Questions and Answers
Based on the assessments, what action would the nurse take?
For which physiological alterations would the nurse assess in a client with congestive heart failure and a heart rate of 128 beats/min? (Select all that apply)
Which instructions would the nurse include in teaching a client with a new permanent pacemaker? (Select all that apply)
Which education would the nurse include for a client who has premature ectopic beats? (Select all that apply)
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How would the nurse interpret the observation that not all QRS complexes are preceded by a P wave?
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Which activity modification would the nurse suggest to avoid further slowing of the heart rate in a client with an average heart rate of 56 beats/min?
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Which client would the nurse identify as being at greatest risk for atrial fibrillation?
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Which manifestation would alert the nurse to the possibility of a serious complication from a client with atrial fibrillation?
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Which medication would the nurse expect to find on a client’s medication administration record to prevent a common complication of chronic atrial fibrillation?
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Which response would the nurse assess for as the expected therapeutic response after administering prescribed adenosine?
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Which assessment would the nurse complete next for a client who has a heart rate of 35 beats/min?
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What action would the nurse take next if a pacing spike is observed without a QRS complex on a client's ECG?
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Which intervention is appropriate for the nurse to perform prior to defibrillating a client in ventricular fibrillation?
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Which statement by a client with an implantable cardioverter-defibrillator (ICD) indicates correct understanding of the teaching?
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Which intervention would the nurse implement for a client with atrial fibrillation who reports fatigue during daily activities?
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What action would the nurse take prior to the cardioversion of a client experiencing acute atrial fibrillation?
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What priority information should be communicated to the home health nurse upon the discharge of a client with a cardiac dysrhythmia?
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Which clinical manifestation requires immediate intervention by a nurse caring for a client with tachycardia?
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Which statement would the nurse include in the teaching for a client experiencing occasional premature atrial contractions (PACs)?
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What puts clients who use cocaine at risk?
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What should the nurse provide to the assistive personnel (AP) related to electrocardiographic monitoring?
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How should the nurse document a client's ECG strip that shows sinus rhythm with premature ventricular contractions (PVCs)?
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What action would the nurse take first for a client on a cardiac monitor with a rhythm showing ventricular tachycardia?
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What action would the nurse take first for a 75-year-old client with chronic diseases presenting bradycardia?
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After calling for assistance for an unresponsive client with no pulse, what action would the nurse take next?
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Study Notes
Dysrhythmias Overview
- Electrocardiogram (ECG) with missing P waves before QRS complexes suggests independent depolarization sites for ventricles and atria.
- Bradycardia (heart rate <60 beats/min) can be exacerbated by activities like straining during bowel movements.
- A history of cardiac surgery increases the risk for atrial fibrillation, particularly in older patients.
Atrial Fibrillation
- Atrial fibrillation can lead to embolic strokes indicated by alterations in speech and mentation.
- Anticoagulants like warfarin are essential for preventing embolic events associated with atrial fibrillation.
- Fatigue during daily activities in atrial fibrillation patients may be managed by scheduling rest and exercise periods.
Emergency Care and Interventions
- Adenosine administration may result in a brief asystole period; monitoring response is vital.
- Clients with a heart rate of 35 beats/min should be assessed for consciousness due to risks of inadequate cerebral perfusion.
- Loss of capture in temporary pacemakers requires immediate assessment of vital signs and consciousness.
Defibrillation and Cardioversion
- Prior to defibrillation in ventricular fibrillation, ensure all personnel are clear to prevent injury.
- Ongoing monitoring includes assessing airway, breathing, and circulation first in emergency situations.
- Cardioversion procedures require stopping oxygen therapy to prevent fire risks during the procedure.
Communication and Education
- Discharging clients with cardiac dysrhythmias necessitates sharing medication orders with home health nurses for continuity of care.
- Lifestyle changes, such as reducing caffeine intake, help manage occasional premature atrial contractions (PACs).
- Clients with implantable cardioverter-defibrillators (ICD) should avoid strong electromagnetic fields to ensure device functionality.
Drug Effects and Monitoring
- Amiodarone can lead to bradycardia; therefore, infusions should be slowed if bradycardia symptoms arise without further complications.
- Ventricular tachycardia is a serious condition that may warrant CPR if unresponsive, requiring quick response to maintain circulation.
- Understanding the client's medication history is essential in evaluating causes of bradycardia, especially in older patients with multiple chronic conditions.### Assessment of Physiologic Alterations
- Decrease in cardiac output and blood pressure, along with urine output, are key indicators in patients with conditions like congestive heart failure or chronic tachycardia.
- Elevated heart rates can initially increase blood pressure and cardiac output, but prolonged conditions may reverse this effect.
- As cardiac output and blood pressure fall, urine output also declines, highlighting the interplay between these physiological parameters.
Teaching for Clients with Permanent Pacemakers
- Patients should avoid submerging their pacemaker in water until the incision is fully healed, allowing only showers.
- It is crucial for clients to report any pulse rates that fall below the settings of their pacemaker, emphasizing the device's role in maintaining heart rhythm.
- Physical activity restrictions are advised for 8 weeks post-implantation to promote proper healing and stabilization of the pacemaker.
- Patients must be informed about the dangers of MRI procedures due to the presence of metal components in the pacemaker, which can result in complications.
Education for Clients with Premature Ectopic Beats
- Smoking cessation is essential as it can exacerbate arrhythmias and overall cardiac health.
- Effective stress management techniques should be taught to mitigate triggers that can lead to premature beats.
- Patients should be instructed on the importance of adhering to prescribed medications and to be vigilant about reporting any adverse effects.
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Description
Test your knowledge on the assessment and interpretation of electrocardiograph tracings in patients with dysrhythmias. This quiz focuses on key concepts from Chapter 31, challenging you to apply nursing knowledge to clinical scenarios. Ideal for nursing students and professionals looking to enhance their understanding of cardiac care.
