Exemplar 16.I Life-Threatening Dysrhythmias

Exemplar 16.I Life-Threatening Dysrhythmias 1) During a blood pressure screening, an older adult client tells the nurse about chest fluttering while doing yard work. The client reports no other symptoms and the frequency is intermittent. Which action is correct by the nurse? A) Suggest the client stop exercising B) Reassure these are normal changes associated with aging C) Ensure the client is evaluated by his/her medical provider D) Check laboratory values for hypothyroidism Answer: C Explanation: A) New-onset dysrhythmias may signal the onset of a serious underlying illness that requires further medical evaluation. Exercise intolerance would include shortness of breath, which the client does not report. These symptoms are not normal cardiac changes. Chest fluttering can be a sign of hyperthyroidism, not hypothyroidism. Page Ref: 1271-1272 2) The nurse is assessing an adult client with a cardiac dysrhythmia. Which finding would the nurse identify as possibly contributing to this client's dysrhythmia? A) Drinks caffeinated coffee in the morning and for lunch B) Does not smoke or ingest any alcohol C) Plays golf three times a week and gardens daily D) Takes antihypertensive medication as prescribed Answer: A Explanation: A) Caffeine increases the risk of ectopic beats and rapid heart rates. The client is a non-smoker and does not ingest alcohol, both of which would contribute to cardiac dysrhythmias. Engaging in routine physical activity will not cause dysrhythmias or conduction defects. Antihypertensive medications are not associated with cardiac dysrhythmias. Page Ref: 1271 Cognitive Level: Analyzing 3) An adult client is experiencing paroxysmal supraventricular tachycardia. Which nursing interventions are appropriate based on the data provided? Select all that apply. A) Initiate oxygen therapy B) Prepare for cardioversion C) Begin anticoagulation therapy as prescribed D) Administer intravenous adenosine as prescribed E) Administer a beta blocker as prescribed Answer: A, B, D, E Explanation: A) Management of paroxysmal supraventricular tachycardia includes carotid sinus massage, oxygen therapy, adenosine, beta blockers, and synchronized cardioversion. Anticoagulant therapy is not a part of the management for this dysrhythmia. Page Ref: 1272Cognitive Level: Applying 4) A client admitted with a cardiac dysrhythmia reports being easily fatigued and has difficulty performing normal daily activities. Which nursing diagnosis should the nurse select to address this client's issue? A) Excess Fluid Volume B) Activity Intolerance C) Depression D) Situational Low Self-Esteem Answer: B Explanation: A) The client is experiencing fatigue and frustration with the inability to perform normal daily activities. The nursing diagnosis to address this client's issue would be Activity Intolerance. There is no evidence that the client is experiencing excess fluid volume. The client may or may not be experiencing depression. The client may develop situational low self-esteem if the diagnosis of Activity Intolerance is not addressed. Page Ref: 1289 Cognitive Level: Analyzing 5) The nurse is planning care for a client admitted with a cardiac dysrhythmia. Which action would be the most appropriate for this client? A) Restrict fluids B) Encourage bedrest C) Monitor serum electrolyte levels D) Instruct in a low-fat diet Answer: C Explanation: A) The nurse should monitor serum electrolyte levels because electrolyte imbalances affect cardiac depolarization and repolarization and may cause dysrhythmias. There is no evidence to suggest the client needs to have fluids restricted. More information is needed before determining whether the client needs to be on bedrest. There is no evidence to suggest the client needs instruction on a low-fat diet. Page Ref: 1289 Cognitive Level: Applying 6) A client is receiving procainamide hydrochloride (Pronestyl) for treatment of a dysrhythmia. Which is an appropriate client outcome related to adhering to the provided medication instruction? A) The client will monitor the pulse and not take the medication if the pulse is less than 60. B) The client will take the medication as directed, even when feeling well. C) The client will take the medication on an empty stomach. D) The client will take the medication with food. Answer: B Explanation: A) It is very important for clients to understand that medication must be taken as directed, even if the client is feeling well. The beta-adrenergic blocking drugs cause bradycardia, not group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken on an empty stomach or with food. Page Ref: 1289Cognitive Level: Analyzing 7) A client is scheduled for temporary pacemaker insertion. What instruction will this client need prior to discharge? A) Dizziness is to be expected. B) There are no special precautions. C) Wear a tight-fitting shirt to help hold the pacemaker in place. D) Use battery-powered equipment. Answer: D Explanation: A) When available, battery-powered equipment should be used instead of electrical equipment. Dizziness is not to be expected and should be reported to the healthcare provider. The client should wear loose-fitting clothing. Page Ref: 1283 Cognitive Level: Applying 8) A client with sepsis has a temperature of 40°C. Which dysrhythmia is most likely to occur in this client? A) Bradydysrhythmia B) Tachydysrhythmia C) Wolff-Parkinson-White dysrhythmia D) Long QT dysrhythmia Answer: B Explanation: A) Stressors such as fever, sepsis, and hyperthyroidism may precipitate paroxysmal supraventricular tachycardia, which is a tachydysrhythmia. Fever does not cause bradydysrhythmia. Wolff-Parkinson-White and long QT are both syndromes which are caused by genetic cardiac problems.Page Ref: 1275—1276Cognitive Level: Understanding 9) A nurse caring for a client in the in the intensive care unit (ICU) notes that the client is experiencing a ventricular tachycardia dysrhythmia. Which rhythm is a type of ventricular tachycardia? A) Sinus tachycardia B) Atrial flutter C) Junctional escape D) Torsades de Pointes Answer: D Explanation: A) Torsades de Pointes is a type of ventricular tachycardia. Sinus tachycardia, atrial flutter, and junctional escape are all supraventricular rhythms, not ventricular rhythms. Page Ref: 1277 Cognitive Level: Understanding 10) A nurse working in the emergency department is participating in the resuscitation of a client experiencing sudden cardiac death. After five cycles of CPR, the nurse evaluates the client's cardiac rhythm as asystole. What is the next action by the nurse? A) Administer epinephrine B) Immediately defibrillate the client C) Assess the cardiac monitor electrodes D) Assess the client's pulse Answer: D Explanation: A) According to the American Heart Association (AHA) CPR guidelines, after five rounds of CPR, the nurse should assess the client's pulse. All other choices are incorrect actions by the nurse. Page Ref: 1286-1287 Cognitive Level: Applying 11) Which property of cardiac cells is mechanical in nature? A) Automaticity B) Excitability C) Conductivity D) Contractility Answer: D Explanation: A) Cardiac cells have five unique properties. Four of these properties are electrical: automaticity, excitability, conductivity, and refractoriness. The fifth property is cardiac muscle's mechanical response to electrical stimulation: contractility. Page Ref: 1270-1271: Remembering 12) Which dysrhythmia is most commonly associated with sudden cardiac death (SCD)? A) Atrial flutter B) Ventricular fibrillation C) Paroxysmal supraventricular tachycardia D) Junctional escape rhythm Answer: B Explanation: A) Ventricular fibrillation most commonly leads to sudden cardiac death. The other dysrhythmias are not normally associated with SCD. Page Ref: 1286Cognitive Level: Understanding 13) The nurse is caring for a 6-year-old child when the child goes into cardiac arrest. When performing compressions for CPR, what should the nurse do? A) Place thumbs side by side and perform compressions below the nipple line B) Use two fingers in the upright position to perform compressions C) Use two fingers plus the heel of the other hand to perform compressions D) Use both hands on the lower half of the breastbone to perform compressions Answer: C Explanation: A) When performing CPR on neonates, thumbs should be placed side by side, or overlapping in very small neonates, and compressions should be performed below the nipple line. For infants, two fingers placed in the upright position should be used for compressions. For children, the provider should use two fingers plus the heel of the other hand to perform compressions. For adults, use both hands on the lower half of the breastbone to perform compressions.Cognitive Level: Applying