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Study Guide for Medical-Surgical Nursing: Assessment and Management of Clinical Problems

Sharon L. Lewis RN PhD FAAN, Shannon Ruff Dirksen RN PhD, Linda Bucher RN PhD CEN

Chapter 36

Nursing Management: Dysrhythmias - all with Video Answers

Educators

Chapter Questions

03:06

Problem 1

What accurately describes electrocardiographic (ECG) monitoring?
a. Depolarization of the cells in the ventricles produces the T wave on the ECG.
b. An abnormal cardiac impulse that arises in the atria, ventricles, or atrioventricular (AV) junction can create a premature beat that is known as an artifact.
c. Lead placement for $\mathrm{V}_1$ includes one lead each for right arm, right leg, left arm, and left leg with the fifth lead on the fourth intercostal space to the right of the sternal border.
d. If the sinoatrial (SA) node fails to discharge an impulse or discharges very slowly, a secondary pacemaker in the AV node is able to discharge at a rate of 30 to 40 times per minute.

Rehana Riaz
Rehana Riaz
Numerade Educator
02:17

Problem 2

What accurately describes the PR interval (select all that apply)?
a. 0.16 seconds
b. $<0.12$ seconds
c. 0.06 to 0.12 seconds
d. 0.12 to 0.20 seconds
e. Time of depolarization and repolarization of ventricles
f. Measured from beginning of $P$ wave to beginning of $Q R S$ complex

Rehana Riaz
Rehana Riaz
Numerade Educator
01:49

Problem 3

A patient with a regular heart rate (HR) has four QRS complexes between every 3-second marker on the ECG paper. Calculate the patient's heart rate.
_________bpm

Ren Jie Tuieng
Ren Jie Tuieng
Numerade Educator
01:18

Problem 4

The ECG pattern of a patient with a regular HR reveals 20 small squares between each $R-R$ interval. What is the patient's heart rate? _____________bpm

Yujie Wang
Yujie Wang
College of San Mateo
00:50

Problem 5

What describes the SA node's ability to discharge an electrical impulse spontaneously?
a. Excitability
b. Contractility
c. Conductivity
d. Automaticity

Ronald Prasad
Ronald Prasad
Numerade Educator
00:30

Problem 6

What describes refractoriness?
a. Abnormal electrical impulses
b. Period in which heart tissue cannot be stimulated
c. Areas of the heart do not repolarize at the same rate because of depressed conduction
d. Sodium migrates rapidly into the cell so it is positive compared to the outside of the cell

Sam Limsuwannarot
Sam Limsuwannarot
Numerade Educator

Problem 7

The patient's PR interval comprises six small boxes on the ECG graph. What does the nurse determine that this indicates?
a. A normal finding
b. A problem with ventricular depolarization
c. A disturbance in the repolarization of the atria
d. A problem with conduction from the SA node to the ventricular cells

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Problem 8

The nurse plans close monitoring for the patient during electrophysiologic testing because this test
a. requires the use of dyes that irritate the myocardium.
b. causes myocardial ischemia, resulting in dyshythmias.
c. involves the use of anticoagulants to prevent thrombus and embolism.
d. induces dysrhythmias that may require cardioversion or defibrillation to correct.

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Problem 9

What should the nurse reading the monitor strip call a rhythm with a regular PR interval but a blocked QRS complex?
a. Asystole
b. Atrial fibrillation
c. First-degree AV block
d. Type II second-degree AV block

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Problem 10

After defibrillation, the advanced cardiac life support (ACLS) nurse says that the patient has pulseless electrical activity (PEA). What is most important for the nurse to understand about this rhythm?
a. The heart rate is 40 to $60 \mathrm{bpm}$.
b. Hypoxemia and hypervolemia are common with PEA.
c. There is dissociated activity of the ventricle and atrium.
d. There is electrical activity with no mechanical response.

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Problem 11

The nurse is evaluating the telemetry ECG rhythm strip. How should the nurse document the distorted $P$ wave causing an irregular rhythm?
a. Atrial flutter
b. Sinus bradycardia
c. Premature atrial contraction (PAC)
d. Paroxysmal supraventricular tachycardia (PSVT)

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Problem 12

A patient with an acute myocardial infarction (MI) develops the following ECG pattern: atrial rate of 82 and regular; ventricular rate of 46 and regular; $\mathrm{P}$ wave and $\mathrm{QRS}$ complex are normal but there is no relationship between the $\mathrm{P}$ wave and the QRS complex. What dysrhythmia does the nurse identify this as and what treatment is expected?
a. Sinus bradycardia treated with atropine
b. Third-degree heart block treated with a pacemaker
c. Atrial fibrillation treated with electrical cardioversion
d. Type I second-degree AV block treated with observation

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00:34

Problem 13

Which rhythm abnormality has an increased risk of ventricular tachycardia and ventricular fibrillation?
a. PAC
b. PVC on the T wave
c. Accelerated idioventricular rhythm
d. Premature ventricular contraction (PVC) couplet

Sam Limsuwannarot
Sam Limsuwannarot
Numerade Educator

Problem 14

A patient with an acute MI has sinus tachycardia of $126 \mathrm{bpm}$. The nurse recognizes that if this dysrhythmia is not treated, the patient is likely to experience
a. hypertension.
b. escape rhythms.
c. ventricular tachycardia.
d. an increase in infarct size.

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Problem 15

A patient with no history of heart disease has a rhythm strip that shows an occasional distorted $\mathrm{P}$ wave followed by normal AV and ventricular conduction. What should the nurse question the patient about?
a. The use of caffeine
b. The use of sedatives
c. Any acrobic training
d. Holding of breath during exertion

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Problem 16

Priority Decision: A patient's rhythm strip indicates a normal $\mathrm{HR}$ and rhythm with normal $\mathrm{P}$ waves and $\mathrm{QRS}$ complexes, but the PR interval is 0.26 second. What is the most appropriate action by the nurse?
a. Continue to assess the patient.
b. Administer atropine per protocol.
c. Prepare the patient for synchronized cardioversion.
d. Prepare the patient for placement of a temporary pacemaker.

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Problem 17

In the patient with a dysrhythmia, which assessment indicates decreased cardiac output (CO)?
a. Hypertension and bradycardia
b. Chest pain and decreased mentation
c. Abdominal distention and hepatomegaly
d. Bounding pulses and a ventricular heave

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Problem 18

Priority Decision: A patient with an acute $\mathrm{MI}$ is having multifocal PVCs and ventricular couplets. He is alert and has a BP of $118 / 78 \mathrm{~mm} \mathrm{Hg}$ with an irregular pulse of $86 \mathrm{bpm}$. What is the priority nursing action at this time?
a. Continue to assess the patient.
b. Ask the patient to perform Valsalva maneuver.
c. Prepare to administer antidysrhythmic drugs per protocol.
d. Be prepared to administer cardiopulmonary resuscitation (CPR).

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02:04

Problem 19

Which rhythm pattern finding is indicative of PVCs?
a. A QRS complex $\geq 0.12$ second followed by a $P$ wave
b. Continuous wide QRS complexes with a ventricular rate of $160 \mathrm{bpm}$
c. $P$ waves hidden in QRS complexes with a regular rhythm of $120 \mathrm{bpm}$
d. Saw-toothed $\mathrm{P}$ waves with no measurable $\mathrm{PR}$ interval and an irregular rhythm

Joanna Quigley
Joanna Quigley
Numerade Educator
01:00

Problem 20

In the patient experiencing ventricular fibrillation (VF), what is the rationale for using cardiac defibrillation?
a. Enhance repolarization and relaxation of ventricular myocardial cells
b. Provide an electrical impulse that stimulates normal myocardial contractions
c. Depolarize the cells of the myocardium to allow the SA node to resume pacemaker function
d. Deliver an electrical impulse to the heart at the time of ventricular contraction to convert the heart to a sinus rhythm

Joanna Quigley
Joanna Quigley
Numerade Educator

Problem 21

What action is included in the nurse's responsibilities in preparing to administer defibrillation?
a. Applying gel pads to the patient's chest
b. Setting the defibrillator to deliver 50 joules
c. Setting the defibrillator to a synchronized mode
d. Sedating the patient with midazolam (Versed) before defibrillation

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Problem 22

While providing discharge instructions to the patient who has had an implantable cardioverter-defibrillator (ICD) inserted, the nurse teaches the patient that if the ICD fires, he or she should do what?
a. Lie down.
b. Call the cardiologist.
c. Push the reset button on the pulse generator.
d. Immediately take his or her antidysrhythmic medication.

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Problem 23

A patient with a sinus node dysfunction has a permanent pacemaker inserted. Before discharge, what should the nurse include when teaching the patient?
a. Avoid cooking with microwave ovens.
b. Avoid standing near antitheft devices in doorways.
c. Use mild analgesics to control the chest spasms caused by the pacing current.
d. Start lifting the arm above the shoulder right away to prevent a "frozen shoulder."

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Problem 24

Priority Decision: A patient on the cardiac telemetry unit goes into ventricular fibrillation and is unresponsive. Following initiation of the emergency call system (Code Blue), what is the next priority for the nurse in caring for this patient?
a. Begin CPR.
b. Get the crash cart.
c. Administer amiodarone IV.
d. Defibrillate with 360 joules.

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01:00

Problem 25

The use of catheter ablation therapy to "burn" areas of the cardiac conduction system is indicated for the treatment of
a. sinus arrest.
b. heart blocks.
c. tachydysrhythmias.
d. premature ventricular tachycardia.

Joanna Quigley
Joanna Quigley
Numerade Educator

Problem 26

A patient with chest pain that is unrelieved by nitroglycerin is admitted to the coronary care unit for observation and diagnosis. While the patient has continuous ECG monitoring, what finding would most concern the nurse?
a. Occasional PVCs
b. An inverted T wave
c. ST segment elevation
d. A PR interval of 0.18 second

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Problem 27

A 54-year-old patient who has no structural heart disease has an episode of syncope. An upright tilt table test is performed to rule out neurocardiogenic syncope. The nurse explains to the patient that if neurocardiogenic syncope is the problem, the patient will experience what?
a. No change in HR or BP
b. Palpitations and dizziness
c. Tachydysrhythmias and chest pain
d. Marked bradycardia and hypotension

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04:15

Problem 28

The patient is brought to the emergency department with acute coronary syndrome (ACS). What changes should the nurse expect to see on the ECG if only myocardial injury has occurred?
a. Absent $\mathbf{P}$ wave
b. A wide $Q$ wave
c. Inverted $\mathrm{T}$ wave
d. ST segment elevation

Mithlesh Kumari
Mithlesh Kumari
Numerade Educator
02:05

Problem 29

Identify the following cardiac rhythms using the systematic approach to assessing cardiac rhythms found in Table $36-5$ in the textbook. All rhythm strips are 6 seconds.
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l.photo can't copy
m. photo can't copy
n. photo can't copy
o.

Rehana Riaz
Rehana Riaz
Numerade Educator