Chapter 34: Care of Patients with Dysrhythmias

Chapter 34: Care of Patients with Dysrhythmias

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse assesses a client’s electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation?
   1. The client has hyperkalemia causing irregular QRS complexes.
   2. Ventricular tachycardia is overriding the normal atrial rhythm.
   3. The client’s chest leads are not making sufficient contact with the skin.
   4. Ventricular and atrial depolarizations are initiated from different sites.

ANS:   D

Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization. This finding on an electrocardiograph tracing is not an indication of hyperkalemia, ventricular tachycardia, or disconnection of leads.

DIF:     Understanding/Comprehension         REF: 649

KEY:   Cardiac electrical conduction

MSC:   Integrated Process: Nursing Process: Analysis                      NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?
   1. “Make certain that your bath water is warm.”
   2. “Avoid straining while having a bowel movement.”
   3. “Limit your intake of caffeinated drinks to one a day.”
   4. “Avoid strenuous exercise such as running.”

ANS:   B

Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in slowing of the heart rate. Such a response is not desirable in a person who has bradycardia. The other instructions are not appropriate for this condition.

DIF:     Applying/Application                         REF: 663                    KEY: Functional ability MSC:             Integrated Process: Nursing Process: Implementation           NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

3. A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation?
   1. A 45-year-old who takes an aspirin daily
   2. A 50-year-old who is post coronary artery bypass graft surgery
   3. A 78-year-old who had a carotid endarterectomy
   4. An 80-year-old with chronic obstructive pulmonary disease

ANS:   B

Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft surgery. The other conditions do not place these clients at higher risk for atrial fibrillation.

DIF:            Applying/Application                         REF:    666                   KEY: Health screening| cardiac electrical conduction                                              MSC: Integrated Process: Nursing Process: Assessment                      NOT:                                                 Client Needs Category: Safe and Effective Care Environment: Management of Care

4. A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition?
   1. Sinus tachycardia
   2. Speech alterations
   3. Fatigue
   4. Dyspnea with activity

ANS:           B

Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes in mentation, speech, sensory function, and motor function. Clients with atrial fibrillation often have a rapid ventricular response as a result. Fatigue is a nonspecific complaint. Clients with atrial fibrillation often have dyspnea as a result of the decreased cardiac output caused by the rhythm disturbance.

DIF:            Applying/Application                         REF:    666                   KEY: Cardiac electrical conduction| vascular perfusion                               MSC: Integrated Process: Nursing Process: Assessment                      NOT:                                                 Client Needs Category: Physiological Integrity: Reduction of Risk Potential

5. A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client’s medication administration record to prevent a common complication of this condition?
   1. Sotalol (Betapace)
   2. Warfarin (Coumadin)
   3. Atropine (Sal-Tropine)
   4. Lidocaine (Xylocaine)

ANS:           B

Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.

DIF:            Applying/Application                         REF:    667                   KEY: Cardiac electrical conduction| medication                                                      MSC:             Integrated Process: Nursing Process: Analysis                                                    NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse administers prescribed adenosine (Adenocard) to