What does stimulation of the sympathetic nervous system produce?
Contractility and dilation of coronary vessels and increased heart rate.
The primary pacemaker of the heart, the sinoatrial (SA) node, is functional if a patient's pulse is at what regular rate?
60 to 100 beats/min
The nurse is taking vital signs and reviewing the electrocardiogram (ECG) of a patient who is training for a marathon. The heart rate is 45 beats/min and the ECG shows sinus bradycardia. How does the nurse interpret this data?
An adequate stroke volume that is associated with cardiac conditioning
The nurse is performing the shift assessment on a cardiac patient. In order to determine if the patient has a pulse deficit, what does the nurse do?
Assess the apical and radial pulses for a full minute and observe for differences.
What does the P wave in an ECG represent?
Atrial depolorization
What is the normal measurement of the PR interval in an ECG?
0.12 to 0.20 second
What is the QRS complex in an ECG normally?
Less than 0.12 second
What is the ST segment in an ECG normally?
Isoelectric
What is the total time required for ventricular depolarization and repolarization as represented on the ECG?
QT interval
The nurse is performing a 12-lead ECG on a patient with chest pain. Because the positioning of the electrodes is crucial, how does the nurse place the ECG components?
Four leads are placed on the limbs and six are places on the chest
Cardiac dysrhythmias are abnormal rhythms of the heart's electrical system. How does this affect the heart's function?
It cannot effectively pump oxygenated blood throughout the body
The nurse is caring for several patients in the telemetry unit who are being remotely watched by a monitor technician. What is the nurse's primary responsibility in the monitoring process of these patients?
Assessment and management
A patient in the telemetry unit is having continuous ECG monitoring. The patient is scheduled for a test in the radiology department. Who is responsible for determining when monitoring can be suspended?
Health care provider
The nurse is reviewing preliminary ECG results of a patient admitted for mental status changes. The nurse alerts the health care provider about ST elevation or depression in the patient because it is an indication of which condition?
Myocardial injury or ischemia
The nurse is reviewing ECG results of a patient admitted for fluid and electrolyte imbalances. The T waves are tall and peaked. The nurse reports this finding to the provider and obtains an order for which serum level tests?
Potassium
Which actions are the responsibilities of the monitor tech? (SATA)
Watch the bank of monitors on a unit
Print routine ECG strips
Interpret the rhythms
The nurse is notified by the telemetry monitor technician about a patient's heart rate. Which method does the nurse use to confirm the technician's report?
Assess the patient's heart rate directly by taking an apical pulse
A patient's ECG rhythm strip is irregular. Which method does the nurse use for an accurate assessment?
6-second strip method
The nurse is assessing a patient's ECG rhythm strip and checking the regularity of the atrial rhythm. What is the correct technique?
Place one caliper point on a P wave; place the other point on the precise spot on the next P Wave
The nurse is assessing a patient's ECG rhythm strip and analyzing the P waves. Which questions does the nurse use to evaluate the P waves? (SATA)
Are P waves present?
Are the P waves occurring regularly?
Do all the P waves look similar?
Are the P waves smooth, rounded, and upright in appearance?
The nurse is assessing a patient's ECG rhythm strip and notes that occasionally the QRS complex is missing. How does the nurse interpret this finding?
A dysrhythmia
The student nurse is looking at a patient's ECG rhythm strip and suspects a normal sinus rhythm (NSR). Which ECG criteria are included for NSR? (SATA)
Rhythm: Atrial and ventricular rhythms regular
P waves: Present, consistent configuration, one P wave before each QRS complex
QRS duration: 0.04 to 0.10 second and constant
The heart monitor of a patient shows a rhythm that appears as a wandering or fuzzy baseline. What is the priority action for the nurse?
Assess the patient to differentiate artifact from actual lethal rhythms
What does the T wave on an ECG represent?
Ventricular repolarization
The remote telemetry technician calls the nurse to report that a patient's ECG signal transmission is not very clear. What does the nurse do to enhance the transmission?
Ensure that the area for the electrode placement is dry and nonhairy
With the speed set for 25 mm/second, the segment between the dark lines on a monitor ECG strip represents how many seconds?
3
Which components measure ECG waveforms?
Amplitude (voltage) and duration (time)
What is the heart rate from an ECG strip when there are 25 small blocks from one R wave to the next R wave?
60/minute
How does the nurse interpret the measurement of the PR interval when the interval to be measured is six small boxes on the ECG strip?
a. Atrium is taking longer to repolarize
b. Longer-than-normal impulse time from the SA node to the ventricles is shown.
Longer than normal impulse time from the SA node to the ventricles is shown
What is the heart rate shown on a 6-second ECG strip when the number of R-R intervals is 5? What is this rhythm?
50/minute bradycardia
The nurse is reviewing a patient's ECG and interprets a wide distorted QRS complex of 0.14 second followed by a P wave. What does this finding indicate?
Premature ventricular contraction
Which clinical manifestations are reflections of sustained tachdysrhythmias and bradydysrhythmias? (select all that apply)
Weakness and fatigue
Dyspnea
Decreased urine output
Which dysrhythmia results in asynchrony of atrial contraction and decreased cardiac output?
Atrial fibrillation
Which dysrhythmia causes the ventricles to quiver, resulting in absence of cardiac output?
Ventricular fibrillation
The nurse hears in report that a patient has sinus arrhythmia. In order to validate that this is associated with the changes in intrathoracic pressure, what does the nurse do next?
Observe that the heart rate increases slightly during inspiration and decreases slightly during exhalation.
The nurse is caring for a patient with coronary artery disease (CAD). The patient reports palpitations and chest discomfort and the nurse notes a tachydysrhythmia on the EG monitor. What does the nurse do next?
Give supplemental oxygen
The nurse is taking the initial history and vital signs on a patient with fatigue. The nurse notes a regular apical pulse of 130 beats/min. Which contributing factors does the nurse assess for? (select all that apply)
Anxiety or stress
Fever
Hypovolemia
Anemia or hypoxemia
The nurse is taking a history and vital signs on a patient who has come to the clinic for a routine checkup. The patient has a pulse rate of 50 beats/min, but denies any distress. What does the nurse do next?
Check the blood pressure
The nurse is reviewing the monitored rhythms of several patients in the cardiac stepdown unit. The patient with which cardiac anomaly has the greatest need of immediate attention?
Sustained rapid ventricular response
A patient is diagnosed with recurrent SVT. What does the nurse do in order to accomplish the preferred treatment?
Provide information about radiofrequency catheter ablation therapy.
Based on the prevalence and risk factors for atrial fibrillation (AF), which patient group is at highest risk for AF?
a. Older adults
b. Diabetics
c. Substance abusers
d. Pediatric cardiology patients
Older adults
The patient has sustained SVT and the health care provider orders IV adnosine. Which important actions must the nurse perform when this drug is given? ( select all that apply)
Have emergency equipment at the bedside.
Follow the drug injection with a normal saline bolus.
Monitor the patient for bradycardia, nausea, and vomiting
What are the risk factors for AF? (select all that apply)
Hypertension
Valvular disease
A patient with AF suddenly develops shortness of breath, chest pain, hemoptysis, and a feeling of impending doom. The nurse recognizes these symptoms as which complication?
Pulmonary embolism
A patient scheduled to have elective cardioversion for AF will receive drug therapy for about 6 weeks before the procedure. What information about the drug therapy does the nurse teach the patient?
Watching for bleeding signs
The bedside cardiac monitor of a postoperative patient who becomes confused shows sinus rhythm, but there is no palpable pulse. How does the nurse interpret these findings?
Pulseless electrical activity with inadequate perfusion
The remote telemetry technician alerts the nurse to the presence of premature ventricular contractions (PVCs) in a newly admitted patient. How does the nurse assess whether the premature complexes perfuse to the extremities?
Palpate peripheral arteries while observing the monitor for widened complexes.
What is the primary significance of ventricular tachycardia (VT) in a cardiac patient?
It is commonly the initial rhythm before deterioration into ventricular fibrillation (VF)
The nurse is interviewing a patient who suddenly becomes faint, immediately loses consciousness, and becomes pulseless and apneic. There is no blood pressure, and heart sounds are absent. What does the nurse do next?
Begin compressions.
A patient is in full cardiac arrest and CPR is in progress. The ECG monitor shows ventricular asystole. What does the nurse do next?
Assess another ECG lead to ensure the rhythm is asystole and not fine VF
Traditionally, what medications will most likely be ordered for a patient with AF? (select all that apply)
Diltiazem hydrochloride (Cardizem)
Heparin
Enoxaparin (Lovenox)
Sodium warfarin (Coumadin)
A patient is diagnosed with torsades de pointes. The nurse prepares to administer which emergency medication?
Magnesium sulfate
In a patient's record, the nurse notes frequent episodes of bradycardia and hypotension related to unintended vagal stimulation. Which instruction for this patient's care does the nurse relay to the unlicensed assistive personnel (UAP)?
Avoid raising the patient's arms above the head during hygiene.
Excessive vagal simulation can result form which activities? (select all that apply)
Carotid sinus massage
Suctioning
Valsalva maneuver
The nurse is caring for several patients who have dysrhythmia. What does the nurse instruct these patients to do?
Learn the procedure for assessing the pulse.
A patient reports chest pain and dizziness after exertion, and the family reports a concurrent new onset of mild confusion in the patient, as well as difficulty concentrating. What is the priority problem for this patient?
Decreased cardiac output
According to the Vaughn-Williams classification of antidysrhythmics, which class II drug controls dysrhythmias associated with excessive beta-adrenergic stimulation?
Propranolol hydrochloride ( Inderal)
Which drug for symptomatic bradycardia does the nurse prepare to administer to a patient with bradydysrhythmia?
Atropine
Which medication does an adult patient with VG or pulseless VT receive?
Epinephrine (Adrenalin chloride)
The respiratory therapist (RT) and the medical student are ventilating a patient in cardiac arrest, while the nurse and provider are preparing the patient and equipment for intubation. At which point does the nurse intervene?
The medical student sets the oxygen flow meter at 2 L/min
After advanced cardiac life support (ACLS) is performed, a patient who experienced VF has a return of spontaneous circulation. To protect the patient's nervous system, which intervention does the nurse anticipate with be performed?
Application of a cooling blanket
The nurse discovers a patient is unconscious and without palpable pulses and immediately initiates CPR. For what reason is CPR started on this patient?
For the rapid return of a pulse, blood pressure, and consciousness
AED electrodes are placed on a patient who is unconscious and pulseless. The nurse prepares to immediately defibrillate if the monitor shows which cardiac anomaly?
VF
A patient is found pulseless and the cardiac monitor shows a rhythm that has no recognizable deflections, but instead has coarse "waves" of varying amplitudes. What is the priority ACLS intervention for this rhythm?
Immediate defibrillation
A patient has no pulse and the cardiac monitor shows VF. Which drugs does the nurse prepare to administer during the resuscitation? (select all that apply)
Lidocaine
Epinephrine
Amiodarone hydrochloride (Cordarone)
Magnesium sulfate
The nurse is placing the electrodes on a patient for cardioversion. What is the correct placement for the electrodes?
One electrode is placed to the left of the precordium, and the other is placed on the right next to the sternum and below the clavicle.
A patient is in VF. The nurse sets the biphasic defibrillator to deliver how many joules?
200
A patient is about to undergo elective cardioversion. The nurse sets the defibrillator for synchronized mode so that the electrical shock is not delivered on the T wave. This is done to avoid which complication?
VF
The nurse is performing external defibrillation. Which step is most vital in this procedure?
No-one must touch the patient at the time a shock is delivered
Which definition best describes the synchronous (demand) pacing mode?
The pacemaker's sensitivity is set to sense the patient's own beats
The nurse is assisting the provider to perform temporary pacing for a patient who has atropine-refractory symptomatic bradycardia. What is the desired outcome for this patient as evidenced by the cardiac monitor?
A spike followed by a QRS complex indicating ventricular depolarization
The provider has completed the placement of lead wires for the invasive temporary pace-maker in a patient who is asystolic. In turning on a pacing unit, which setting does the nurse use?
Asynchronous pacing mode
The nurse in the telemetry unit must perform transcutaneous pacing. How does the nurse position the electrodes?
One on the upper chest to the right of the sternum and one over the heart apex.
A patient has an invasive temporary pace-maker. In what ways does the nurse ensure the patient's safety related to electrical issues with the pacemaker? (select all that apply)
Ensure that external ends of the lead wires are insulated with rubber gloves.
Loop the wire ends and cover with non-conductive tape.
Report frayed wire to the biomedical engineering department.
What effects does dobutamine (Dobutrex) have on the heart? (select all that apply)
Stimulates beta-adrenergic receptors
Improves myocardial contractility
May cause dysrhythmias
Which descriptions are characteristic of a class III antidysrhythmic? (select all that apply)t
Lengthens the absolute refractory period
Prolongs repolarization
Includes bradycardia as a side effect
A patient has an implantable cardioverter defibrillator (ICD). In cardioversion shock, the defibrillator is set in the synchronized mode to do what?
Avoid discharging the shock during the T wave
A patient with atrial fibrillation is scheduled to have an elective cardioversion. The nurse ensures that the patient has a prescription for 4-6 week supply of which ytpe of medication?
Anticoagulants
The nurse is teaching a patient with an ICD. What instruction does the nurse emphasize to the patient?
Expect that the shock may feel like a thud or a painful kick in the chest.
A patient has had synchronized cardioversion for unstable VT. Which interventions does the nurse include in the patient's care after the procedure? (select all that apply)
Assess vital signs and the level of consciousness.
Administer antidysrhythmic drug therapy
Monitor for dysrhthmias
Assess for chest burns from electrodes
The nurse is teaching a community group how to use an AED. What is the first step for using the AED that the nurse teaches?
Place the patient on a firm, dry surface
A patient has had a permanent pacemaker surgically implanted. What are the nursing responsibilities for the care of this patient related to the surgery? (select all that apply)
Assess the implantation site for bleeding
Teach about and monitor for the initial activity restrictions
Monitor the ECG rhythm to check that the pacemaker is working correctly
The nurse is interviewing a patient with spontaneous VT who may be a possible candidate for an ICD. The nurse senses that the patient is anxious. What is the nurse's most therapeutic response?
You seem anxious. What are your concerns about having this treatment?
The nurse is teaching a patient with a permanent pacemaker. What information about the pacemaker does the nurse tell the patient? (select all that apply)
Report any pulse rate lower than what is set on the pacemaker.
Keep handheld cellular phones at least 6 inches away from the generator.
Avoid sources of strong electro magnetic fields, such as magnets.
Carry a pacemaker identification card and wear a medi