Chapter 36: Care of Patients with Dysrhythmias

Chapter 36: Care of Patients with Dysrhythmias

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A client’s cardiac status is being observed by telemetry monitoring. The nurse observes a P wave that changes shape in lead II. What conclusion does the nurse make about the P wave?

a.	It originates from an ectopic focus.
b.	The P wave was replaced by U waves.
c.	It is from the sinoatrial (SA) node.
d.	Multiple P waves are present.

 

 

ANS:  A

If the P wave is firing consistently from the SA node, the P wave will have a consistent shape in a given lead. If the impulse is from an ectopic focus, then the P wave will vary in shape in that lead.

 

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 715

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

2. The nurse is assessing the client’s electrocardiography (ECG). What does the P wave on the ECG tracing represent?

a.	Contraction of the atria
b.	Contraction of the ventricles
c.	Depolarization of the atria
d.	Depolarization of the ventricles

 

 

ANS:  C

The ECG tracing of a P wave represents electrical changes caused by atrial depolarization.

 

DIF:    Cognitive Level: Knowledge/Remembering                       REF:   p. 715

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Assessment)

 

3. A nurse notes that the PR interval on a client’s electrocardiograph (ECG) tracing is 0.14 second. What action does the nurse take?

a.	Assess serum cardiac enzymes.
b.	Administer 1 mg epinephrine IV.
c.	Administer oxygen via nasal cannula.
d.	Document the finding in the client’s chart.

 

 

ANS:  D

The PR interval normally ranges from 0.12 to 0.20 second. This is a normal finding, so the nurse simply documents this. No further action is required.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity Physiological Integrity (Physiological Adaptation—Pathophysiology)      MSC:  Integrated Process: Nursing Process (Analysis)

 

4. When analyzing a client’s electrocardiograph (ECG) tracing, the nurse observes that not all QRS complexes are preceded by a P wave. What is the nurse’s interpretation of this observation?

a.	The client has hyperkalemia causing irregular QRS complexes.
b.	Ventricular tachycardia is overriding the normal atrial rhythm.
c.	The client’s chest leads are not making sufficient contact with the skin.
d.	Ventricular and atrial depolarizations are initiated from different sites.

 

 

ANS:  D

Normal rhythm shows one P wave preceding each QRS, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization.

 

DIF:    Cognitive Level: Comprehension/Understanding               REF:   p. 718

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Analysis)

 

5. The nurse observes a prominent U wave on the client’s electrocardiograph (ECG) tracing. What is the most appropriate action for the nurse to take?

a.	Document the finding as a normal variant.
b.	Review the client’s daily electrolyte results.
c.	Move the crash cart closer to the client’s room.
d.	Call for an immediate electrocardiogram.

 

 

ANS:  B

Prominent U waves may be the result of hypokalemia. The nurse should review the client’s daily electrolyte results. Although documentation is important, this is not a normal variant. Moving the crash cart closer to the room may or may not be warranted. The client does not need an immediate ECG.

 

DIF:    Cognitive Level: Application/Applying or higher               REF:   N/A

TOP:   Client Needs Category: Physiological Integrity (Physiological Adaptation—Pathophysiology)

MSC:  Integrated Process: Nursing Process (Analysis)