NURS 222 Chapter 28 Dysrhythmias Study Guide

Questions and Answers

What is the primary consequence of pulmonary arterial vasoconstriction in the context of severe COPD?

Right ventricular hypertrophy (correct)

Aneurysm formation

Left ventricular hypertrophy

Coronary artery disease

Which sign or symptom is NOT associated with cor pulmonale?

Cough with sputum (correct)

Ascites

JVD

Hepatomegaly

What indicates a potential air leak in a closed drainage system for a chest tube?

Excessive bubbling in the water-seal chamber (correct)

No bubbling in the water-seal chamber

Flat water level in the chamber

Recognizable tidaling

What should a nurse monitor for at the chest tube insertion site?

Signs of infection Signup and view all the answers

What is the role of CD4 T cells in the immune response affected by HIV?

Supporting both cell-mediated and antibody-mediated immunity Signup and view all the answers

Which statement about HIV and AIDS is accurate?

HIV can remain inactive in CD4 T cells Signup and view all the answers

What is a potential complication of diuretic use that can lead to digoxin toxicity?

Hypokalemia Signup and view all the answers

Which positioning strategy is effective for older adults experiencing heart failure?

Elevate head of bed Signup and view all the answers

Which of the following medication side effects should be monitored in patients with heart failure?

Elevated potassium levels Signup and view all the answers

What is a common problem associated with chronic diuretic use?

Dehydration Signup and view all the answers

Which symptom indicates mitral valve prolapse?

Blood regurgitation into the left atrium during systole Signup and view all the answers

What condition may result from excessive fluid loss due to diuretics?

Hypotension Signup and view all the answers

What should be closely monitored to avoid complications in older adults with heart failure?

Fluid intake and output Signup and view all the answers

Which medication class is associated with hyperkalemia in heart failure treatment?

ACE inhibitors Signup and view all the answers

What is a key focus area in the priority of care for heart failure patients?

Increasing gas exchange Signup and view all the answers

What can cause generalized weakness as a side effect in heart failure management?

Hypokalemia Signup and view all the answers

What characterizes the cough associated with left ventricular failure in its early stages?

Dry and nonproductive, often mistaken for asthma Signup and view all the answers

What is indicated by the presence of large quantities of frothy sputum that is pink or tan?

Acute decompensated heart failure with pulmonary edema Signup and view all the answers

Which of the following signs indicates decreased renal perfusion due to heart failure?

Oliguria and nocturia Signup and view all the answers

Which symptom is most likely associated with decreased brain perfusion in heart failure?

Dizziness and confusion Signup and view all the answers

What causes the SNS to release catecholamines in heart failure?

Decreased cardiac output and stroke volume Signup and view all the answers

What does pitting edema primarily indicate in a patient with right-sided heart failure?

Fluid retention from venous congestion Signup and view all the answers

What systemic clinical manifestation is associated with right-sided heart failure that can lead to weight gain?

Fluid retention and edema Signup and view all the answers

Which of the following symptoms would most likely appear in a patient with decreased cardiac output?

Fatigue and activity intolerance Signup and view all the answers

What is the normal resting heart rate range for a healthy adult?

60 to 100 bpm Signup and view all the answers

What is indicated by the presence of jugular venous distension (JVD) in a patient?

Systemic venous congestion Signup and view all the answers

Which characteristic is NOT true regarding the normal PR interval?

It may vary significantly depending on the heart's condition. Signup and view all the answers

Which of the following does not typically occur due to decreased perfusion in heart failure?

Enhanced renal function Signup and view all the answers

What heart rate defines sinus tachycardia?

100 to 180 bpm Signup and view all the answers

Which of the following signs or symptoms is typically associated with sinus tachycardia?

Dehydration Signup and view all the answers

What is the expected appearance of P waves in sinus tachycardia?

Normal and upright before each QRS Signup and view all the answers

When monitoring a patient with sinus tachycardia, how often should vital signs be assessed?

At least every 4 hours and as needed Signup and view all the answers

What is a potential complication of sinus tachycardia if it persists?

Decreased cardiac output Signup and view all the answers

What does a 'camel hump' appearance in the waveform indicate in a patient with rapid heart rates?

Merging of P waves and T waves Signup and view all the answers

Which of the following does NOT typically describe the rhythm of a patient with sinus tachycardia?

Variable intervals between heartbeats Signup and view all the answers

What is a common symptom experienced by individuals with a mitral valve issue?

Chest pain Signup and view all the answers

Which of the following is a known nursing intervention for patients with mitral valve disorders?

Implement dietary restrictions Signup and view all the answers

What is a primary characteristic of emphysema?

Overdistention of alveoli Signup and view all the answers

What risk factor is highlighted for patients to avoid complications related to endocarditis?

Safe oral hygiene practices Signup and view all the answers

Which symptom is particularly associated with chronic bronchitis?

Productive cough Signup and view all the answers

In patients with emphysema, which of the following occurs?

Chronic hypercapnia Signup and view all the answers

What is an expected physical characteristic in a person with advanced emphysema?

Barrel-shaped chest Signup and view all the answers

Which type of breathing is commonly associated with patients who have emphysema?

Pursed-lip breathing Signup and view all the answers

Which symptom is associated with chronic obstructive pulmonary disease (COPD) as a general condition?

Dyspnea Signup and view all the answers

What characterizes bronchitis as compared to emphysema?

Difficulty taking air in Signup and view all the answers

Study Notes

Dysrhythmias

Dysrhythmias, also known as arrhythmias, are abnormal heart rhythms that impair cardiac efficiency in pumping oxygenated blood.
Normal sinus rhythm (NSR) originates from the SA node with a resting heart rate of 60-100 bpm and a regular rhythm.
Key characteristics of NSR:
- P waves: upright, consistent in size and shape, precede each QRS complex.
- PR interval: 0.12 to 0.20 seconds.
- QRS complex: lasts 0.04–0.44 seconds.
- ST segment: should be on the baseline.
- QT interval: varies but generally up to 0.44 seconds.
- T waves: usually positive and less than 5 mm in height.

Sinus Tachycardia

Characterized by heart rates exceeding 100 bpm, typically not exceeding 180 bpm.
Regular rhythm with visible P waves before each QRS complex; P waves may merge with T waves at high rates.
PR interval is normal (0.12-0.20 seconds), and QRS complex remains under 0.12 seconds.
Symptoms include:
- Often asymptomatic; possible hypovolemia, dehydration, decreased urinary output, and blood pressure.
- Dry skin/mucous membranes, anginal pain, and palpitations.
Nursing interventions include vital signs monitoring and assessing for dysrhythmias.

Heart Failure Indicators

Left ventricular failure leads to decreased cardiac output, which can cause:
- Dry/hack cough mistaken for asthma or COPD; may produce large quantities of pink frothy sputum in acute decompensated heart failure.
- Pulmonary crackles indicate fluid accumulation; may not clear with coughing.
- Low oxygen saturation and potential presence of S3 or gallop sounds.
Right-sided heart failure symptoms include:
- JVD and peripheral edema, especially in feet and ankles, worsening with prolonged sitting or standing.
- Hepatomegaly and ascites, along with GI distress and weight gain due to fluid retention.
Key nursing activities: monitoring fluid status, daily weights, adherence to low sodium diets, and anxiety management.

Mitral Valve Prolapse

Occurs when mitral valve leaflets enlarge and prolapse into the left atrium during systole, which allows regurgitation of blood.
Commonly asymptomatic but can manifest as fatigue, chest pain, SOB, dizziness, syncope, and palpitations.
May result in a mid-systolic click and late systolic murmur.
Nursing interventions include dietary restrictions (avoid stimulants), smoking cessation, and infection risk minimization.

Chronic Obstructive Pulmonary Disease (COPD)

Symptoms include dyspnea, productive cough, wheezing, clubbing of fingers, and a barrel-shaped chest.
Pathophysiology involves lower airway disorders affecting airflow and gas exchange, mainly emphysema and bronchitis.
- Emphysema: Overdistended alveoli, difficulty exhaling, chronic hypercapnia, known as "pink puffers."
- Bronchitis: Hypersecretion of mucus, difficulty inhaling, inflammation resulting in cyanosis, referred to as "blue bloaters."
Cor pulmonale, a complication of severe COPD, may result in right ventricular hypertrophy and heart failure, presenting with symptoms like ascites and JVD.

Chest Tube Management

Closed drainage systems are standard, with nursing responsibilities including monitoring for effective drainage and assessing the patient's respiratory status.
Bubbling in the water-seal indicates air drainage; excessive bubbling suggests leaks while cessation could indicate blockage.
Tidaling indicates normal respiratory movement.
Nursing care includes:
- Regularly assessing lung sounds and breathing effectiveness.
- Inspecting the insertion site for infection or subcutaneous emphysema.
- Encouraging deep breathing and coughing with the use of incentive spirometry.

Human Immunodeficiency Virus (HIV)

HIV leads to the progressive depletion of CD4 T cells vital for immune defense against infections.
Understood as a retrovirus, it contains RNA and uses reverse transcriptase to convert RNA into DNA in host cells.
It transforms CD4 cells into virus-producing factories, ultimately disabling them.
Important distinction: all individuals with AIDS are HIV positive, but not all who have HIV develop AIDS.

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Description

This quiz focuses on Chapter 28 of the NURS 222 course, covering dysrhythmias, also known as arrhythmias. It includes key concepts of abnormal heart rhythms, the normal sinus rhythm, and their effects on the body's ability to pump oxygenated blood. Perfect for exam preparation and understanding cardiac electrical systems.