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Cardiac Dysrhythmias questions and answers 2023 updated
Describe cardiac dysrhythmia. What is another word for this? any cardiac rhythm that deviates from normal sinus rhythm. Also called arrhythmia Norm... [Show More] al Sinus rhythm originates from where? (THINK HEARTS PACEMAKER) SA node Describe Normal Sinus Rhythm Rate: 60-100 bpm P waves: precede QRS P-R interval: between atrial and ventricular repolarization QRS: ventricular depolarization T wave: Ventricular repolarization Rhythm: Regular Think - normal EKG, normal heart rate, etc Sinus Bradycardia slow rhythm - originating in the SA node 1. pulse less than 60 bpm *Can be life threatening if cause is not found Sinus Tachycardia rapid, regular rhythm originating in the SA node 1. heartbeat 100-150 bpm or more *Considered a normal rhythm and usually not caused by cardiac problem bradycardia can be caused by what? 1. obstructive sleep apnea 2. vomiting 3. intracranial tumors 4. MI 5. medications 6. carotid sinus massage 7. vagal stimulation 8. endocrine disturbances 9. increased intracranial pressure 10. hypothermia When do you typically see clinical manifestations with patients with bradycardia? What are some of these manifestations? when heart rate falls below 50. fatigue, lightheadedness, syncope A patient's sinus bradycardia was found to be caused by SA node dysfunction? How will this patient typically be treated? Artificial pacemaker Management for bradycardia is determined by the cause. For example: If it is caused by: 1. vagal stimulation (bearing down toilet/straining)(vomiting) = administer stool softener or antiemetics 2. Drug related? = blood drawn, drug withheld Altropine (Atreza) does what? increases heart rate Ventricular tachycardia (VT) occurs when 3 or more PVCs occur. Can be deadly, heart rate greater than 100 bpm (140-240 bpm) What do procainamide and aminodarone do? depress cardiac muscle and slow conduction in the atria, bundle of His, ventricles If pharmacologic interventions are unsuccessful in treating VT, what is another treatment option? cardioversion Repeated and prolonged episodes of VT after MI may be a warning of what? What does this condition require? ventricular fibrillation. Requires aggressive evaluation and treatment Premature Ventricular Contractions (PVCs) also called extra systole. - abnormal heartbeats that arise from R/L ventricles. Clinical Manifestation PVCs *depend on frequency of PVCs *some pt. asymptomatic and others - *palpations, weakness, lightheadedness, decreased cardiac output Medical Management for PVCs *focus on treating the underlying heart condition symptomatic PVC treated with: - beta-adrenergic blockers (carvedilol), - antiangials - propranolo - antidysthrymics (procainamde, amiodarone, or lidocaine) PVC can be single event or happen several times. PVCs that last long enough can result in what? death Ventricular Fibrillation !! Medical Emergency !! occurs when ventricles of the heart are quivering. Rapid and disorganized ventricle pulsation Cause of Ventricle Fibrillation myocardial ischemia or infarction untreated VT electrolyte imbalances digitalis or quinidine toxicity hypothermia Clinical Manifestation Ventricle Fibrillation no cardiac output loss of consciousness lack of pulse decrease BP & respirations possible seizures death if untreated Medical Management Ventricle Fibrillation CPR Defibrillation * most effective performed 15-20 seconds of onset to avoid brain damage medications like: lidocaine or procainamide Assessment Cardiac Dysrhythmia S/S Palpitations, skipped beats, nausea, lightheadedness, fatigue, anxiety, vertigo, dyspnea, chest discomfort, ECG monitor indicates dysrhythmia, syncope, irregular pulse, tachycardia, tachypnea, [Show Less]
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Brunner dysrhythmias questions with complete solutions 2023
The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patient's heart? A) P wave B) T wave C) U ... [Show More] wave D) QRS complex Ans: T wave Feedback: The T wave specifically represents ventricular muscle depolarization, also referred to as the resting state. Ventricular muscle depolarization does not result in the P wave, U wave, or QRS complex. The nursing educator is presenting a case study of an adult patient who has abnormal ventricular depolarization. This pathologic change would be most evident in what component of the ECG? A) P wave B) T wave C) QRS complex D) U wave Ans: QRS complex Feedback: The QRS complex represents the depolarization of the ventricles and, as such, the electrical activity of that ventricle. An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show? A) PP interval and RR interval are irregular. B) PP interval is equal to RR interval. C) Fewer QRS complexes than P waves D) PR interval is constant. Ans: Fewer QRS complexes than P waves Feedback: In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis. The nurse is writing a plan of care for a patient with a cardiac dysrhythmia. What would be the most appropriate goal for the patient? A) Maintain a resting heart rate below 70 bpm. B) Maintain adequate control of chest pain. C) Maintain adequate cardiac output. D) Maintain normal cardiac structure. Ans: Maintain adequate cardiac output. Feedback: For patient safety, the most appropriate goal is to maintain cardiac output to prevent worsening complications as a result of decreased cardiac output. A resting rate of less than 70 bpm is not appropriate for every patient. Chest pain is more closely associated with acute coronary syndrome than with dysrhythmias. Nursing actions cannot normally influence the physical structure of the heart. a a The nurse is caring for an adult patient who has gone into ventricular fibrillation. When assisting with defibrillating the patient, what must the nurse do? A) Maintain firm contact between paddles and patient skin. B) Apply a layer of water as a conducting agent. C) Call "all clear" once before discharging the defibrillator. D) Ensure the defibrillator is in the sync mode. Ans: Maintain firm contact between paddles and patient skin. Feedback: When defibrillating an adult patient, the nurse should maintain good contact between the paddles and the patient's skin to prevent arcing, apply an appropriate conducting agent (not water) between the skin and the paddles, and ensure the defibrillator is in the nonsync mode. "Clear" should be called three times before discharging the paddles. A patient who is a candidate for an implantable cardioverter defibrillator (ICD) asks the nurse about the purpose of this device. What would be the nurse's best response? A) "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia" B) "To detect and treat bradycardia, which is an excessively slow heart rate" C) "To detect and treat atrial fibrillation, in which your heart beats too quickly and inefficiently" D) "To shock your heart if you have a heart attack at home" Ans: "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular tachycardia" Feedback: The ICD is a device that detects and terminates life-threatening episodes of ventricular tachycardia and ventricular fibrillation. It does not treat atrial fibrillation, MI, or bradycardia. The nurse is caring for a patient who has just had an implantable cardioverter defibrillator (ICD) placed. What is the priority area for the nurse's assessment? A) Assessing the patient's activity level B) Facilitating transthoracic echocardiography C) Vigilant monitoring of the patient's ECG D) Close monitoring of the patient's peripheral perfusion Ans: Vigilant monitoring of the patient's ECG Feedback: After a permanent electronic device (pacemaker or ICD) is inserted, the patient's heart rate and rhythm are monitored by ECG. This is a priority over peripheral circulation and activity. Echocardiography is not indicated. During a patient's care conference, the team is discussing whether the patient is a candidate for cardiac conduction surgery. What would be the most important criterion for a patient to have this surgery? A) Angina pectoris not responsive to other treatments B) Decreased activity tolerance related to decreased cardiac output C) Atrial and ventricular tachycardias not responsive to other treatments D) Ventricular fibrillation not responsive to other treatments Ans: Atrial and ventricular tachycardias not responsive to other treatments Feedback: Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing. Angina, reduced activity tolerance, and ventricular fibrillation are not criteria. A nurse is caring for a patient who is exhibiting ventricular tachycardia (VT). Because the patient is pulseless, the nurse should prepare for what intervention? A) Defibrillation B) ECG monitoring C) Implantation of a cardioverter defibrillator D) Angioplasty Ans: Defibrillation Feedback: Any type of VT in a patient who is unconscious and without a pulse is treated in the same manner as ventricular fibrillation: Immediate defibrillation is the action of choice. ECG monitoring is appropriate, but this is an assessment, not an intervention, and will not resolve the problem. An ICD and angioplasty do not address the dysrhythmia. A patient converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin and Cardizem are given. The nurse caring for the patient understands that the main goal of treatment is what? treatment is what? A) Decrease SA node conduction B) Control ventricular heart rate C) Improve oxygenation D) Maintain anticoagulation Ans: Control ventricular heart rate Feedback: Treatment for atrial fibrillation is to terminate the rhythm or to control ventricular rate. This is a priority because it directly affects cardiac output. A rapid ventricular response reduces the time for ventricular filling, resulting in a smaller stroke volume. Control of rhythm is the initial treatment of choice, followed by anticoagulation with heparin and then Coumadin. The nurse and the other members of the team are caring for a patient who converted to ventricular fibrillation (VF). The patient was defibrillated unsuccessfully and the patient remains in VF. According to national standards, the nurse should anticipate the administration of what medication? "type answer" treatment is what? A) administer Epinephrine 1 mg IV push B) Control ventricular heart rate C) Improve oxygenation D) Maintain anticoagulation Ans: Epinephrine 1 mg IV push Feedback: Epinephrine should be administered as soon as possible after the first unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic medications such as amiodarone and licocaine are given if ventricular dysrhythmia persists. The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient? A) Start lifting the arm above the shoulder right away to prevent chest wall adhesion. B) Avoid cooking with a microwave oven. C) Avoid exposure to high-voltage electrical generators. D) Avoid walking through store and library antitheft devices. Ans: Avoid exposure to high-voltage electrical generators. Feedback: High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function. A patient is brought to the ED and determined to be experiencing symptomatic sinus bradycardia. The nurse caring for this patient is aware the medication of choice for treatment of this dysrhythmia is the administration of atropine. What guidelines will the nurse follow when administering atropine? A) Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. B) Administer atropine as a continuous infusion until symptoms resolve. C) Administer atropine as a continuous infusion to a maximum of 30 mg in 24 hours. D) Administer atropine 1.0 mg sublingually. Ans: Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg. Feedback: Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5 minutes to a maximum total dose of 3.0 mg is the medication of choice in treating symptomatic sinus bradycardia. By this guideline, the other listed options are inappropriate. An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement? A) Clean the skin with providone-iodine solution. B) Ensure that the area for electrode placement is dry. C) Apply tincture of benzoin to the electrode sites and wait for it to become "tacky." D) Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth. Ans: Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth. Feedback: An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. Disinfecting the skin is unnecessary and conduction gel is used. The nurse is caring for a patient who has just undergone catheter ablation therapy. The nurse in the step-down unit should prioritize what assessment? A) Cardiac monitoring B) Monitoring the implanted device signal C) Pain assessment D) Monitoring the patient's level of consciousness (LOC) Ans: Cardiac monitoring Feedback: Following catheter ablation therapy, the patient is closely monitored to ensure the dysrhythmia does not reemerge. This is a priority over monitoring of LOC and pain, although these are valid and important assessments. Ablation does not involve the implantation of a device. The ED nurse is caring for a patient who has gone into cardiac arrest. During external defibrillation, what action should the nurse perform? A) Place gel pads over the apex and posterior chest for better conduction. B) Ensure no one is touching the patient at the time shock is delivered. C) Continue to ventilate the patient via endotracheal tube during the procedure. D) Allow at least 3 minutes between shocks. Ans: Ensure no one is touching the patient at the time shock is delivered. Feedback: In external defibrillation, both paddles may be placed on the front of the chest, which is the standard paddle placement. Whether using pads, or paddles, the nurse must observe two safety measures. First, maintain good contact between the pads or paddles and the patient's skin to prevent leaking. Second, ensure that no one is in contact with the patient or with anything that is touching the patient when the defibrillator is discharged, to minimize the chance that electrical current will be conducted to anyone other than the patient. Ventilation should be stopped during defibrillation. A group of nurses are participating in orientation to a telemetry unit. What should the staff educator tell this class about ST segments? A) They are the part of an ECG that reflects systole. B) They are the part of an ECG used to calculate ventricular rate and rhythm. C) They are the part of an ECG that reflects the time from ventricular depolarization through repolarization. D) They are the part of an ECG that represents early ventricular repolarization. Ans: They are the part of an ECG that represents early ventricular repolarization. Feedback: ST segment is the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave. The part of an ECG that reflects repolarization of the ventricles is the T wave. The part of an ECG used to calculate ventricular rate and rhythm is the RR interval. The part of an ECG that reflects the time from ventricular depolarization through repolarization is the QT interval. 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Types of dysrhythmias correctly answered 2023
Sinus bradycardia -ECG: HR <60 bpm, rhythm regular -S/sx: pale, cool skin; hypotension, weakness, angina, dizziness or syncope; confusion or disorientati... [Show More] on; and shortness of breath Treat: atropine. if that's ineffective, transcutaneous pacing, or a dopamine or epi infusion Sinus tachycardia -ECG: HR 101-200 bpm, rhythm regular -Treat: depends on underlying cause (treat pain if caused by pain) -S/sx: dizziness, dyspnea, hypotension -Associations: exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardia ischemia, heart failure, hyperthyrodism, anxiety, and fear Premature atrial contraction (PAC) -Contraction starting from an ectopic focus in the atrium and coming sooner than the next expected sinus beat -ECG: HR varies, rhythm irregular. P wave has a different shape, or it may be hidden in the T wave -S/sx: may report palpations or that heart "skipped a beat" -Treat: b-blockers -Associations: emotional stress, physical fatigue, tobacco, caffeine, or alcohol. Hypoxia, electrolyte imbalances, hyperthyroidism, COPD, heart disease Paroxysmal supraventricular tachycardia (PSVT) a dysrhythmia starting in an ectopic focus anywhere above the split of the bundle of His -S/sx: prolonged episode and HR >180 bpm will cause decreased CO b/c of reduced stroke volume. Hypotension, palpations, dyspnea, and angina Treat: vagal stimulation and drugs -Associations: overexertion, emotional stress, deep inspiration, caffeine, and tobacco. Rheumatic heart disease, CAD, cor pulmonale Atrial flutter -Atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in teh right atrium -ECG: atrial rate 200-300 bpm, regular. Ventricular rate ~150, regular -Treat: b blockers and Ca channel blockers. radiofrequency catheter ablation. -Associations: CAD, HTN, mitral valve disorders, pulmonary embolus, chronic lung disease, cor pulmonale, cardiomyopathy, hyperthyroidism, and the use of drugs like digoxin, quinidine, and epi ** these pts have increased risk for stroke Atrial fibrillation -Total disorganization of atrial electrical activity b/c of multiple ectopic foci, resulting in loss of effective atrial contraction -ECG: atrial rate 350-600. P waves replaced by chaotic fibrillatory waves. Ventricular rhythm irregular -Treat: Ca channel blockers, b-blockers, dronedarone, digoxin. Electrical cardioversion. If drugs or cardioversion doesn't work, long term Warfarin. -Associations: usually develops in pt with underlying heart disease. Acutely develops with alcohol intoxication, caffeine use, electrolyte disturbances, cardiac surgery, and stress. **results in decrease in CO. Thrombi form in the atria because of blood stasis. An embolized clot may develop and move to the brain, causing a stroke Junctional dysrhythmia -Start in the area of the AV node, they result because the SA node fails to fire or the signal is blocked ECG: HR 40-60 (junctional escape) HR 61-100 (accelerated junctional). 101-180 (junctional tachycardia). Rhythm regular. P wave abnormal in shape and inverted, or may be hidden by QRS complex -Treat: atropine -Associations: CAD, heart failure, cardiomyopathy, electrolyte imbalances, inferior MI, and rheumatic heart disease **they serve as a safety mechanism when the SA node hasn't been effective. accelerated junctional rhythm is due to sympathetic stimulation to improve CO Ventricular fibrillation -ECG: HR not measurable. Rhythm irregular and chaotic. P wave not visible, and the PR interval and QRS interval aren't measurable. -Treat: immediate initiation of CPR and advanced cardiac life support with the use of efibrillation and definitive drug therapy -Associations: occurs in acute MI and myocardial ischemia and in heart failure and cardiomyopathy. can occur in cardiac pacing or cardiac catheterization procedures. also electric shock, hyperkalemia, hypoxemia, acidosis, and drug toxicity **results in unresponsive, pulseless and apneic state, if not rapidly treated, patient won't recover Asystole -The total absence of ventricular activity -Treat: CPR with initiation of ACLS measures. These include definitive drug therapy with epi and/or vasopressin and intubation -Associations: usually a result of advanced cardiac disease, a severe cardiac conduction system disturbance, or end-stage heart failure **usually they have end-stage heart disease or has prolonged arrest and can't be resuscitated [Show Less]
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Chapter 29- Drugs for Dysrhythmias with complete solutions 2023
The client has a diagnosis of junctional rhythm. The nurse would expect to find which of the following during the assessment of vital signs? a. Heart ra... [Show More] te < 30 b. Heart rate 40-60 c. Heart rate 60-100 d. Heart rate 100-120 Answer: b. Heart rate 40-60 Objective: Classify dysrhythmias based on their location and type of rhythm abnormality. Rationale: The AV node has a property of automaticity and can generate action potentials and continue heart contractions of 40-60 beats per minute. Cognitive Level: Assessment Client Need: Physiological Integrity Nursing Process: Application The nurse in the telemetry unit explains two nonpharmacological treatments such as ___________, or ___________, can be used to treat dysrhythmias. a. ECG; pacemaker b. Cardioversion; defibrillation c. Aspirin; Plavix d. Exercise; stress test Answer: b. Cardioversion; defibrillation Objective: Identify the importance of nonpharmacological therapies in the treatment of dysrhythmias. Rationale: The more serious types of dysrhythmias are corrected through electrical shock of the heart, a treatment called elective cardioversion, or defibrillation. Cognitive Level: Implementation Client Need: Health Promotion and Maintenance Nursing Process: Comprehension The client is scheduled for implantable cardioverter defibrillators (ICD) for treatment of a dysrhythmia. The nurse explains that the action of this procedure is to: a. Trigger electrical impulses to the heart. b. Take over SA node function. c. Block AV node transmission of impulses. d. Increase ventricular conduction. Answer: a. Trigger electrical impulses to the heart. Objective: Identify the importance of nonpharmacological therapies in the treatment of dysrhythmias. Rationale: Implantable cardioverter defibrillators (ICD) are placed in clients to restore normal rhythm by either pacing the heart or giving it an electric shock when dysrhythmias occur. Temporary cessation of electrical activity will stimulate the ICD to release a charge to the SA node to automatically return conduction to normal sinus rhythm. Cognitive Level: Implementation Client Need: Health Promotion and Maintenance Nursing Process: Application A priority nursing intervention for a client receiving quinidine sulfate (Quinidex) for treatment of dysrhythmias is: a. Monitoring for GERD. b. Monitoring respiratory status. c. Monitoring for constipation. d. Monitoring blood glucose. Answer: b. Monitoring respiratory status. Objective: Know representative drug examples for each of the drug classes listed in Drugs at a Glance, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: Quinidine can cause an arterial embolism related to formation of small clots in the atrium that occur while the client is treated for atrial fibrillation. Cognitive Level: Implementation Client Need: Physiological Integrity Nursing Process: Analysis The nurse recognizes that the action of beta blockers for treatment of dysrhythmias is: a. Positive inotropic effect. b. Negative inotropic effect. c. Positive chronotropic effect. d. Negative chronotropic effect. Answer: d. Negative chronotropic effect. Objective: Identify the primary mechanisms of antidysrhythmic drugs. Rationale: Beta blockers slow the heart rate (negative chronotropic effect) and decrease conduction velocity through the AV node. Cognitive Level: Evaluation Client Need: Physiological Integrity Nursing Process: Knowledge A client with a diagnosis of cardiac dysrhythmias and a history of type I diabetes mellitus is placed on propranolol therapy. The client asks the nurse if the drug will affect insulin needs. The best response by the nurse would be that: a. The drug will have no effect on insulin needs. b. The drug might cause hypoglycemia. c. The drug could cause hyperglycemia. d. The client should ask the physician this question. Answer: b. The drug might cause hypoglycemia. Objective: Know representative drug examples for each of the drug classes listed in Drugs at a Glance, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: There is increased incidence of hypoglycemia with type I diabetes mellitus, because propranolol can inhibit glycogenolysis. Cognitive Level: Implementation Client Need: Health Promotion and Maintenance Nursing Process: Synthesis The nurse notes third-degree heart block on the EKG of a client receiving diltiazem (Cardizem) for treatment of a supraventricular dysrhythmia. The appropriate action by the nurse is to: a. Administer the next dose as prescribed, and monitor the EKG. b. Hold the next dose, document the EKG finding, and notify the physician. c. Treat the heart block, and continue the Cardizem. d. Increase IV fluids, and administer half the dose of Cardizem. Answer: b. Hold the next dose, document the EKG finding, and notify the physician. Objective: Describe the nurse's role in the pharmacologic management of clients with dysrhythmias. Rationale: Diltiazem (Cardizem) should never be given to clients with sick sinus syndrome, heart block, hypotension, cardiogenic shock, or severe HF. The drug can produce lethal ventricular dysrhythmias. Cognitive Level: Implementation Client Need: Physiological Integrity Nursing Process: Analysis The nurse discusses mineral therapy with a client diagnosed with atrial fibrillation. Which of the following deficiencies will the nurse most likely discuss with the client? a. Iron b. Calcium c. Magnesium d. Sodium Answer: c. Magnesium Objective: Use the nursing process to care for clients receiving drug therapy for dysrhythmias. Rationale: Magnesium deficiency is associated with dysrhythmias, including atrial fibrillation, premature atrial and ventricular contractions, ventricular tachycardia, and ventricular fibrillation. This might be related to its role in maintaining intracellular potassium. Cognitive Level: Implementation Client Need: Health Promotion and Maintenance Nursing Process: Application The nurse adjusts the care plan of a client of Asian descent who is receiving propranolol to include increased monitoring of: a. Heart rate. b. Blood pressure. c. Glucose. d. Potassium. Answer: a. Heart rate. Objective: Use the nursing process to care for clients receiving drug therapy for dysrhythmias. Rationale: Studies show that lack of the drug-metabolizing enzyme mephenytoin hydroxylase causes Asians to metabolize propranolol more quickly than do Caucasians. The nurse should assess for high early buildup and overdose. Cognitive Level: Planning Client Need: Physiological Integrity Nursing Process: Synthesis When planning care for a client receiving treatment for cardiac dysrhythmias, an appropriate client outcome would be: a. The client will avoid use of caffeine during therapy. b. The client will maintain heart rate below 60 beats per minute. c. The client will limit fluid intake to 1000 mL/day. d. The client will limit cigarettes to 15/day. Answer: a. The client will avoid use of caffeine during therapy. Objective: Use the nursing process to care for clients receiving drug therapy for dysrhythmias. Rationale: Causes of dysrhythmias include electrolyte imbalance, hyperthyroidism, anxiety, caffeine ingestion, and tobacco use. The client should be taught to avoid caffeine and tobacco. Cognitive Level: Planning Client Need: Physiological Integrity Nursing Process: Application A client with type 1 diabetes on insulin therapy reports that he takes propranolol (Inderal) for his hypertension. The nurse will teach the client to check glucose levels more frequently because of what concern? 1. The propranolol can produce insulin resistance. 2. The two drugs used together will increase the risk of ketoacidosis. 3. propranolol will increase insulin requirements by antagonizing the effects at the receptors. 4. The propranolol may mask symptoms of hypoglycemia Answer: 4. The propranolol may mask symptoms of hypoglycemia Rationale: Beta blockers such as propranolol decrease the body's adrenergic "fight-or-flight" resposes and may diminish or mask the symptoms and signals of hypoglycemia that a client with diabetes normally perceives as blood glucose drops. Options a, b and c are incorrect. Beta blockers may inhibit glycogenolysis, resulting in hypoglycemia, and have no effect on the development of insulin resistance. Cognitive Level: Analyzing Nursing Process: Implementation Client Need: Physiological Integrity When monitoring for therapeutic effect of any antidysrhythmic drug, the nurse would be sure to assess which essential parameter? 1. Pulse 2. Blood pressure 3. Drug level 4. Hourly urine output Answer: 1. Pulse Rationale: In the absence of ECG monitoring, the nurse would assess the pulse for rate, regularity, quality, and volume, noting any changes. The nurse should also teach the client to monitor the pulse for rate and regularity, before sending the client home. Options b, c, and d are incorrect. The nurse is monitoring for the therapeutic effects of antidysrhythmic therapy. Although blood pressure and drug level may also be monitored, they do not evaluate the therapeutic effects of the drug. Urine output may change related to the type of drug given and any effects on cardiac output, but frequent output monitoring is not indicated in routine antidysrhythmic therapy and will not assess for therapeutic drug effect. Cognitive Level: Analyzing Nursing Process: Evaluation Client Need: Physiological Integrity Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in clients with which cardiovascular condition? 1. Hypertension 2. Tachycardia 3. Heart Failure 4. Angina Answer: 3. Heart Failure Rationale: Calcium channel blockers such as verapamil (Calan) are used cautiously or are contraindicated in clients with heart failure because the drug may cause bradycardia, which may precipitate or worsen heart failure. Options a, b and d are incorrect. Verapamil and calcium channel blockers are often prescribed to treat hypertension, tachycardia, and angina. Cognitive Level: Analyzing Nursing Process: Assessment Client Need: Physiological Integrity Common adverse effects of antidysrhythmic medications include which of the following? (Select all that apply) 1. Hypotension 2. Hypertension 3. Dizziness 4. Weakness 5. Panic attacks Answers: 1. Hypotension 3. Dizziness 4. Weakness Rationale: Because antidysrhythmics can slow the heart rate, the client may experience hypotension, dizziness, or weakness. Options b and e are incorrect. Some antidysrhythmics classes such as beta blockers and calcium channel blockers are used in the treatment of hypertension, which is a therapeutic rather than adverse effect of the drug. Antidysrhythmics are not used in the treatment of panic disorders. Cognitive Level: Analyzing Nursing Process: Assessment Client Need: Physiological Integrity [Show Less]
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Dysrhythmia questions and answers 2023 updated
mechanical and electrical activity correlation between the electrical and mechanical functions of the heart electrical activity stimulates the heart to c... [Show More] ontract ECG shows both functions electrical pulse = action potential videos https://www.youtube.com/watch?v=nGIsS6c7pBA https://www.youtube.com/watch?v=nGIsS6c7pBA what's the difference between telemetry and ECG? ECG is diagnostic while telemetry monitors rhythm changes Cardiac monitoring is used to diagnose dysrhythmias, chamber enlargement, Mycoardial ischemia or infarction, monitor effects of electrolye imbalances of medication administration. Cardiac electrical activity can be monitored by an ECG. 12 - lead, ambulatory (Holter monitoring), or telemetry. For continuous monitoring or telemetry most monitors use 2-4 electrodes. These electrodes create an imaginary line, called a lead, that serves a reference point from which the electrical activity is viewed. A lead is like an eye of a camera - it has a narrow peripheral view, looking only at the electrical activity directly in front of it. The electrical impulse that travels through the heart can be viewed by means of electrocardiography, the end product of which is an electrocardiogram. Each phase of the cardiac cycle is reflected by specific waveforms on the screen of a cardiac monitor or on a strip of ECG graph paper. In other words, it represents the function of the heart's conduction system. ECG can show ischemia, infarction, enlarged cardiac chambers, electrolyte imbalances, drug toxicity. placing telemetry leads white goes on right black opposite white "grass under snow" (green) "fire under smoke" (red) brown in the middle changes leads for shower (remove old, shower, add new) placing EKG electrodes 12-lead EKG, we only put on 10 leads 4 limb 2 saddle the sternum 4 on the left side of the chest client needs to remain still and breathe normally properties of cardiac cells conductivity contractility automaticity excitability refractoriness Conductivity: transmit electrical impulses across cell membranes and from cell to cell. Contractility: A/V muscle cells shorten fiber lengths to propel blood forward during contraction. Automaticity: Ability of cardiac cells to initiate an impulse (primary pacemaker cells). Excitability: Ability to respond to stimulus and then depolarize. Refractoriness: Cells unable to respond to stimulus until recovered from previous stimulus (repolarization). Although the SA node and AV node ordinarily initiate the pacing of the heart, all of the cells have the capability of doing so. Depolarization: normally negatively charge cells developing a positive charge. Depolarization produces mechanical contractions. arrhythmia no rhythm dysrhythmia abnormal rhythm classified by the site of origin: -SA node -Atrial -AV node -ventricular PQRST complex one heart beat P wave SA node fires at the beginning the wave itself shows the atria contracting P wave: atrial depolarization (contraction); PR interval conduction from SA to AV normal is 0.12-0.20 sec (3-5 dots) PR interval: beginning of P wave to end of PR interval: atrial depolarization, AV delay and travel time to purkinje fibers. 0.12 - 0.20. QRS complex conduction from AV node to Purkinje fibers ventricular contraction normal is < 0.10 sec (2.5 dots) QRS complex: ventricular depolarization (contraction). Time required for depolarization of both ventricles: 0.04-0.10. QT interval QT interval: ventricular depolarization + repolarization. QT may be prolonged with some medications; can be a dangerous sign. ST segment ST segment: early ventricular repolarization. Should not be elevated more than 1 mm or 1 line above or depressed more than 0.5 mm (1/2 line below). Elevated ST segment indicates an MI: STEMI or NSTEMI. Depressed means ischemia. T wave ventricles are relaxed and filling during this time, they won't respond to stimulation we want a wide T wave, but not one that's too tall T wave: ventricular repolarization: resting and cannot respond to a stimulus. Rhythm Strip Analysis 1. Determine Regularity (of R waves): -determine underlying rhythm (regular or irregular) -"March it across" (calipers) and make sure the spacing between each QRS peak is equal 2. Calculate the (ventricular) rate: -dots = 0.04 sec -boxes = 0.2 sec -hashtags = 3 sec -if patient has a regular rhythm, count the peaks between 3 hashmarks (6 seconds) and multiply by 10 to get a rough estimate of the heart rate OR -count # of small squares between 2 consecutive R ways and divide this number into 1500 (1500/23 boxes = 65 bpm) 3. Assess the P waves: -present? -P for every QRS (1:1)? -are they all the same? 4. Measure the PR interval: -normal (0.12-0.20)? -consistent? -pattern? 5. Measure the QRS complex: -normal (<0.10)? -are they all the same? normal sinus rhythm HR 60-100bpm regular rhythm P waves are identical and present before each QRS PR interval 0.12-0.20 QRS <0.12 when rhythms are NOT normal Cardiac dysthrmias are heartbeat disturbances (beat formation, beat conduction). The terms dysrhythmias and arrhythmias are used interchangeably. In reality, dysrhythmia means abnormal rhythm and arrhythmia means absent rhythm. Dysrhythmias are classified by the site of origin: SA node, Atrial, AV node, ventricular. ectopy FLB (funny little beats) causes of dysrhythmia cardiac: -valve issues -cardiomyopathy -heart failure -MI -conduction defects pulmonary: -hypoxia -acidosis other: -electrolyte imbalance (K+) -blunt trauma -drugs -caffeine -electrical shock -hypoglycemia -hypothermia -clots [Show Less]
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Chapter 31: Concepts of Care for Patients with Dysrhythmias 2023
31-1 Which priority concept does the nurse focus on when a client is diagnosed with a dysrhythmia? A. Clotting B. Fluid & Electrolytes C. Perfusio... [Show More] n D. Acid-base balance C 31-2 Which normal hr does the nurse expect to be initiated by the primary pacemaker of the heart (SA node) in clients when the heart is regular? SATA A. 55 bpm B. 62 bpm C. 74 bpm D. 86 bpm E. 98 bpm F. 110 bpm B, C, D, E 31-3 Which waveform does the nurse recognize as atrial depolarization when a client is placed on a cardiac monitor? A. P wave B. PR segment C. QRS complex D. T wave A [Show Less]
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Chapter 23: Drugs Used to Treat Dysrhythmias with complete solutions 2023
What is the action of amiodarone (Cordarone), a class III agent used to treat cardiac dysrhythmias? It slows the rate of electrical conduction and prolong... [Show More] s the time between contractions. How many milligrams of lidocaine will the nurse administer via intravenous (IV) bolus to a 30-year-old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction? 75 A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do? Change positions slowly. A patient who is started on phenytoin (Dilantin), who is also taking amiodarone (Cordarone), should be assessed for what possible effect? Increase in serum phenytoin levels Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias? Injectable lidocaine without preservative Patients who are on neuromuscular blocking agents and lidocaine must be closely observed for which complication? Respiratory depression Which statement is true regarding the antidysrhythmic agent adenosine (Adenocard)? It is a naturally occurring chemical in the body. Amiodarone is contraindicated for patients with which condition? Severe sinus node dysfunction causing bradycardia The patient recently prescribed quinidine is at highest risk for which common adverse effect? Diarrhea Which symptom will the nurse encourage the patient taking flecainide to report to the health care provider? Weight gain A patient is admitted to the acute care telemetry unit with a diagnosis of atrial fibrillation. The physician orders dofetilide (Tikosyn). Before initiating this medication, the nurse will assess potassium level. A patient is admitted to the telemetry unit with a diagnosis of cardiovascular disease. When performing the initial assessment, the nurse records blood pressure in the left arm of 142/84, blood pressure in the right arm of 138/80, temperature of 98.8° F, and radial pulse of 80 that is weak and irregular. The nurse should notify the physician regarding pulse only. The nurse is assessing a patient who was recently admitted to the emergency department with dysrhythmias and shortness of breath. Which baseline nursing assessment(s) should be the priority(ies)? (Select all that apply.) a. ECG monitoring b. Medication history c. Oxygen saturation d. Presence of chest pain, dyspnea, and fatigue e. Mental status The nurse is preparing to administer adenosine to a patient with supraventricular tachycardia. Which consideration(s) should the nurse take into account before administration? (Select all that apply.) a. Constant ECG monitoring is necessary. c. Rapid IV bolus administration is recommended. d. Saline flush following bolus is necessary. [Show Less]
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Dysrhythmias & Treatments questions with complete solutions 2023
What are cardiac dysrhythmias? abnormal rhythms of the heart's electrical system that can affect its ability to effectively pump oxygenated blood througho... [Show More] ut the body What are the two questions you ask yourself when you have a patient with a dysrhythmia? 1. Is the patient symptomatic? (diaphoresis, light headed, unresponsive, decreased LOC, decreased BP, tachy/brady) 2. Is the heart going to wear out keeping this up? Electrical changes in cardiac cells primarily involve the movement of what across the cell membrane? The movement of Na+, K+ and Ca++ across the cell membrane What happens to the cardiac cells during the resting state (polarization)? cells in ready state and no current is flowing What happens to the cardiac cells during depolarization? Na+ rushes into cell ↓ Ca++ enters slowly, as K+ leaves slowly ↓ This electrical activity stimulates cells to contract What happens to the cardiac cells during repolarization? cells return to resting state What is the inherent rate of the SA node at rest? 60-100 Where is the SA node located? Right atrium After the SA node and the atria, where does the impulse go? AV node Describe the normal conduction pathway, step by step: The sino-atrial (SA) node ↓ The atrio-ventricular (AV) node ↓ The bundle of His ↓ The left and right bundle branches ↓ The Purkinje fibres Define automaticity: the ability of myocardial cells to initiate electrical impulses (the SA node, AV node, His-Purkinjie are considered to be the "pacemaker" cells) Define excitability: ability of the myocardial cells to respond to electrical stimulus Define conductivity: ability of the myocardial cells to receive electrical stimulus and send it on Define contractility: ability of myocardial cells to contract in response to electrical stimuli Where does the white lead go when placing the 5 electrodes? "White on the right" (underneath the clavicle) Where does the black lead go when placing the 5 electrodes? "Smoke above fire" (underneath the left clavicle) Where does the red lead go when placing the 5 electrodes? "Fire!" (below the smoke, or the black lead, at the base of the left rib cage) Where does the green lead go when placing the 5 electrodes? "Clouds above grass" (below the white and brown, at the base of the right rib cage, directly across from the red) Where does the brown lead go when placing the 5 electrodes? A dog taking a pooo below the white clouds onto the green grass below ahaha What does the P wave represent? atrial depolarization What does the QRS represent? ventricular depolarization What does the T wave represent? ventricular repolarization [Show Less]
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Cardiac Dysrhythmias Test Bank Questions correct answers verified
The nurse assesses a client's ECG tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation... [Show More] ? 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. D. Ventricular and atrial depolarizations are initiated from different sites. Rationale: Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarizatoin is initiated at the SA node. QRS complexes without a P wave indicate a different source of initiation of depolarization. This finding on an ECG tracing is not an indication of hyperkalemia, ventricular tachycardia, or disconnection of leads. 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? A. Make certain that your bath water is warm. B. Avoid straining while having a bowel movement. C. Limit your intake of caffeinated drinks to one a day. D. Avoid strenuous exercise such as running. B. Avoid straining while having a bowel movement. Rationale: 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 result is not desirable in a person who has bradycardia. The other instructions are not appropriate for this condition. A nurse is assessing clients on a med-surg unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation? A. A 45-year-old who takes an aspirin daily. B. a 50-year-old who is post coronary artery bypass surgery. C. A 78-year-old who had a carotid endarterectomy. D. An 80-year-old with COPD. B. a 50-year-old who is post coronary artery bypass surgery. Rationale: 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. A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition? A. Sinus tachycardia B. Speech Alterations C. Fatigue D. Dyspnea with activity B. Speech Alterations Rationale: 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. 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? A. Solatol (Betapace) B. Warfarin (Coumadin) C. Atropine (Sal-Tropine) D. Lidocaine (Xylocaine) B. Warfarin (Coumadin) Rationale: A-fib puts clients at risk for developing emboli. Clients at risk for developing emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication. [Show Less]
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EKG and Dysrhythmias NCLEX with correct answers rated A+ 2023
Answer: D. A pulse would be assessed for first. Then the patient will be defibrillized and chest compressions will begin immediately. You are the nurse wo... [Show More] rking on the telemetry unit and you have finally gotten to sit down to work on some charting. Suddenly the heart monitors at the station start beeping. Patient in room 18 is showing this rhythm on the monitor. The medical team advances together into the room and finds them unconscious. What is priority action by the nurse? A) Prepare to administer adenosine to the patient B) Begin chest compressions C) Prepare for defibrillation D) Check for a pulse Answer: C. Anemia can contribute to sinus tachycardia. The nurse sees the following rhythm on the monitor. Which of the following lab values does the nurse identify as being most likely to have caused this dysrhythmia? a) K 3.0 b) Ca 10.5 c) Hgb 9 d) Magnesium 2.1 Answer: A. Following defibrillation, CPR is immediately initiated if a perfusable rhythm is not initiated. The client may need to be shocked again, but chest compressions must begin first. The patient who has recently been experiencing runs of ventricular tachycardia suddenly loses consciousness. The patient is defibrillated, and the rate returns as the following. What should the nurse do first? A) Begin compressions B) Shock the client again immediately C) Prepare for intubation D) Administer adenosine Answer: B. Antiarrhythmic medications are prescribed with the use of an ICD in order to prevent the tachycardic (or other deadly arrhythmia) from occurring in the first place. This makes sure that the ICD is used only when absolutely necessary. A patient with cardiomyopathy has been given an ICD. Which of the following medications would the nurse expect to see in the MAR for this patient? A) Warfarin B) Cardizem C) Nitroglycerin D) Digoxin Answer: B. Atrial flutter places the client at high risk for development of clot formation in the atria. Because the client is stable at this time, cardioversion or adenosine would not be performed at this time. Before cardioversion can occur in a patient, anticoagulant therapy should be begun at least 48 hours beforehand if possible. The patient with a history of hypertension and diabetes has the following rhythm strip. The patient's vitals are as follows: BP 145/89, HR 90, SpO2 95%, RR 19. Which of the following does the nurse expect to do at this time? a) Prepare the client for cardioversion STAT b) Begin administering anticoagulants c) Grab the crash cart for administration of adenosine d) Teach the client about possibility of pacemaker installation Answer: A, B, and D. Adenosine is administered as a very quick IV push. The physician must be present in the room and the crash cart must be on hand. An ekg monitor should be in the room to monitor the effectiveness of the medication. The nurse is preparing to administer adenosine to the patient with the following rhythm which is symptomatic. What should the nurse plan on having in the patient room? a) Physician b) Crash cart c) IV pump d) EKG monitor e) Lidocaine Answer: B. This finding would be expected upon administration of adenosine. The rhythm should then begin again in some other rhythm, hopefully normal sinus rhythm. It would be important to document the exact time of this change and continue to monitor the change back to NSR. If this change does not occur, or if another rhythm is produced, appropriate action would then be taken based on the result. The nurse has just administered adenosine via IV push and sees the following rhythm on the monitor. What is the nurse's priority intervention? a) Apply conductive gel and defibrillate the patient b) Document the findings and continue to monitor c) Administer another mg of the medication d) Begin chest compressions Answer: B. With SVT (Supraventricular tachycardia), the first thing to do would be to instruct the pt. to perform the Valsalva maneuver by bearing down. You, the nurse, note the following rhythm on the EKG monitor for a patient named billy. What is the first thing the nurse should do? a) Check for a pulse b) Tell Billy to try to poop c) Prepare to defibrillate billy d) Prepare to administer Amiodorone Answer(s): 2, 3 The ATRIAL rate is 220-300 bpm. Ventricular is about 75-150. The rhythm is regular, with the P wave appearing as little flutter or a "saw tooth pattern". The PR interval is not measurable r/t this saw-tooth P wave. The QRS is normal. A group of nursing students are discussing atrial flutter. These students recognize that which of the following are seen with atrial flutter? Select all that apply: 1) Ventricular rate of 220-300 bpm. 2) Regular rhythm 3) Saw-tooth pattern 4) Measurable PR interval 5) Long QRS interval Answer: 2) Cardioversion is used if the patient is unstable. Anticoagulants are used if the arrhythmia has stuck around for 48 hr +. Adenosine may be used with a narrow QRS and regular RR interval. I made up Altemose. A nursing student is aware that which of the following is the treatment for unstable atrial flutter? 1) Adenosine (Adenocard) 6 mg rapid IVP. 2) Cardioversion with adjacent Heparin therapy 3) Defibrillation STAT followed by CPR. 4) Altemose 3 mg IVP over 1-2 seconds. Answer: 2) Patients with a-fib are at risk for pulmonary and systemic emboli, and new onset of confusion may indicate a stroke in this patient. Patients with atrial flutter may feel more tired some days than others. A nurse working on a CVT unit receives report from day shift. After receiving report, which patient should the nurse see first? 1) A 23-year-old professional tennis player with a HR of 47 bpm. 2) A 69-year-old male with atrial fibrillation who has new onset confusion. 3) A 72-year-old female with atrial flutter who reports feeling unusually tired today and yesterday. 4) A 33-year-old female with sinus tachycardia who is asking for her at-home Metoprolol. Answer: 1) Although electrolytes are likely the culprit, the nurse first needs to first assess the patient. Then, the nurse should look in the patient's chart and evaluate or request an order for electrolyte levels. This may eventually need to be documented, but the nurse can be held liable for neglect if he/she does not assess the patient first. The physician may or may not need to be contacted. A nurse on a CVT unit views the monitor and sees the patient in room 452 has just begun having occasional PVCs. Which action should the nurse take first? 1) Check on the patient 2) Check last magnesium and potassium levels 3) Document the occurrence and watch for further PVCs 4) Contact the physician Answer: 3) This is describing ventricular tachycardia (QRS is a giveaway), and the treatment for a stable patient is Amiodarone or cardioversion. If the patient were unstable, we'd go ahead and defibrillate. Which of the following does the nursing student realize is the treatment for a stable patient presenting with QRS intervals above 0.12 seconds with a regular rhythm and a rate of 100-250 bpm? 1) Atropine 2) Defibrillation 3) Amiodarone 4) Adenosine Answer: d) We cannot defibrillate asystole. A The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? a) Administer atropine 0.5 mg b) Administer epinephrine c) Defibrillate with 360 joules d) Begin cardiopulmonary resuscitation (CPR) Answer(s): 2, 3, 4, 5 Diarrhea will not stimulate a vagal response, but vomiting can. Chronic constipation will cause a consistent vagal response. Digoxin, beta blockers, and calcium channel blockers can all contribute to first degree blocks. Relate this to bradycardia. A group of nursing students are studying AV blocks and ask their instructor, "what causes a first-degree block?" The nursing instructor responds that which of the following can cause a first-degree block: Select all that apply 1) Diarrhea 2) Chronic constipation 3) Diltiazem 4) Digoxin 5) Metoprolol Answer: 3 Patients with atrial fibrillation are at incredibly high risk for clots, even with anticoagulation therapy. Shortness of breath could indicate a PE, and this should be immediately investigated by the nurse. The patient should be NPO for at least 4 hr. prior to the procedure related to anesthesia use, but this is not as urgent of a concern. The patient should also withhold Digoxin therapy for 48 hours to ensure that, once cardioverted, NSR returns. A 26-year-old client with atrial fibrillation that has not responded to medication therapy has arrived at the hospital for an elective cardioversion. Which of the following patient statements most concerns the nurse? 1) "I can't wait to stop taking this Coumadin. I've been on this crap for weeks now." 2) "I'm starving. I haven't eaten anything in 3 hours." 3) "I feel really short of breath, can I lie down?" 4) "I haven't taken my Digoxin since 9 o'clock last night. Is that okay?" Answer: B - prolonged hiccups indicate pacemaker failure. Other signs and symptoms of pacemaker failure are dysrhythmias, dizziness, faintness, chest pain, shortness of breath, increase or decrease in apical rate. Which of the following signs and symptoms indicate pacemaker failure? a) excessive thirst b) prolonged hiccups c) flushing of the skin d) increased urine output [Show Less]
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