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The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis. P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. Which of the following cardiac rhythms should the nurse interpret from these findings?
- A. Atrial fibrillation
- B. Sinus tachycardia
- C. Ventricular fibrillation
- D. Ventricular tachycardia
Correct Answer: D
Rationale: The absence of P waves, wide QRS, rate >150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.
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The nurse is caring for a patient with dilated cardiomyopathy who has an atrial fibrillation that has been unresponsive to drug therapy for several days. Which of the following actions should the nurse anticipate?
- A. Electrical cardioversion
- B. IV adenosine
- C. Anticoagulant therapy with warfarin
- D. Insertion of an implantable cardioverter-defibrillator
Correct Answer: C
Rationale: Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for 3 weeks before attempting cardioversion; this is done to prevent embolization of clots from the atria. Adenosine is not used to treat atrial fibrillation. Cardioversion may be done after several weeks of warfarin therapy. ICDs are used for patients with recurrent ventricular fibrillation.
The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has no P wave, and has a QRS complex with a wide and bizarre shape. How should the nurse document the rhythm?
- A. Ventricular couplets
- B. Ventricular bigeminy
- C. Ventricular R-on-T phenomenon
- D. Ventricular multifocal contractions
Correct Answer: B
Rationale: Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as couplets. There is no indication that the premature ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.
The nurse is interpreting an ECG strip to determine whether there is a delay in impulse conduction above the ventricles. Which of the following components of an ECG strip should the nurse measure?
- A. P-wave
- B. P-R interval
- C. Q-T interval
- D. QRS complex
Correct Answer: B
Rationale: The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibres. The QRS represents ventricular depolarization. The Q-T interval represents depolarization and repolarization of the entire conduction system.
Which of the following actions by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs?
- A. The nurse assists the patient to do active range-of-motion exercises for all extremities.
- B. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet.
- C. The nurse gives atenolol to the patient without consulting first with the health care provider.
- D. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.
Correct Answer: A
Rationale: The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.
Which of the following laboratory results for a patient whose cardiac monitor shows multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider?
- A. Blood glucose 12.8 mmol/L
- B. Serum chloride 90 mmol/L
- C. Serum sodium 133 mmol/L
- D. Serum potassium 2.8 mmol/L
Correct Answer: D
Rationale: Electrolyte imbalances increase the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation; the health care provider will need to prescribe a potassium infusion to correct this hypokalemia. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the patient's PVCs and do not require immediate correction.