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Questions and Answers
What should a client with an automatic implanted cardiac defibrillator use instead of digital cellular telephones?
Microwave ovens are safe for clients with an automatic implanted cardiac defibrillator.
True
What is the term used when the appropriate electrocardiogram (ECG) complex follows the pacing spike?
captured
What is the best response for a nurse evaluating a client with a temporary pacemaker, showing each P wave followed by the pacing spike?
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What are the side effects of vasopressor drugs?
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It is necessary to place a client flat during or after vasopressor administration.
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What information is important to document when administering cholinergic antagonists?
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What is the expected condition during electrophysiology (EP) studies for treatment of atrial tachycardia?
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What is meant by a ventricular bigeminy cardiac rhythm?
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What procedure is recommended for a client with atrial fibrillation if drug therapies do not control the arrhythmia?
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What medication is likely ordered for a client diagnosed with atrial fibrillation persisting for more than 48 hours?
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What action should the nurse take for a client with symptoms of sinus tachycardia?
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What is the primary goal of treatment for a patient in atrial fibrillation with a ventricular response of 166 beats/min?
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What ECG characteristic is commonly associated with a serum potassium level of 6.6 mEq/L?
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Which procedure could be used to treat a client with an atrial dysrhythmia?
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Which ECG waveform characterizes conduction through the left ventricle?
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Cardioversion should occur during the T wave.
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What is true regarding sinus arrhythmia?
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What is a common instruction for a client with an implanted pacemaker?
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Which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other?
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For which client does the nurse anticipate cardioversion as a possible medical treatment?
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What is the most likely medication the nurse will administer to a client with second-degree atrioventricular block, Type I with symptomatic bradycardia?
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What should the nurse document about the pacemaker in a patient with a permanent pacemaker?
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After a client reports heart palpitations, what should the nurse instruct the client to avoid?
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What client statement indicates the client requires more teaching about fast heart rates?
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Which client statement indicates effective teaching about an implantable cardioverter defibrillator (ICD)?
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A pacemaker is the treatment of choice for which cardiac arrhythmia?
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What disorder might be indicated by a heart rate of 210 beats/minute and a sawtooth waveform pattern on cardiac monitor?
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What is the nurse's first response upon seeing a flat line on a continuous telemetry monitor?
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How can a nursing student differentiate between ventricular tachycardia and ventricular fibrillation?
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What important procedure should a client with dysrhythmia be taught to monitor their response to treatment?
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What heart rate on an electrocardiogram would indicate sinus bradycardia?
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What is a key safety precaution to communicate to a client after a permanent pacemaker insertion?
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If a client counts 9 RR intervals on a 6-second rhythm tracing, what is their heart rate?
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What ECG characteristics define atrial fibrillation?
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What is the treatment of choice for a client who is pulseless and unresponsive?
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What is the best advice for a client who plays tennis a week after receiving a permanent pacemaker?
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What should a nurse do when noticing an absence of spikes from a fixed-rate pacemaker?
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What characteristic indicates a normal sinus rhythm?
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What action should a nurse take after calling for assistance when a client shows signs of ventricular fibrillation?
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What rhythm does the nurse anticipate viewing in a patient with chest pain after cocaine use?
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Which medication is indicated for a client with newly diagnosed atrial fibrillation to prevent atrial thrombi?
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Which statement is correct regarding defibrillation?
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Which of the following is a potential cause of premature ventricular complexes (PVCs)?
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What is the nurse's best response to a client concerned about sexual activity after receiving an implantable cardioverter defibrillator (ICD)?
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What is the PR interval for a normal sinus rhythm?
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How does the nurse interpret a rhythm with a regular ventricular rate of 82 beats/min and 'sawtooth' P waves?
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What is the only difference between sinus rhythm and sinus bradycardia?
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What should the nurse shout before pressing the discharge button on a defibrillator?
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Which statement indicates a need for additional teaching regarding caffeine for a client with mitral valve prolapse?
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Which equipment should be placed in a room for a client with ventricular arrhythmias?
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Which medication classification is expected when caring for a client with atrial fibrillation?
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Implanted cardioverter defibrillators (ICD) are used in which clients?
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What is the therapeutic effect of atenolol in treating hypertension?
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What PR interval indicates a first-degree heart block?
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What condition might a healthy adult experience when stating, 'Occasionally, my heart skips a beat'?
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What is indicated by the presence of continuous hiccups in a patient who has had a permanent pacemaker inserted?
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What instructional guideline must be provided to a client with a permanent pacemaker?
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What is the initial nursing intervention for a client with second-degree heart block, Mobitz Type 1?
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Which dysrhythmia is characterized by an atrial rate between 250 and 400 with saw-toothed P waves?
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Which statement by a client with an ICD indicates further teaching is required?
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What does telemetry do in a coronary care unit?
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What causes the heart to be an effective pump?
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What characteristic indicates a client has a permanent pacemaker?
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Which is not a likely origination point for cardiac arrhythmias?
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What characterizes a first-degree atrioventricular (AV) block?
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What must a nurse do when administering prescribed vasopressors to a client with a cardiac dysrhythmia?
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Study Notes
Heart Block and Arrhythmias
- Third-degree AV heart block results in independent atrial and ventricular contractions, affecting cardiac output.
- Second-degree AV block allows some atrial impulses through the AV node to the ventricles, while first-degree AV block shows delayed conduction.
- Asystole indicates a complete absence of electrical activity in the heart.
Cardioversion and Treatment Indications
- Cardioversion is indicated for clients with atrial arrhythmias to restore normal heart rhythm.
- Myocardial infarction patients generally require different interventions due to tissue damage.
- Clients with bradycardia in second-degree AV block may be treated with atropine sulfate to counteract vagal stimulation.
Pacemaker Management
- Vital signs should monitor the pacer rate post-insertion, ensuring the heart rate aligns with the set parameters.
- Pacemakers are crucial for treating complete heart block, while other arrhythmias may require alternative treatments.
Premature Atrial Complexes (PACs)
- Clients experiencing PACs should avoid caffeine, as it may trigger the arrhythmia.
- Non-invasive measures should be taken if PACs are infrequent with no direct medical interventions required.
Educating Patients on Heart Rate Management
- Patients should understand that elimination of stimulants like caffeine and smoking can help control heart rates.
- Teaching patients about the effects of medications like metoprolol helps maintain a normal heart rate despite potentially harmful habits.
Implantable Cardioverter Defibrillator (ICD) Guidelines
- Keeping a log of ICD discharges helps in tracking arrhythmia patterns effectively for patient and healthcare coordination.
- Clients with ICDs should avoid contact sports and extreme magnetic fields to protect device integrity.
Electrocardiogram (ECG) Interpretation
- Atrial flutter is recognized by a ventricular rate lagging behind an excessively rapid atrial rate, depicted as a sawtooth pattern on ECG.
- Ventricular fibrillation is identified by erratic waveforms with no identifiable QRS complexes on the ECG.
Cardiac Emergency Responses
- Assessing patients before initiating CPR or defibrillation is essential to understand underlying conditions that may simulate asystole.
- Immediate defibrillation is crucial in emergencies like pulseless ventricular tachycardia.
Sinus Rhythm Characteristics
- Normal sinus rhythm is characterized by a heart rate of 60-100 bpm, with the SA node initiating impulses and a normal PR interval duration.
Discharge Instructions Post-Pacemaker
- Patients must avoid overhead arm movements post-pacemaker insertion to prevent lead dislodgment during the healing phase.
- Routine activities can usually resume after two weeks, emphasizing the need for caution against vigorous activities.
Atrial Fibrillation and Anticoagulation
- Warfarin is used post-cardioversion in atrial fibrillation patients to prevent thrombus formation due to impaired atrial function.
Causes of Arrhythmias
- Hypokalemia is a significant risk factor for PVCs, alongside stressors like cardiac ischemia and increased heart workload.
Emotional Impact of Cardiac Devices
- Emotional support is vital for clients adjusting to life with devices like ICDs, adding to their physical and psychological well-being.### ECG and Cardiac Rhythms
- A normal PR interval in sinus rhythm is between 0.12 and 0.2 seconds, indicating healthy conduction through the AV node.
- Atrial flutter features a regular atrial rate between 250 and 400 beats per minute, with characteristic "sawtooth" P waves.
- Sinus bradycardia is defined by a heart rate below 60 beats per minute, while characteristics otherwise match normal sinus rhythm.
- Before defibrillation, it's essential to shout "Clear!" to ensure safety for those in the vicinity.
Client Education and Interventions
- Clients with mitral valve prolapse should avoid caffeine to prevent exacerbating palpitations.
- Continuous monitoring for patients with ventricular arrhythmias includes having a defibrillator readily available.
- Anticoagulant therapy is crucial for clients with atrial fibrillation to prevent emboli formation.
- A permanent pacemaker is indicated for clients with recurrent life-threatening tachydysrhythmias.
Medications and Therapeutic Effects
- Atenolol decreases cardiac output and blood pressure while beta blockers generally increase peripheral resistance.
- In first-degree heart block, the PR interval exceeds 0.20 seconds due to delayed conduction through the AV node.
- After placement of an implantable cardioverter defibrillator (ICD), clients do not need CPR training, but family members should be informed.
Rhythm Identification
- Atrial flutter can be recognized by sawtooth P waves and rapid atrial rates, distinct from atrial fibrillation's disorganized activity.
- The presence of a "spike" on the ECG strip confirms a client has a permanent pacemaker.
- Cardiac arrhythmias can originate from the atria, ventricles, or AV node but not from the bundle of His.
Monitoring and Nursing Actions
- Monitoring vital signs and cardiac rhythm is vital when administering vasopressors for dysrhythmias.
- Electrophysiology studies involve reproducing the dysrhythmia under controlled conditions to assess and potentially treat it.
- Bigeminy rhythms consist of alternating normal and premature ventricular contractions, illustrating irregularity in rhythm patterns.
Additional Notes
- Elective cardioversion is recommended for persistent atrial fibrillation if medications fail, while defibrillation is reserved for immediate life-threatening rhythms.
- Heparin is often prescribed for atrial fibrillation lasting longer than 48 hours to mitigate clot formation risks.
- Clients exhibiting tachycardia with restlessness and dilated pupils may indicate substance use, necessitating further assessment regarding drugs or alcohol.### Tachycardia Treatment and Causes
- Tachycardia can result from sympathetic stimulation, certain medications, stimulants, or illicit drugs.
- Treatment goals focus on identifying and removing the cause, with symptom severity guiding interventions.
Atrial Fibrillation Management
- A patient transitioned from sinus rhythm to atrial fibrillation with a rate of 166 beats/min.
- Primary treatment goal: Control ventricular rate by managing anticoagulation and rhythm.
- Initial treatment includes rhythm control, followed by anticoagulation with heparin, and later Coumadin.
Holter Monitor Interpretations
- An elevated heart rate above 105 beats/min in a healthy heart can be caused by fever, strenuous exercise, or shock.
Dilated Cardiomyopathy Interventions
- Frequent ventricular fibrillation episodes may require an internal cardioverter defibrillator (ICD) insertion for termination.
- Radiofrequency ablation can also be utilized but primarily targets irregular heartbeats.
Atrial Flutter Characteristics
- Atrial flutter features an atrial rate between 250 and 400 beats/min with distinct saw-toothed P waves.
PR Interval Significance
- The PR interval measures the time from sinus node stimulation through AV node conduction, indicating normal heart function.
ECG Changes with High Potassium Levels
- A serum potassium level of 6.6 mEq/L is associated with peaked T waves on ECG, indicating ventricular repolarization issues.
Cardioversion Procedure Explanation
- Elective electrical cardioversion is a procedure to correct rapid non-life-threatening atrial dysrhythmias.
- It involves delivering a timed electrical impulse to restore normal heart rhythm without destroying myocardial cells.
Nursing Interventions for Cardioversion
- Patients must restrict food and oral intake prior to elective electrical cardioversion to prevent complications.
Pacemaker Monitoring
- A reported pulse lower than the pacemaker's set rate may indicate malfunction; immediate assessment is necessary.
- All significant changes in heart rate warrant clinical evaluation.
PVC Patterns
- Bigeminy refers to a pattern where every other beat is a PVC and should be correctly documented.
Sinus Arrhythmia Recognition
- Sinus arrhythmia is characterized by heart rate variations with breathing but maintains normal sinus rhythm otherwise.
Patient Education for Defibrillator Recipients
- Clients should avoid devices with strong magnetic fields and prefer analog cellular phones to prevent interference with the implanted device.
Pacemaker Functionality Verification
- Capture indicates appropriate response from the pacemaker when the ECG complex follows the pacing spike; this requires ongoing monitoring.
Nursing Response to ECG Findings with Pacemaker
- Documenting findings and monitoring are sufficient when pacing is appropriate, showing each P wave followed by a pacing spike.
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Description
Test your knowledge on the management of patients with arrhythmias and conduction problems. This quiz includes key terms and definitions related to various heart rhythms, including the differences between heart blocks. Perfect for nursing students or healthcare professionals.