You are the nurse working on the telemetry unit and you have finally gotten to sit down to work on some charting. Suddenly the heart monitors at the station start beeping. Patient in room 18 is showing this rhythm on the monitor. The medical team advances
Answer: D. A pulse would be assessed for first. Then the patient will be defibrillized and chest compressions will begin immediately.
The nurse sees the following rhythm on the monitor. Which of the following lab values does the nurse identify as being most likely to have caused this dysrhythmia?
a) K 3.0
b) Ca 10.5
c) Hgb 9
d) Magnesium 2.1
Answer: C. Anemia can contribute to sinus tachycardia.
The patient who has recently been experiencing runs of ventricular tachycardia suddenly loses consciousness. The patient is defibrillated, and the rate returns as the following. What should the nurse do first?
A) Begin compressions
B) Shock the client aga
Answer: A. Following defibrillation, CPR is immediately initiated if a perfusable rhythm is not initiated. The client may need to be shocked again, but chest compressions must begin first.
A patient with cardiomyopathy has been given an ICD. Which of the following medications would the nurse expect to see in the MAR for this patient?
A) Warfarin
B) Cardizem
C) Nitroglycerin
D) Digoxin
Answer: B. Antiarrhythmic medications are prescribed with the use of an ICD in order to prevent the tachycardic (or other deadly arrhythmia) from occurring in the first place. This makes sure that the ICD is used only when absolutely necessary.
The patient with a history of hypertension and diabetes has the following rhythm strip. The patient's vitals are as follows: BP 145/89, HR 90, SpO2 95%, RR 19. Which of the following does the nurse expect to do at this time?
a) Prepare the client for card
Answer: B. Atrial flutter places the client at high risk for development of clot formation in the atria. Because the client is stable at this time, cardioversion or adenosine would not be performed at this time. Before cardioversion can occur in a patient, anticoagulant therapy should be begun at least 48 hours beforehand if possible.
The nurse is preparing to administer adenosine to the patient with the following rhythm which is symptomatic. What should the nurse plan on having in the patient room?
a) Physician
b) Crash cart
c) IV pump
d) EKG monitor
e) Lidocaine
Answer: A, B, and D. Adenosine is administered as a very quick IV push. The physician must be present in the room and the crash cart must be on hand. An ekg monitor should be in the room to monitor the effectiveness of the medication.
The nurse has just administered adenosine via IV push and sees the following rhythm on the monitor. What is the nurse's priority intervention?
a) Apply conductive gel and defibrillate the patient
b) Document the findings and continue to monitor
c) Adminis
Answer: B. This finding would be expected upon administration of adenosine. The rhythm should then begin again in some other rhythm, hopefully normal sinus rhythm. It would be important to document the exact time of this change and continue to monitor the change back to NSR. If this change does not occur, or if another rhythm is produced, appropriate action would then be taken based on the result.
You, the nurse, note the following rhythm on the EKG monitor for a patient named billy. What is the first thing the nurse should do?
a) Check for a pulse
b) Tell Billy to try to poop
c) Prepare to defibrillate billy
d) Prepare to administer Amiodorone
Answer: B. With SVT (Supraventricular tachycardia), the first thing to do would be to instruct the pt. to perform the Valsalva maneuver by bearing down.
A group of nursing students are discussing atrial flutter. These students recognize that which of the following are seen with atrial flutter? Select all that apply:
1) Ventricular rate of 220-300 bpm.
2) Regular rhythm
3) Saw-tooth pattern
4) Measurable P
Answer(s): 2, 3
The ATRIAL rate is 220-300 bpm. Ventricular is about 75-150. The rhythm is regular, with the P wave appearing as little flutter or a "saw tooth pattern". The PR interval is not measurable r/t this saw-tooth P wave. The QRS is normal.
A nursing student is aware that which of the following is the treatment for unstable atrial flutter?
1) Adenosine (Adenocard) 6 mg rapid IVP.
2) Cardioversion with adjacent Heparin therapy
3) Defibrillation STAT followed by CPR.
4) Altemose 3 mg IVP over
Answer: 2)
Cardioversion is used if the patient is unstable. Anticoagulants are used if the arrhythmia has stuck around for 48 hr +. Adenosine may be used with a narrow QRS and regular RR interval. I made up Altemose.
A nurse working on a CVT unit receives report from day shift. After receiving report, which patient should the nurse see first?
1) A 23-year-old professional tennis player with a HR of 47 bpm.
2) A 69-year-old male with atrial fibrillation who has new ons
Answer: 2)
Patients with a-fib are at risk for pulmonary and systemic emboli, and new onset of confusion may indicate a stroke in this patient. Patients with atrial flutter may feel more tired some days than others.
A nurse on a CVT unit views the monitor and sees the patient in room 452 has just begun having occasional PVCs. Which action should the nurse take first?
1) Check on the patient
2) Check last magnesium and potassium levels
3) Document the occurrence and w
Answer: 1)
Although electrolytes are likely the culprit, the nurse first needs to first assess the patient. Then, the nurse should look in the patient's chart and evaluate or request an order for electrolyte levels. This may eventually need to be documented, but the nurse can be held liable for neglect if he/she does not assess the patient first. The physician may or may not need to be contacted.
Which of the following does the nursing student realize is the treatment for a stable patient presenting with QRS intervals above 0.12 seconds with a regular rhythm and a rate of 100-250 bpm?
1) Atropine
2) Defibrillation
3) Amiodarone
4) Adenosine
Answer: 3)
This is describing ventricular tachycardia (QRS is a giveaway), and the treatment for a stable patient is Amiodarone or cardioversion. If the patient were unstable, we'd go ahead and defibrillate.
The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse?
a) Administer atropine 0.5 mg
Answer: d)
We cannot defibrillate asystole. A
A group of nursing students are studying AV blocks and ask their instructor, "what causes a first-degree block?" The nursing instructor responds that which of the following can cause a first-degree block: Select all that apply
1) Diarrhea
2) Chronic const
Answer(s): 2, 3, 4, 5
Diarrhea will not stimulate a vagal response, but vomiting can. Chronic constipation will cause a consistent vagal response. Digoxin, beta blockers, and calcium channel blockers can all contribute to first degree blocks. Relate this to bradycardia.
A 26-year-old client with atrial fibrillation that has not responded to medication therapy has arrived at the hospital for an elective cardioversion. Which of the following patient statements most concerns the nurse?
1) "I can't wait to stop taking this C
Answer: 3
Patients with atrial fibrillation are at incredibly high risk for clots, even with anticoagulation therapy. Shortness of breath could indicate a PE, and this should be immediately investigated by the nurse. The patient should be NPO for at least 4 hr. prior to the procedure related to anesthesia use, but this is not as urgent of a concern. The patient should also withhold Digoxin therapy for 48 hours to ensure that, once cardioverted, NSR returns.
Which of the following signs and symptoms indicate pacemaker failure?
a) excessive thirst
b) prolonged hiccups
c) flushing of the skin
d) increased urine output
Answer: B
- prolonged hiccups indicate pacemaker failure. Other signs and symptoms of pacemaker failure are dysrhythmias, dizziness, faintness, chest pain, shortness of breath, increase or decrease in apical rate.
The nurse is providing discharge teaching to the client who has just received a pacemaker. Which of the following should the nurse include in the plan of care? SATA:
A) Use your cell phone on the opposite side of your pacemaker
B) You should avoid using a
Answer: A, C, D, and E. A cellphone should not be used near the pacemaker and it's best to keep the phone about half a foot away from the pacemaker. It is not necessary for the client to avoid using a microwave or other electrical devices. However, magnets should be kept away from the device. In order to prevent disruption of the leads after implantation (the most common complication), patients are often taught to limit activity on the affected side for awhile after implantation. Pulses are a good indicator of whether the pacemaker is supplying the body with enough cardiac output.