Cardiology Chapter 22 Flashcards

Questions and Answers

What should a client with an automatic implanted cardiac defibrillator use instead of digital cellular telephones?

Analog cellular telephones (correct)

Satellite phones

Landline phones

Smartphones

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?

Document the findings and continue to monitor the client Signup and view all the answers

What are the side effects of vasopressor drugs?

Hypertension, dysrhythmias, pallor, and oliguria. Signup and view all the answers

It is necessary to place a client flat during or after vasopressor administration.

False Signup and view all the answers

What information is important to document when administering cholinergic antagonists?

Heart rate. Signup and view all the answers

What is the expected condition during electrophysiology (EP) studies for treatment of atrial tachycardia?

The client is awake and may experience symptoms related to the dysrhythmia. Signup and view all the answers

What is meant by a ventricular bigeminy cardiac rhythm?

The rhythm has a normal beat, then a premature beat pattern. Signup and view all the answers

What procedure is recommended for a client with atrial fibrillation if drug therapies do not control the arrhythmia?

Elective cardioversion Signup and view all the answers

What medication is likely ordered for a client diagnosed with atrial fibrillation persisting for more than 48 hours?

Heparin Signup and view all the answers

What action should the nurse take for a client with symptoms of sinus tachycardia?

Question the client about alcohol and illicit drug use. Signup and view all the answers

What is the primary goal of treatment for a patient in atrial fibrillation with a ventricular response of 166 beats/min?

Control ventricular rate. Signup and view all the answers

What ECG characteristic is commonly associated with a serum potassium level of 6.6 mEq/L?

Peaked T waves Signup and view all the answers

Which procedure could be used to treat a client with an atrial dysrhythmia?

Elective electrical cardioversion Signup and view all the answers

Which ECG waveform characterizes conduction through the left ventricle?

QRS complex Signup and view all the answers

Cardioversion should occur during the T wave.

False Signup and view all the answers

What is true regarding sinus arrhythmia?

The heart rate increases during inspiration and decreases during expiration. Signup and view all the answers

What is a common instruction for a client with an implanted pacemaker?

Avoid devices with a magnetic field. Signup and view all the answers

Which heart rhythm occurs when the atrial and ventricular rhythms are both regular, but independent of each other?

Third-degree atrioventricular (AV) heart block Signup and view all the answers

For which client does the nurse anticipate cardioversion as a possible medical treatment?

A client with atrial arrhythmias Signup and view all the answers

What is the most likely medication the nurse will administer to a client with second-degree atrioventricular block, Type I with symptomatic bradycardia?

Atropine sulfate Signup and view all the answers

What should the nurse document about the pacemaker in a patient with a permanent pacemaker?

Pacer rate Signup and view all the answers

After a client reports heart palpitations, what should the nurse instruct the client to avoid?

Avoid caffeinated beverages Signup and view all the answers

What client statement indicates the client requires more teaching about fast heart rates?

I will drink coffee with only two of my meals. Signup and view all the answers

Which client statement indicates effective teaching about an implantable cardioverter defibrillator (ICD)?

I'll keep a log of each time my ICD discharges. Signup and view all the answers

A pacemaker is the treatment of choice for which cardiac arrhythmia?

Complete heart block Signup and view all the answers

What disorder might be indicated by a heart rate of 210 beats/minute and a sawtooth waveform pattern on cardiac monitor?

Atrial flutter Signup and view all the answers

What is the nurse's first response upon seeing a flat line on a continuous telemetry monitor?

Assess the client and monitor leads. Signup and view all the answers

How can a nursing student differentiate between ventricular tachycardia and ventricular fibrillation?

Ventricular fibrillation is irregular with undulating waves and no QRS complex; ventricular tachycardia is usually regular and fast with wide QRS complexes. Signup and view all the answers

What important procedure should a client with dysrhythmia be taught to monitor their response to treatment?

Technique for palpating and counting the radial pulse. Signup and view all the answers

What heart rate on an electrocardiogram would indicate sinus bradycardia?

Heart rate of 42 beats per minute (bpm). Signup and view all the answers

What is a key safety precaution to communicate to a client after a permanent pacemaker insertion?

Avoid undergoing magnetic resonance imaging (MRI). Signup and view all the answers

If a client counts 9 RR intervals on a 6-second rhythm tracing, what is their heart rate?

90 bpm. Signup and view all the answers

What ECG characteristics define atrial fibrillation?

Atrial rate of 300 to 400. Signup and view all the answers

What is the treatment of choice for a client who is pulseless and unresponsive?

Immediate defibrillation. Signup and view all the answers

What is the best advice for a client who plays tennis a week after receiving a permanent pacemaker?

You will need to cancel this activity; you must restrict arm movement above your head for 2 weeks. Signup and view all the answers

What should a nurse do when noticing an absence of spikes from a fixed-rate pacemaker?

Double-check the monitoring equipment. Signup and view all the answers

What characteristic indicates a normal sinus rhythm?

The sinoatrial (SA) node initiates the impulse. Signup and view all the answers

What action should a nurse take after calling for assistance when a client shows signs of ventricular fibrillation?

Begin cardiopulmonary resuscitation (CPR). Signup and view all the answers

What rhythm does the nurse anticipate viewing in a patient with chest pain after cocaine use?

Sinus tachycardia Signup and view all the answers

Which medication is indicated for a client with newly diagnosed atrial fibrillation to prevent atrial thrombi?

Warfarin Signup and view all the answers

Which statement is correct regarding defibrillation?

It is used to eliminate ventricular arrhythmias. Signup and view all the answers

Which of the following is a potential cause of premature ventricular complexes (PVCs)?

Hypovolemia Signup and view all the answers

What is the nurse's best response to a client concerned about sexual activity after receiving an implantable cardioverter defibrillator (ICD)?

You seem apprehensive about resuming sexual activity. Signup and view all the answers

What is the PR interval for a normal sinus rhythm?

0.12 and 0.2 seconds. Signup and view all the answers

How does the nurse interpret a rhythm with a regular ventricular rate of 82 beats/min and 'sawtooth' P waves?

Atrial flutter Signup and view all the answers

What is the only difference between sinus rhythm and sinus bradycardia?

The heart rate. Signup and view all the answers

What should the nurse shout before pressing the discharge button on a defibrillator?

Clear! Signup and view all the answers

Which statement indicates a need for additional teaching regarding caffeine for a client with mitral valve prolapse?

I can still drink coffee and tea. Signup and view all the answers

Which equipment should be placed in a room for a client with ventricular arrhythmias?

A defibrillator Signup and view all the answers

Which medication classification is expected when caring for a client with atrial fibrillation?

Anticoagulant Signup and view all the answers

Implanted cardioverter defibrillators (ICD) are used in which clients?

Clients with recurrent life-threatening tachydysrhythmias Signup and view all the answers

What is the therapeutic effect of atenolol in treating hypertension?

Decreased cardiac output and decreased systolic and diastolic blood pressure Signup and view all the answers

What PR interval indicates a first-degree heart block?

0.24 seconds Signup and view all the answers

What condition might a healthy adult experience when stating, 'Occasionally, my heart skips a beat'?

Premature atrial contraction Signup and view all the answers

What is indicated by the presence of continuous hiccups in a patient who has had a permanent pacemaker inserted?

Lead wire dislodgement. Signup and view all the answers

What instructional guideline must be provided to a client with a permanent pacemaker?

Avoid sources of electrical interference. Signup and view all the answers

What is the initial nursing intervention for a client with second-degree heart block, Mobitz Type 1?

Administer an IV bolus of atropine. Signup and view all the answers

Which dysrhythmia is characterized by an atrial rate between 250 and 400 with saw-toothed P waves?

Atrial flutter Signup and view all the answers

Which statement by a client with an ICD indicates further teaching is required?

I need to take a cardiopulmonary resuscitation (CPR) class now that I have an ICD. Signup and view all the answers

What does telemetry do in a coronary care unit?

The small box will transmit the heart rhythm to the central monitor all the time. Signup and view all the answers

What causes the heart to be an effective pump?

Inherent rhythmicity of cardiac muscle tissue. Signup and view all the answers

What characteristic indicates a client has a permanent pacemaker?

Spike on the rhythm strip. Signup and view all the answers

Which is not a likely origination point for cardiac arrhythmias?

Bundle of His Signup and view all the answers

What characterizes a first-degree atrioventricular (AV) block?

Delayed conduction, producing a prolonged PR interval. Signup and view all the answers

What must a nurse do when administering prescribed vasopressors to a client with a cardiac dysrhythmia?

Monitor vital signs and cardiac rhythm. Signup and view all the answers

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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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.