The nurse is caring for a patient who has had an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. How should the nurse best respond?
Recognize that the view of the electrical current changes in relation to the lead placement.
Recognize that the electrophysiological conduction of the heart differs with lead placement.
Inform the technician that the ECG equipment has malfunctioned.
Inform the physician that the patient is experiencing a new onset of dysrhythmia.
The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patient’s heart?
P wave
T wave
U wave
QRS complex
The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG?
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
PP interval & RR interval are irregular
PP interval is equal to RR interval
Fewer QRS complexes than P waves
PR interval is constant
The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient?
Maintain a resting heart rate below 70 bpm.
Maintain adequate control of chest pain.
Maintain adequate cardiac output.
Maintain normal cardiac structure.
A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient?
Chest pain
Bleeding at the implantation site
Malignant hyperthermia
Bradycardia
A patient the nurse is caring for has a permanent pacemaker implanted with the identification code beginning with VVI. What does this indicate?
Ventricular paced, ventricular sensed, inhibited
Variable paced, ventricular sensed, inhibited
Ventricular sensed, ventricular situated, implanted
Variable sensed, variable paced, inhibited
The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do?
Maintain firm contact between paddles and patient skin.
Apply a layer of water as a conducting agent.
Call “all clear” once before discharging the defibrillator.
Ensure the defibrillator is in the sync mode.
A patient who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse’s best response?
“To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia”
“To detect and treat bradycardia, which is an excessively slow heart rate”
“To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently”
“To shock your heart if you have a heart attack at home”
A nurse is providing health education to a patient scheduled for cryoablation therapy. The nurse should describe what aspect of this treatment?
Peeling away the area of endocardium responsible for the dysrhythmia
Using electrical shocks directly to the endocarduim to eliminate the source of dysrhythmia
Using high-frequency sound waves to eliminate the source of dysrhythmia
Using a cooled probe to eliminate the source of dysrhythmia
The nurse is caring for a patient who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse’s assessment?
Assessing the patient’s activity level
Facilitating transthoracic echocardiography
Vigilant monitoring of the patient’s ECG
Close monitoring of the patient’s peripheral perfusion
During a patient’s care conference, the team is discussing whether the patient is a candidate for cardiac conduction surgery. What would be the most important criterion for a patient to have this surgery?
Angina pectoris not responsive to other treatments
Decreased activity tolerance related to decreased cardiac output
Atrial and ventricular tachycardias not responsive to other treatments
Ventricular fibrillation not responsive to other treatments
A nurse is caring for a patient who is exhibiting ventricular tachycardia (VT). Because the patient is pulseless, the nurse should prepare for what intervention?
Defibrillation
ECG monitoring
Implantation of a cardioverter defibrillator
Angioplasty
A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the main goal of treatment is what?
Decrease SA node conduction
Control ventricular heart rate
Improve oxygenation
Maintain anticoagulation
The nurse and the other members of the team are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated unsuccessfully and the patient remains in VF. According to national standards, the nurse should anticipate the administration of what medication?
Epinephrine 1 mg IV push
Lidocaine 100 mg IV push
Amiodarone 300 mg IV push
Sodium bicarbonate 1 amp IV push
The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient?
Start lifting the arm above the shoulder right away to prevent chest wall adhesion.
Avoid cooking with a microwave oven.
Avoid exposure to high-voltage electrical generators.
Avoid walking through store and library antitheft devices.
A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine?
Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
Administer atropine as a continuous infusion until symptoms resolve.
Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours.
Administer atropine 1.0 mg sublingually.
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement?
Clean the skin with providone-iodine solution.
Ensure that the area for electrode placement is dry.
Apply tincture of benzoin to the electrode sites and wait for it to become “tacky.”
Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
The nurse is caring for a patient who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment?
Cardiac monitoring
Monitoring the implanted device signal
Pain assessment
Monitoring the patient’s level of consciousness (LOC)
The ED nurse is caring for a patient who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform?
Place gel pads over the apex and posterior chest for better conduction.
Ensure no one is touching the patient at the time shock is delivered.
Continue to ventilate the patient via endotracheal tube during the procedure.
Allow at least 3 minutes between shocks.
A group of nurses are participating in orientation to a telemetry unit. What should the staff educator tell this class about ST segments?
They are the part of an ECG that reflects systole.
They are the part of an ECG used to calculate ventricular rate and rhythm.
They are the part of an ECG that reflects the time from ventricular depolarization through repolarization.
They are the part of an ECG that represents early ventricular repolarization.
The nurse is providing care to a patient who has just undergone an electrophysiologic (EP) study. The patient states that she is nervous about “things going wrong” during the procedure. What is the nurse’s best response?
“This is basically a risk-free procedure.”
“Thousands of patients undergo EP every year.”
“Remember that this is a step that will bring you closer to enjoying good health.”
“The whole team will be monitoring you very closely for the entire procedure.”
New nurses on the telemetry unit have been paired with preceptors. One new nurse asks her preceptor to explain depolarization. What would be the best answer by the preceptor?
“Depolarization is the mechanical contraction of the heart muscles.”
“Depolarization is the electrical stimulation of the heart muscles.”
“Depolarization is the electrical relaxation of the heart muscles.”
“Depolarization is the mechanical relaxation of the heart muscles.”
A cardiac care nurse is aware of factors that result in positive chronotropy. These factors would affect a patient’s cardiac function in what way?
Exacerbating an existing dysrhythmia
Initiating a new dysrhythmia
Resolving ventricular tachycardia
Increasing the heart rate
The nurse is caring for a patient with refractory atrial fibrillation who underwent the maze procedure several months ago. The nurse reviews the result of the patient’s most recent cardiac imaging, which notes the presence of scarring on the atria. How should the nurse best respond to this finding?
Recognize that the procedure was unsuccessful.
Recognize this as a therapeutic goal of the procedure.
Liaise with the care team in preparation for repeating the maze procedure.
Prepare the patient for pacemaker implantation.
A patient is scheduled for catheter ablation therapy. When describing this procedure to the patient’s family, the nurse should address what aspect of the treatment?
Resetting of the heart’s contractility
Destruction of specific cardiac cells
Correction of structural cardiac abnormalities
Clearance of partially occluded coronary arteries
A patient has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this patient’s care, what nursing diagnosis is most appropriate?
Acute pain
Risk for unilateral neglect
Risk for activity intolerance
Risk for fluid volume excess
The nurse is caring for a patient on telemetry. The patient’s ECG shows a shortened PR interval, slurring of the initial QRS deflection, and prolonged QRS duration. What does this ECG show?
Sinus bradycardia
Myocardial infarction
Lupus-like syndrome
Wolf-Parkinson-White (WPW) syndrome
A patient is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurse’s responsibility in the care of the patient’s pacemaker?
Monitoring for pacemaker malfunction or battery failure
Determining when it is appropriate to remove the pacemaker
Making necessary changes to the pacemaker settings
Selecting alternatives to future pacemaker use
The nurse caring for a patient whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this patient?
Implanted pacemaker
Trancutaneous pacemaker
ICD
Asynchronous defibrillator
The nurse is caring for a patient who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output?
Increased blood pressure
Bounding peripheral pulses
Changes in level of consciousness
Skin flushing
Following cardiac resuscitation, a patient has been placed in a state of mild hypothermia before being transferred to the cardiac intensive care unit. The nurse’s assessment reveals that the patient is experiencing neuromuscular paralysis. How should the nurse best respond?
Administer hypertonic IV solution.
Administer a bolus of warned normal saline.
Reassess the patient in 15 minutes.
Document this as an expected assessment finding.
The nurse is caring for a patient who has had a biventricular pacemaker implanted. When planning the patient’s care, the nurse should recognize what goal of this intervention?
Resynchronization
Ablation
When planning the care of a patient with an implanted pacemaker, what assessment should the nurse prioritize?
Core body temperature
Heart rate and rhythm
Blood pressure
Oxygen saturation level
The nurse is assessing a patient who had a pacemaker implanted 4 weeks ago. During the patient’s most recent follow-up appointment, the nurse identifies data that suggest the patient may be socially isolated and depressed. What nursing diagnosis is suggested by these data?
Decisional conflict related to pacemaker implantation
Deficient knowledge related to pacemaker implantation
Spiritual distress related to pacemaker implantation
Ineffective coping related to pacemaker implantation
The nurse is caring for a patient who is in the recovery room following the implantation of an ICD. The patient has developed ventricular tachycardia (VT). What should the nurse assess and document?
ECG to compare time of onset of VT and onset of device’s shock
ECG so physician can see what type of dysrhythmia the patient has
Patient’s level of consciousness (LOC) at the time of the dysrhythmia
Patient’s activity at time of dysrhythmia
The staff educator is teaching a CPR class. Which of the following aspects of defibrillation should the educator stress to the class?
Apply the paddles directly to the patient’s skin.
Use a conducting medium between the paddles and the skin.
Always use a petroleum-based gel between the paddles and the skin.
Any available liquid can be used between the paddles and the skin.
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructor’s best response?
“Cardioversion is done on a beating heart; defibrillation is not.”
“The difference is the timing of the delivery of the electric current.”
“Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not.”
“Cardioversion is always attempted before defibrillation because it has fewer risks.”
A patient is admitted to the cardiac care unit for an electrophysiology (EP) study. What goal should guide the planning and execution of the patient’s care?
Ablate the area causing the dysrhythmia.
Freeze hypersensitive cells.
Diagnose the dysrhythmia.
Determine the nursing plan of care.
A patient calls his cardiologist’s office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the patient to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what?
Infection
Failure to capture
Premature battery depletion
Oversensing of dysrhythmias
