answer

• Maintaining a patent airway • Administering oxygen • Assessing vital signs and the level of consciousness • Administering antidysrhythmic drug therapy, as prescribed • Monitoring for dysrhythmias • Assessing for chest burns from electrodes • Providing emotional support • Documenting the results of cardioversion

question

defibrillation

answer

An asynchronous countershock that depolarizes a critical mass of myocardium simultaneously to stop the re-entry circuit, allowing the sinus node to regain control of the heart.

question

radiofrequency catheter ablation

answer

An invasive procedure that uses radiofrequency waves to abolish an irritable focus that is causing a supraventricular or ventricular tachydysrhythmia.

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The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. A. Respiratory rate B. QT interval C. Heart rate and rhythm D. Magnesium level E. Urine output

answer

QT interval Heart rate and rhythm Magnesium level

question

The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication? A. ST segment B. Heart rate C. Troponin D. Myoglobin

answer

Heart rate

question

The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? A. Heparin B. Atropine C. Dobutamine D. Magnesium sulfate

answer

Heparin

question

The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60; a P wave precedes each QRS complex, and the PR interval is 0.24 second. Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. The following medications are available on the medication record. What action should the nurse take? A. Administer atropine. B. Administer digoxin. C. Administer clonidine. D. Continue to monitor.

answer

Continue to monitor.

question

You are the charge nurse on the telemetry unit and are responsible for making client assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit? A. The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min B. The 71-year-old admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min C. The 88-year-old admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min D. The 92-year-old admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min

answer

The 64-year-old admitted for weakness who has a first-degree heart block with a heart rate of 58 beats/min

question

A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88. For which additional therapy does the nurse plan? A. Synchronized cardioversion B. Electrophysiology studies (EPS) C. Anticoagulation D. Radiofrequency ablation therapy

answer

Anticoagulation

question

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? A. Defibrillate the client at 200 J. B. Check the client for a pulse. C. Cardiovert the client at 50 J. D. Give the client IV lidocaine.

answer

Check the client for a pulse.

question

A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action should the nurse take next? A. Defibrillate at 200 J. B. Establish IV access. C. Place an oral airway and ventilate. D. Start cardiopulmonary resuscitation (CPR).

answer

Defibrillate at 200 J.

question

Which information would cause the nurse to withhold digoxin in the client with atrial fibrillation and heart failure? A. The client has sinus tachycardia with a rate of 102. B. The cardiac monitor shows atrial fibrillation with a heart rate of 98. C. The client has a creatinine level of 1.0 mg/dL. D. The digoxin level is 2.8 mg/dL.

answer

The digoxin level is 2.8 mg/dL.

question

In teaching clients at risk for bradydysrhythmias, what information does the nurse include? A. "Avoid potassium-containing foods." B. "Stop smoking and avoid caffeine." C. "Take nitroglycerin for a slow heartbeat." D. "Use a stool softener."

answer

"Use a stool softener."

question

The nurse is determining whether the client's rhythm strip demonstrates proper firing of the sinoatrial (SA) node. Which waveform indicates proper function of the SA node? A. The QRS complex is present. B. The PR interval is 0.24 second. C. A P wave precedes every QRS complex. D. The ST segment is elevated.

answer

A P wave precedes every QRS complex.

question

The professional nurse is supervising a nursing student performing a 12-lead electrocardiogram (ECG). Under which circumstance does the nurse correct the student? A. The client is semirecumbent in bed. B. Chest leads are placed as for the previous ECG. C. The client is instructed to breathe deeply through the mouth. D. The client is instructed to lie still.

answer

The client is instructed to breathe deeply through the mouth.

question

The nurse is caring for a client with heart rate of 143. For which manifestations should the nurse observe? Select all that apply. A. Palpitations B. Increased energy C. Chest discomfort D. Flushing of the skin E. Hypotension

answer

Palpitations Chest discomfort Hypotension

question

The nurse is caring for a client who has developed a bradycardia. Which possible causes should the nurse investigate? A. Bearing down for a bowel movement B. Possible inferior wall myocardial infarction (MI) C. Client stating that he just had a cup of coffee D. Client becoming emotional when visitors arrived E. Diltiazem (Cardizem) administered an hour ago

answer

Bearing down for a bowel movement Possible inferior wall myocardial infarction (MI) Diltiazem (Cardizem) administered an hour ago

question

How does the nurse recognize that atropine has produced a positive outcome for the client with bradycardia? A. Client states he is dizzy and weak. B. The nurse notes dyspnea. C. The client has a heart rate of 42. D. The monitor shows sinus rhythm.

answer

The monitor shows sinus rhythm.

question

The nurse teaches a client with new-onset atrial fibrillation that risk factors for this dysrhythmia may include which? Select all that apply. A. Use of beta-adrenergic blockers B. Excessive alcohol use C. Advancing age D. High blood pressure E. Palpitations

answer

Excessive alcohol use Advancing age High blood pressure

question

What teaching does the nurse include for a client with atrial fibrillation who has a new prescription for warfarin? A. It is important to consume a diet high in green leafy vegetables. B. You should take aspirin or ibuprofen for headache. C. Report nosebleeds to your provider immediately. D. Avoid caffeinated beverages.

answer

Report nosebleeds to your provider immediately.

question

The nurse is caring for a client with advanced heart failure who develops asystole. The nurse corrects the new graduate when the graduate offers to perform which intervention? A. Defibrillation B. Cardiopulmonary resuscitation (CPR) C. Administration of atropine D. Administration of oxygen

answer

Defibrillation

question

The nurse receives in report that the client with a pacemaker has experienced loss of capture. Which situation is consistent with this? A. The pacemaker spike falls on the T wave. B. Pacemaker spikes are noted, but no P wave or QRS complex follows. C. The heart rate is 42, and no pacemaker spikes are seen on the rhythm strip. D. The client demonstrates hiccups.

answer

Pacemaker spikes are noted, but no P wave or QRS complex follows.

question

The nurse recognizes that which intervention provides safety during cardioversion? A. Using the defibrillator at 200 joules B. Obtaining informed consent C. Setting the defibrillator to the synchronized mode D. Removing oxygen

answer

Setting the defibrillator to the synchronized mode

question

Which teaching is essential for a client who has had a permanent pacemaker inserted? A. Avoid talking on a cell phone. B. Avoid contact sports and blows to the chest. C. Avoid sexual activity. D. Do not take tub baths.

answer

Avoid contact sports and blows to the chest.

question

The client's rhythm strip shows a heart rate of 76 beats/min, one P wave occurring before each QRS complex, a PR interval measuring 0.24 second, and a QRS complex measuring 0.08 second. How does the nurse interpret this rhythm strip? A. Normal sinus rhythm B. Sinus bradycardia C. Sinus rhythm with first-degree atrioventricular (AV) block D. Sinus rhythm with premature ventricular contractions

answer

Sinus rhythm with first-degree atrioventricular (AV) block

question

The nurse is teaching the client with a new permanent pacemaker. Which statement by the client indicates the need for further discharge education? A. "I will be able to shower again soon." B. "I need to take my pulse every day." C. "I might trigger airport security metal detectors." D. "I no longer need my heart pills."'

answer

"I no longer need my heart pills."'

question

The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? A. Defibrillate using 200 J. B. Check the client for a pulse. C. Cardiovert the client at 50 J. D. Administer IV ibutilide (Corvert).

answer

Check the client for a pulse.

Nurs 432 Ch. 36 – Flashcards

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