Chapter 57: Management of Clients with Dysrhythmias Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 57: Management of Clients with Dysrhythmias

MULTIPLE CHOICE

1. The nurse would assess a heart rate of 55 beats/min as a normal finding in a client who

a.

is an athlete.

b.

is obese.

c.

takes a diuretic.

d.

weighs less than 90 pounds.

ANS: A

In some people, sinus bradycardia can be a normal condition. Athletes often have sinus bradycardia because their heart is an effective pump with a greater-than-normal stroke volume.

DIF: Application/Applying REF: p. 1455 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Alteration in Body Systems

2. The nurse quickly calculating a clients heart rate by examining the electrocardiogram (ECG) would count the number of

a.

large squares between P waves and multiply by 10.

b.

large squares between R waves and multiply by 10.

c.

P waves in a 6-inch strip and multiply by 5.

d.

R waves in a 6-inch strip and multiply by 10.

ANS: D

The simplest method for obtaining the heart rate is to count the number of R waves in a 6-inch strip of the ECG tracing (which equals 6 seconds) and then multiply this sum by 10 to obtain the rate per minute.

DIF: Application/Applying REF: p. 1453 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. A client with no history of heart disease is seen in the clinic for periodic episodes of tachycardia with a regular rate. When taking the nursing history, the nurse would question the client about the existence of

a.

asthma.

b.

diabetes.

c.

stress.

d.

weight gain.

ANS: C

Causes of sinus tachycardia include fever; emotional and physical stress; heart failure; hyperthyroidism; hypercalcemia; medications, including caffeine, atropine, nitrates, epinephrine, isoproterenol, and nicotine; and exercise.

DIF: Application/Applying REF: p. 1454 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. A client with a serum potassium level of 6.6 mEq/L would have a characteristic ECG configuration of

a.

increased PR interval.

b.

inverted QRS complex.

c.

no change.

d.

tall T wave.

ANS: D

An abnormally high serum potassium level will cause the T wave to become very tall, sometimes the height of the QRS complex.

DIF: Knowledge/Remembering REF: p. 1453 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

5. When a client develops sinus bradycardia after a myocardial infarction (MI), the nurse would anticipate the administration of

a.

atropine.

b.

digitalis.

c.

procainamide.

d.

propranolol.

ANS: A

The goal of intervention is to increase the heart rate just enough to relieve manifestations but not enough to cause tachycardia. The intervention sequence for treating symptomatic bradycardia is atropine, transcutaneous pacing if available, dopamine, epinephrine, and isoproterenol or insertion of a temporary transvenous pacemaker.

DIF: Application/Applying REF: p. 1455 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

6. The nurse would clarify to a client that sinus arrest differs from sinus block in that with sinus arrest, the

a.

atrial focus totally takes over pacing responsibility.

b.

atrioventricular (AV) node is the primary pacemaker.

c.

rhythm is regular.

d.

sinoatrial (SA) node occasionally fails to fire.

ANS: D

Sinus arrest differs from SA exit block in that the SA node intermittently fails to fire at all with sinus arrest.

DIF: Comprehension/Understanding REF: p. 1456 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

7. When a client in the cardiac care unit (CCU) suddenly develops paroxysmal atrial tachycardia (PAT) of 200 beats/min and clinical manifestations of severe dizziness, the nurse would help decrease the heart rate by

a.

administering digitalis intravenously.

b.

asking the client to perform the Valsalva maneuver.

c.

increasing the clients oxygen.

d.

lowering the head of the bed.

ANS: B

Any maneuver that stimulates the vagus nerve can successfully terminate PAT or increase AV block. Vagotonic maneuvers include carotid sinus massage and the Valsalva maneuver (bearing down as with bowel movements).

DIF: Analysis/Analyzing REF: p. 1457 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

8. A clients ECG reveals a rapid atrial rate of 300 beats/min, and the P waves resemble a picket fence without 1:1 conduction. The nurse would identify this dysrhythmia as

a.

atrial fibrillation.

b.

atrial flutter.

c.

paroxysmal atrial tachycardia.

d.

sinoatrial block.

ANS: B

Atrial flutter is a dysrhythmia arising in an ectopic pacemaker or the site of a rapid reentry circuit in the atria, characterized by rapid saw-toothed atrial wave formations and usually a slower ventricular response. Atrial flutter differs from PAT in that it produces a much more rapid atrial rate. The P waves are actually inverted or bidirectional, producing a picket fence or saw-toothed pattern of fluttering waves. The atrial rate generally ranges from 220 to 350 beats/min.

DIF: Application/Applying REF: pp. 1453, 1459

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. If a client admitted to the hospital for treatment of atrial fibrillation complains of dyspnea and chest pain, the nurse would suspect

a.

heart block.

b.

myocardial infarction.

c.

pulmonary edema.

d.

pulmonary emboli.

ANS: D

Blood pools in the quivering atria because contraction of the atrial muscle is inadequate. This blood can clot, which increases the potential for cerebral and pulmonary vascular emboli.

DIF: Analysis/Analyzing REF: p. 1458 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

10. The clients ECG shows normal-appearing P waves that occur at regular intervals. Every third impulse from the atria is missing a QRS complex. The nurse would recognize this pattern as the dysrhythmia of

a.

first-degree AV block.

b.

second-degree AV block.

c.

third-degree AV block.

d.

fourth-degree AV block.

ANS: B

Some impulses are conducted and others are blocked in second-degree AV block, a dysrhythmia that results in intermittently dropped QRS complexes. First-degree AV block is a lengthened PR interval. Third-degree AV block is complete atrial-ventricular dissociation. There is no fourth-degree AV block.

DIF: Comprehension/Understanding REF: p. 1461 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. The nurse would be most concerned about premature ventricular contractions (PVCs) that

a.

are uniform in appearance.

b.

fall on a T wave.

c.

occur at a rate of four per minute.

d.

occur with angina.

ANS: B

The downward slope of the T wave is the most vulnerable period of the cardiac cycle. PVCs occurring during this vulnerable period can precipitate the more life-threatening dysrhythmias of ventricular tachycardia and ventricular fibrillation.

DIF: Comprehension/Understanding REF: p. 1464 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

12. A client in the CCU goes into sudden ventricular fibrillation. The priority action by the nurse would be to immediately administer

a.

a lidocaine bolus.

b.

atropine.

c.

cardiopulmonary resuscitation (CPR).

d.

intravenous (IV) magnesium.

ANS: C

When ventricular fibrillation appears, the nurse must immediately initiate CPR until the defibrillator is engaged, and should defibrillate up to three times if needed. The only true effective treatment for ventricular fibrillation is defibrillation, which should occur as soon as possible.

DIF: Application/Applying REF: p. 1468 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

13. A client is being discharged with a prescription for procainamide to treat atrial fibrillation. An important self-care measure the nurse would explain about this medication is to

a.

avoid milk products.

b.

drink large amounts of citrus juice.

c.

have blood pressure monitored frequently.

d.

take the medication with meals.

ANS: D

Procainamide may cause gastrointestinal upset and should be taken with meals. The other three options are not related to taking procainamide.

DIF: Comprehension/Understanding REF: p. 1465 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

14. When a client in the CCU develops ventricular tachycardia and loses consciousness, the priority action by the nurse would be to immediately administer

a.

defibrillation.

b.

lidocaine.

c.

quinidine.

d.

verapamil.

ANS: A

Ventricular tachycardia that cause loss of consciousness must be terminated immediately with defibrillation. Like ventricular fibrillation, the only effective treatment in this situation is defibrillation.

DIF: Application/Applying REF: pp. 1466-1467

OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

15. The client who is to receive cardioversion in 3 days for treatment of continuous atrial fibrillation has laboratory values of Na 139 mEq/L, K 4.0 mEq/L, and Cl 98 mEq/L and is receiving digoxin 0.125 mg daily. Before the procedure the nurse would

a.

confirm an order for a digoxin level before cardioversion.

b.

monitor blood pressure more frequently.

c.

notify the physician regarding the potassium level.

d.

proceed with preparation for cardioversion.

ANS: A

If the client has been taking a digitalis preparation, a therapeutic drug level must be present. Digitalis toxicity may predispose the client to the development of ventricular dysrhythmias during cardioversion.

DIF: Analysis/Analyzing REF: p. 1458 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

16. The nurse would explain to a client who has a demand pacemaker in place that this pacemaker functions by

a.

demanding the heart to contract at a preset rate.

b.

firing after the SA node has started the cycle.

c.

firing if the hearts electrical activity drops below a preset rate.

d.

stimulating the SA node to fire.

ANS: C

There are two basic types of pacemakers. A fixed-rate pacemaker fires constantly at a preset rate without regard to the electrical activity of the clients heart. A demand pacemaker fires when the SA node has not fired at a preset rate.

DIF: Comprehension/Understanding REF: p. 1476 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

17. If the first defibrillation shock at 200 J is not successful on a client with ventricular fibrillation, the nurse in charge of the code would

a.

administer a second shock at 300 J.

b.

reinitiate CPR.

c.

reposition the client and shock at 200 J.

d.

set the defibrillator to synchronous.

ANS: A

Consecutive shocks at 200, 300, and 400 J is the normal protocol for treatment of ventricular fibrillation.

DIF: Application/Applying REF: p. 1468 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

18. At the ambulatory care clinic, the nurse counseling a client who has presented with frequent episodes of paroxysmal atrial tachycardia would advise the client to

a.

avoid all aspirin and nonsteroidal anti-inflammatory drugs.

b.

eat a low-salt, low-fat diet that contains plenty of fiber.

c.

get 30 minutes of exercise and drink six glasses of water per day.

d.

quit smoking and avoid caffeine and alcohol.

ANS: D

Cardiac problems precipitating PAT include MI, cardiomyopathy, extreme emotions, caffeine ingestion, fatigue, smoking, and excessive alcohol intake.

DIF: Application/Applying REF: pp. 1456-1457

OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

19. The nurse working on a telemetry floor would recognize that most dangerous dysrhythmias are

a.

atrial dysrhythmias.

b.

junctional dysrhythmias.

c.

nodal dysrhythmias.

d.

ventricular dysrhythmias.

ANS: D

Ventricular dysrhythmias are generally more serious and life-threatening than atrial or junctional dysrhythmias.

DIF: Knowledge/Remembering REF: p. 1463 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

20. When the nurse in charge of the code is ready to defibrillate a client, the nurse assisting with the defibrillation would

a.

assess for unresponsiveness.

b.

continue to perform CPR.

c.

prepare to administer lidocaine.

d.

stand away from the bed.

ANS: D

To ensure safe defibrillation, clinicians must always announce that they are about to shock. Because electricity is carried along metal devices and the client, all personnel, including the clinician administering the shock, must stand back from the bed. The person defibrillating the client is ultimately responsible for everyones safety.

DIF: Application/Applying REF: pp. 1470-1471

OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

21. For a client being prepared to receive an automatic implantable cardioverter-defibrillator (AICD) after surviving two episodes of ventricular fibrillation, the nurse would address the clients

a.

acute pain.

b.

anxiety.

c.

fatigue.

d.

decreased cardiac output.

ANS: B

All options are valid; however; clients who require AICDs have a great deal of anxiety. Anxiety can develop from past episodes of near death. Other clients fear that the AICD will not be able to reverse their dysrhythmia.

DIF: Application/Applying REF: p. 1473 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

22. When the normal pacemaker is impaired and latent pacemaker cells in the AV node initiate the cardiac cycle, the nurse would clarify that this pacemaker is called the

a.

altered pacemaker.

b.

delayed pacemaker.

c.

escape pacemaker.

d.

junctional pacemaker.

ANS: C

The escape pacemaker is the fail-safe pacemaker that initiates the cardiac cycle in the absence or impairment of the normal SA node.

DIF: Comprehension/Understanding REF: p. 1451 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

23. Before a client receives cardioversion, the nurse should ensure that the client

a.

ate only a light breakfast.

b.

has signed a consent form.

c.

is not wearing jewelry.

d.

skipped todays digoxin dose.

ANS: B

The client having a cardioversion needs to be in a fasting state with electrolyte levels within the normal range. If the client is taking digoxin, the digoxin level needs to be therapeutic. Wearing jewelry will not interfere with cardioversion, as long as the jewelry is not on the chest. Clients must sign an informed consent form before having the procedure, unless it is done on an emergency basis.

DIF: Application/Applying REF: p. 1458 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Informed Consent

24. A client is being discharged after unsuccessful cardioversion for atrial fibrillation. An important self-care measure the nurse should include in the discharge teaching plan is to tell the client to

a.

be sure to get plenty of rest balanced with activity.

b.

not eat too much red meat and other high-fat foods.

c.

reschedule the cardioversion in 2 weeks.

d.

take the Coumadin as scheduled.

ANS: D

In atrial fibrillation, blood pools in the ventricle. This blood is prone to clotting and can lead to embolic phenomenon. Clients who are reliable should be given a prescription for Coumadin if they are in atrial fibrillation.

DIF: Application/Applying REF: p. 1458 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

25. A young athletic client has occasional episode of syncope. On further questioning, the nurse discovers the client has several relatives who had sudden cardiac death. The nurse should suggest the client be screened for

a.

atrial dysrhythmias.

b.

familial sudden cardiac death syndrome.

c.

long QT syndrome.

d.

ventricular dysrhythmias.

ANS: C

Long QT syndrome is an inherited condition in which individuals suffer from frequent tachycardias and syncope. A family history of syncope, sudden death, or unsuccessful resuscitation for cardiac arrest is suspicious for the syndrome. Individuals at high risk can be screened for five known genetic mutations.

DIF: Analysis/Analyzing REF: p. 1468 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems

MULTIPLE RESPONSE

1. To prevent possible complications from cardioversion, before administering the shock, the nurse would ensure that the (Select all that apply)

a.

emergency equipment is nearby and in working order.

b.

joules are set to 50-100 joules initially on a monophasic machine.

c.

machine is set to synchronize with the clients QRS complex.

d.

the Code Blue team has arrived and is prepared.

ANS: A, B, C

Before cardioversion, the nurse selects the appropriate joules to deliver (50-100 initially), ensures that the machine is synching with the clients QRS complex, and has ensured that emergency resuscitation equipment and supplies are ready to use if needed. Cardioversion is an elective procedure (usually) and does not require the presence of the Code Blue team.

DIF: Application/Applying REF: p. 1458 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

2. A client is being discharge after having a pacemaker implantation. Self-care instructions the nurse should provide the client include (Select all that apply)

a.

carry a pacemaker identification card with you; wear a medical alert bracelet.

b.

do not lift more than 5-10 pounds for the first 2 weeks after discharge.

c.

take your pulse as directed and notify the doctor if it is less than the pacer rate.

d.

you can safely operate most appliances, tools, and office equipment.

ANS: A, C, D

A client with a permanent pacemaker needs to follow the advice in options a, c, and d. the client should not lift more than 5-10 pounds for the first 6 weeks after surgery. See the Client Education Guide on The Client with a Permanent Pacemaker for more self-care measures.

DIF: Comprehension/Understanding REF: p. 1480 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

3. Before the insertion of a temporary pacemaker, the nurse should assess the clients (Select all that apply)

a.

anxiety level.

b.

coping mechanisms.

c.

knowledge level.

d.

past experience with temporary pacers.

ANS: A, B, C

A client getting a temporary pacemaker may well be anxious because of the emergent need for this procedure and because it signifies that the clients heart rate and rhythm is unstable. Assisting the client to manage anxiety includes assessing anxiety, knowledge of the procedure, and coping methods. Clients most likely have not had past experiences with temporary pacing; the need for a temporary pacer often precedes a permanent pacemaker.

DIF: Application/Applying REF: p. 1475 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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