Rhythm Identification
A rhythm has an irregularly irregular rhythm, no distinct P waves, and narrow QRS complexes.
Atrial fibrillation
Your patient has symptomatic sinus bradycardia with a heart rate of 34 bpm. Name the first medication given.
Atropine
Your patient is in new-onset atrial fibrillation with a heart rate of 130 bpm. What is the nurse's priority intervention?
Assess the patient's hemodynamic stability.
Name four common symptoms of atrial fibrillation.
Palpitations, fatigue, SOA, dizziness, chest discomfort
What is the greatest long-term complication of atrial fibrillation?
Stroke
What is the major difference between synchronized cardioversion and defibrillation?
Cardioversion synchronizes with the R wave; defibrillation does not.
A patient has a narrow-complex tachycardia with a heart rate of 190 bpm. P waves cannot be identified.
SVT
A patient is in atrial fibrillation with rapid ventricular response. Name two medications commonly used for rate control.
Diltiazem, Metoprolol, Verapamil
A stable patient develops SVT. What nursing intervention should be attempted before medication? Name 2.
Vagal maneuvers.
Blowing through a straw and valsalva maneuver
Name four symptoms commonly associated with symptomatic bradycardia.
hypotension, altered mental status, chest pain, weakness, SOA, syncope
Frequent PVCs increase the risk of developing which life-threatening dysrhythmia?
Ventricular tachycardia
Why is adenosine administered as a rapid IV push followed immediately by a saline flush?
It has an extremely short half-life
Wide, bizarre QRS complexes, HR 165
Ventricular tachycardia
A patient remains in SVT despite vagal maneuvers. Name the medication administered next.
Adenosine
Your patient is in atrial fibrillation with RVR and BP 78/42. What intervention should you anticipate?
Synchronized cardioversion
A patient suddenly reports palpitations, chest pressure, anxiety, and HR 190. Which rhythm is most likely?
SVT
A patient remains in sustained ventricular tachycardia with a pulse for several minutes. What life-threatening complication is most likely to occur if it is not treated?
Cardiac arrest
When would a patient require a permanent pacemaker?
The ECG shows every P wave followed by a QRS complex, but the PR interval is consistently 0.28 seconds.
First degree AV block
A stable patient develops monomorphic ventricular tachycardia with a pulse. What antiarrhythmic medication may be ordered?
Amiodarone
A patient develops symptomatic third-degree heart block. Besides medications, what intervention should the nurse prepare for immediately?
Transcutaneous pacing
A patient develops ventricular tachycardia with a pulse. What assessment findings indicate the patient is becoming unstable?
hypotension, altered mental status, chest pain, shock, SOA
A patient with second-degree AV block Type II is not treated. What rhythm are they at high risk of progressing to?
Third-degree heart block
A patient is receiving transcutaneous pacing. The monitor shows pacer spikes followed by wide QRS complexes, but the patient remains pulseless. What is occurring?
The patient has electrical capture but no mechanical capture. The nurse should begin CPR if pulseless, assess for a palpable pulse, and notify the provider immediately.
The ECG demonstrates complete AV dissociation. P waves march through independently of the QRS complexes.
Third degree (complete) heart block
A patient is in ventricular fibrillation. Name two medications that could be given.
Epinephrine and Amiodarone
Your patient suddenly becomes pulseless in ventricular tachycardia. List three nursing actions.
CPR, defibrillation, epinephrine
Your patient becomes unconscious with no pulse after frequent PVCs. What rhythm has likely developed?
Complete heart block can rapidly progress to which rhythm if untreated?
Asystole
A patient has frequent PVCs occurring every third beat (trigeminy), a potassium level of 2.9 mEq/L, and a magnesium level of 1.4 mg/dL. What is the priority nursing intervention, and why?
Replace potassium and magnesium as ordered because electrolyte abnormalities increase myocardial irritability and place the patient at high risk for ventricular tachycardia and ventricular fibrillation.