NURS 222 Exam #1 Study Guide: Dysrhythmias

Questions and Answers

What is the normal range for resting heart rate in Normal Sinus Rhythm?

120 to 140 bpm

100 to 120 bpm

40 to 60 bpm

60 to 100 bpm (correct)

What distinguishes a PR interval in a normal ECG reading?

It should be between 0.12 and 0.20 seconds (correct)

It should be greater than 0.20 seconds

It should vary significantly

It should be less than 0.12 seconds

During sinus tachycardia, what is the maximum expected heart rate?

60 bpm

180 bpm (correct)

100 bpm

200 bpm

Which symptom is NOT typically associated with sinus tachycardia?

Bradycardia Signup and view all the answers

What change may occur to P waves at very fast rates during sinus tachycardia?

They merge with T waves Signup and view all the answers

What is the significance of the QRS complex being less than 0.12 seconds in sinus tachycardia?

It shows normal conduction through the ventricles Signup and view all the answers

What assessment should be done for patients experiencing sinus tachycardia?

Assess vital signs at least every 4 hours Signup and view all the answers

Which of the following is a characteristic of Normal Sinus Rhythm?

Upright P waves present before QRS complex Signup and view all the answers

What height should the T wave generally be in a normal ECG?

Less than 5 mm Signup and view all the answers

What is one of the primary physiological consequences of cor pulmonale due to severe COPD?

Right ventricular hypertrophy Signup and view all the answers

Which sign is NOT typically associated with cor pulmonale?

Increased oxygen saturation Signup and view all the answers

What indicates that an air leak is occurring in the chest tube drainage system?

Excessive bubbling in the water-seal chamber Signup and view all the answers

What is the role of reverse transcriptase in the HIV virus?

To convert viral RNA into DNA Signup and view all the answers

Which of the following statements is true regarding the relationship between HIV and AIDS?

Not everyone with HIV has AIDS Signup and view all the answers

In the management of a chest tube system, which of the following is crucial for patient care?

Assessing for pain and assisting with deep breathing Signup and view all the answers

What symptom is commonly reported by some individuals with mitral valve issues?

Dizziness Signup and view all the answers

Which dietary restriction is recommended for patients with mitral valve problems?

Epinephrine Signup and view all the answers

What is a primary characteristic of bronchitis compared to emphysema?

Hypersecretion of mucus Signup and view all the answers

What condition is commonly associated with a 'BLUE BLOATER' phenotype?

Bronchitis Signup and view all the answers

What symptom is NOT typically associated with chronic obstructive pulmonary disease?

Mid systolic click Signup and view all the answers

What is a common risk factor for developing endocarditis in patients with mitral valve problems?

Tattooing Signup and view all the answers

Which of the following symptoms is characteristic of emphysema?

Chronic hypercapnia Signup and view all the answers

What is a recommendation for patients with a tendency toward infection in relation to personal care?

Practice safe oral hygiene Signup and view all the answers

What is the primary impact of chronic bronchitis on airflow?

Difficulty taking air in Signup and view all the answers

What is the primary reason patients with heart valve issues are advised against body piercing?

Increased risk of endocarditis Signup and view all the answers

Which of the following should be monitored for older adults with frequency/incontinence?

Fluid status Signup and view all the answers

What positioning technique helps alleviate fatigue in patients?

Using extra pillows to support lower arms Signup and view all the answers

Which complication is associated with the use of diuretics in heart failure patients?

Hypokalemia Signup and view all the answers

What condition can result from volume depletion due to excessive fluid loss?

Dehydration Signup and view all the answers

What is a primary goal of care in managing heart failure patients?

Increasing gas exchange Signup and view all the answers

Which symptom is indicative of mitral valve prolapse?

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

What should be monitored to prevent potential complications like dysrhythmias in heart failure patients?

Electrolyte levels Signup and view all the answers

What symptom can arise from prolonged diuretic use?

Muscle cramps Signup and view all the answers

Which parameter is essential for diagnosing pulmonary edema?

Improper lung sounds Signup and view all the answers

Which of the following is a risk associated with hypomagnesemia in heart failure patients?

Bradycardia Signup and view all the answers

What is a common initial symptom of left ventricular failure?

Dry, nonproductive cough Signup and view all the answers

Which finding may indicate acute decompensated heart failure with pulmonary edema?

Large quantities of frothy sputum Signup and view all the answers

In left ventricular failure, what causes decreased renal perfusion and oliguria?

Decreased cardiac output Signup and view all the answers

Which symptom is commonly associated with inadequate brain perfusion due to heart failure?

Restlessness Signup and view all the answers

What cardiovascular response occurs due to decreased stroke volume in heart failure?

Increased heart rate Signup and view all the answers

What physical manifestation might indicate right-sided heart failure?

Dependent edema Signup and view all the answers

What system is often interfered with due to right-sided heart failure leading to fluid retention?

Gastrointestinal system Signup and view all the answers

Which physical symptom may be observed due to increased venous pressure in right-sided heart failure?

Jugular venous distention (JVD) Signup and view all the answers

What is a common effect of fluid retention associated with heart failure?

Weight gain Signup and view all the answers

What might cause a patient to experience nocturia in heart failure?

Decreased cardiac workload during sleep 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

Prepare for your NURS 222 Exam #1 with this comprehensive study guide focusing on Chapter 28: Dysrhythmias. Understand the abnormal rhythms of the heart's electrical system and how disturbances affect oxygen delivery. Emphasize the Normal Sinus Rhythm and key concepts crucial for your nursing exam.