Iggy Chapter 34: Care of Patients with Dysrhythmias
74. According to the Vaughn-Williams classification of antidysrhythmics, which class II drug controls dysrhythmias associated with excessive beta-adrenergic stimulation? a. Amiodarone b. Propranolol c. Diltiazem d. Verapamil
b. Propranolol
46. Which are causes of atrial irritability and premature atrial contractions (PACs)? SATA a. Stress b. Caffeine c. Syncope d. Anxiety e. Infection f. Pulmonary hyPOtension
A, B, D, E
40. A patient has an invasive temporary pace-maker. In what ways does the nurse ensure the patient's safety related to electrical issues with the pacemaker? (select all that apply) a. Ensure that external ends of the lead wires are insulated with rubber gloves. b. Loop the wire ends and cover with non-conductive tape. c. Ensure that no electrical equipment is used in the patient's room. d. Report frayed wire to the biomedical engineering department. e. Wash hands before touching any of the wires. f. Notify the HCP if the pacemaker fails to captureand pace the heart
A, B, D, F
29. The nurse is evaluating a patients ECG strip. ST segment elevation of 1.5mm (1.5 small blocks) is noted. Which conditions may be indicated by this ST elevation? a. Myocardial Infarction b.Hyperkalemia c. Hypokalemia d. Ventricular Hypertrophy e. Pericarditis f. Endocarditis
A, B, E
21. The nurse is assessing a patient's ECG rhythm strip and analyzing the P waves. Which questions does the nurse use to evaluate the P waves? (SATA) a. Are P waves present? b. Are the P waves occurring regularly? c. Does one P wave follow each QRS complex? d. Are the P waves greater than 0.20 second? e. Do all the P waves look similar? f. Are the P waves smooth, rounded, and upright in appearance?
A, B, E, F
41. Which statements about permanent pacemakers are accurate? SATA a. They treat conduction disorders such as complete heart block b. They are powered by lithium batteries that can last for 20 years or more c. They are available as pacemaker/defibrillator devices d. Biventricular permanent pacemakers Allow synchronized depolarization of the ventricles e. The pulse generator is usually implanted in the subclavian area f. The pt should be taught to avoid lifting his/her arm over the head for at least 6 months
A, C, D, E
54. Traditionally, what medications will most likely be ordered for a patient with AF? (select all that apply) a Diltiazem hydrochloride (Cardizem) b. Furosemide (Lasix) c. Heparin d. Enoxaparin (Lovenox) e. Sodium warfarin (Coumadin) f. Metoprolol
A, C, D, E, F
83. For the patient who has been defibrilated d/t V-fib, what other essential interventions are needed ASAP after defibrillation? SATA a. High quality CPR b. Placement of an invasive temporary pacemaker c. Admin of epinephrine, vasopressin, and atropine as appropriate d. ID and correction of the cause of the pulseless rhythm e. Continuous ECG monitoring f. Initiation of ACLS protocols ASAP
A, C, D, E, F
34. Which clinical manifestations are reflections of sustained tachydysrhythmias? a. Chest discomfort b. Moist cyanotic skin c. Palpitations d. Hypertension e. Syncope f. Restlessness
A, C, E, F
A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement should the nurse include in this clients teaching? a. Minimize or abstain from caffeine. b. Lie on your side until the attack subsides. c. Use your oxygen when you experience PACs. d. Take amiodarone (Cordarone) daily to prevent PACs.
ANS: A PACs usually have no hemodynamic consequences. For a client experiencing infrequent PACs, the nurse should explore possible lifestyle causes, such as excessive caffeine intake and stress. Lying on the side will not prevent or resolve PACs. Oxygen is not necessary. Although medications may be needed to control symptomatic dysrhythmias, for infrequent PACs, the client first should try lifestyle changes to control them.
A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services. Which priority information should be communicated to the home health nurse upon discharge? a. Medication reconciliation b. Immunization history c. Religious beliefs d. Nutrition preferences
ANS: A The home health nurse needs to know current medications the client is taking to ensure assessment, evaluation, and further education related to these medications. The other information will not assist the nurse to develop a plan of care for the client.
A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring. Which statement should the nurse provide to the UAP related to this procedure? a. Clean the skin and clip hairs if needed. b. Add gel to the electrodes prior to applying them. c. Place the electrodes on the posterior chest. d. Turn off oxygen prior to monitoring the client.
ANS: A To ensure the best signal transmission, the skin should be clean and hairs clipped. Electrodes should be placed on the anterior chest, and no additional gel is needed. Oxygen has no impact on electrocardiographic
3. A nurse is teaching a client with premature ectopic beats. Which education should the nurse include in this clients teaching? (Select all that apply.) a. Smoking cessation b. Stress reduction and management c. Avoiding vagal stimulation d. Adverse effects of medications e. Foods high in potassium
ANS: A, B, D A client who has premature beats or ectopic rhythms should be taught to stop smoking, manage stress, take medications as prescribed, and report adverse effects of medications. Clients with premature beats are not at risk for vasovagal attacks or potassium imbalances.
A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations should the nurse assess? (Select all that apply.) a. Decrease in cardiac output b. Increase in cardiac output c. Decrease in blood pressure d. Increase in blood pressure e. Decrease in urine output f. Increase in urine output
ANS: A, D, E Elevated heart rates in a healthy client initially cause blood pressure and cardiac output to increase. However, in a client who has congestive heart failure or a client with long-term tachycardia, ventricular filling time, cardiac output, and blood pressure eventually decrease. As cardiac output and blood pressure decrease, urine output will fall.
A nurse is assessing clients on a medical-surgical 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 graft surgery c. A 78-year-old who had a carotid endarterectomy d. 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.
A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this clients medication administration record to prevent a common complication of this condition? a. Sotalol (Betapace) b. Warfarin (Coumadin) c. Atropine (Sal-Tropine) d. 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.
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.
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.
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
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.
A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action should the nurse take prior to the initiation of cardioversion? a. Administer intravenous adenosine. b. Turn off oxygen therapy. c. Ensure a tongue blade is available. d. Position the client on the left side.
ANS: B For safety during cardioversion, the nurse should turn off any oxygen therapy to prevent fire. The other interventions are not appropriate for a cardioversion. The client should be placed in a supine position.
After assessing a client who is receiving an amiodarone intravenous infusion for unstable ventricular tachycardia, the nurse documents the findings and compares these with the previous assessment findings: Vital Signs Nursing Assessment Time: 0800 Temperature: 98 F Heart rate: 68 beats/min Blood pressure: 135/60 mm Hg Respiratory rate: 14 breaths/min Oxygen saturation: 96% Oxygen therapy: 2 L nasal cannula Client alert and oriented. Cardiac rhythm: normal sinus rhythm. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Time: 1000 Temperature: 98.2 F Heart rate: 50 beats/min Blood pressure: 132/57 mm Hg Respiratory rate: 16 breaths/min Oxygen saturation: 95% Oxygen therapy: 2 L nasal cannula Client alert and oriented. Cardiac rhythm: sinus bradycardia. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Client voids 420 mL of clear yellow urine. Based on the assessments, which action should the nurse take? a. Stop the infusion and flush the IV. b. Slow the amiodarone infusion rate. c. Administer IV normal saline. d. Ask the client to cough and deep breathe.
ANS: B IV administration of amiodarone may cause bradycardia and atrioventricular (AV) block. The correct action for the nurse to take at this time is to slow the infusion, because the client is asymptomatic and no evidence reveals AV block that might require pacing. Abruptly ceasing the medication could allow fatal dysrhythmias to occur. The administration of IV fluids and encouragement of coughing and deep breathing exercises are not indicated, and will not increase the clients heart rate.
18. The nurse has four patients on telemetry monitors and is analyzing the ECG rhythm strips for assigned pts. What is her 1st action? a. Analyze the P waves b. Determine the heart rate c. Measure the QRS duration d. Measure teh PR interval
b. Determine the heart rate
A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the clients electrocardiogram. Which action should the nurse take next? a. Administer intravenous diltiazem (Cardizem). b. Assess vital signs and level of consciousness. c. Administer sublingual nitroglycerin. d. Assess capillary refill and temperature.
ANS: B In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen without subsequent QRS complexes imply loss of capture. If there is no capture, then there is no ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and level of consciousness. The other interventions would not determine if the client is tolerating the loss of capture.
After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. I should wear a snug-fitting shirt over the ICD. b. I will avoid sources of strong electromagnetic fields. c. I should participate in a strenuous exercise program. d. Now I can discontinue my antidysrhythmic medication.
ANS: B The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields. Clients should avoid tight clothing, which could cause irritation over the ICD generator. The client should be encouraged to exercise but should not engage in strenuous activities that cause the heart rate to meet or exceed the ICD cutoff point because the ICD can discharge inappropriately. The client should continue all prescribed medications.
A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment should the nurse complete next? a. Pulmonary auscultation b. Pulse strength and amplitude c. Level of consciousness d. Mobility and gait stability
ANS: C A heart rate of 40 beats/min or less with widened QRS complexes could have hemodynamic consequences. The client is at risk for inadequate cerebral perfusion. The nurse should assess for level of consciousness, light- headedness, confusion, syncope, and seizure activity.
A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response? a. Decreased intraocular pressure b. Increased heart rate c. Short period of asystole d. Hypertensive crisis
ANS: C Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea, and chest pain. Adenosine has no conclusive impact on intraocular pressure.
A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions should the nurse implement to address this clients concerns? a. Administer oxygen therapy at 2 liters per nasal cannula. b. Provide the client with a sleeping pill to stimulate rest. c. Schedule periods of exercise and rest during the day. d. Ask unlicensed assistive personnel to help bathe the client.
ANS: C Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing activities of daily living. The nurse should schedule periods of exercise and rest during the day to decrease fatigue. The other interventions will not assist the client with self-care activities.
50. What are the risk factors for AF? (select all that apply) a. Chronic obstructive pulmonary disease (COPD) b. Hypertension c. Peripheral Vascular Disease d. Diabetes mellitus e. Valvular disease f. Excessive alcohol use
B, D, E, F
A nurse assesses a clients electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation? a. The client has hyperkalemia causing irregular QRS complexes. b. Ventricular tachycardia is overriding the normal atrial rhythm. c. The clients chest leads are not making sufficient contact with the skin. d. 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.
A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client? a. Make sure the defibrillator is set to the synchronous mode. b. Administer 1 mg of intravenous epinephrine. c. Test the equipment by delivering a smaller shock at 100 joules. d. Ensure that everyone is clear of contact with the client and the bed.
ANS: D To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and ensures their compliance before delivery of the shock. A precordial thump can be delivered when no defibrillator is available. Defibrillation is done in asynchronous mode. Equipment should not be tested before a client is defibrillated because this is an emergency procedure; equipment should be checked on a routine basis. Epinephrine should be administered after defibrillation.
61. The nurse is taking the initial history and vital signs on a patient with fatigue. The nurse notes a regular apical pulse of 130 beats/min. Which contributing factors does the nurse assess for? (select all that apply) a. Anxiety or stress b. Fever c. Hypovolemia d. Anemia or hypoxemia e. Hypothyroidism f. Constipation
Abcd
84. A patient has no pulse and the cardiac monitor shows VF. Which drugs does the nurse prepare to administer during the resuscitation? (select all that apply) a. Lidocaine b. Epinephrine c. Calcium chloride d. Amiodarone hydrochloride (Cordarone) e. Dopamine hydrochloride (Intropin) f. Magnesium sulfate
Abdf
79. A patient has had synchronized cardioversion for unstable VT. Which interventions does the nurse include in the patient's care after the procedure? (select all that apply) a. administer therapeutic hypothermia b. Assess vital signs and the level of consciousness. c. Administer antidysrhythmic drug therapy d. Monitor for dysrhthmias e. Monitor for loss of capture f. Assess for chest burns from electrodes
B, C, D, F
71. Excessive vagal simulation can result form which activities? (select all that apply) a. Jogging b. Carotid sinus massage c. Suctioning d. Voiding e. Valsalva maneuver f. Bearing down as if having a BM
B, C, E, F
90. The nurse is teaching a patient with an ICD. What instruction does the nurse emphasize to the patient? SATA a. Rest for several hours after an internal defibrillator shock before resuming activities b. Have family members step away during the internal defibrillator shock for safety c. Expect that the shock may feel like a thud or a painful kick in the chest. d. Report any pulse rate higher than what is set on the pacemaker e. Expect to cope with the discomfort and fear associated with having an ICD shock the heart
C, E
27. With the speed set for 25 mm/second, the segment between the dark lines on a monitor ECG strip represents how many seconds? a 3 b. 6 c. 10 d. 20
a
7. What is the normal measurement of the QRS complex in an ECG? a Less than 0.12 second b. 0.10 to 0.16 second c. 0.12 to 0.20 second d. 0.16 to 0.24 second
a Less than 0.12 second
37. The nurse is assisting the provider to perform temporary pacing for a patient who has atropine-refractory symptomatic bradycardia. What is the desired outcome for this patient as evidenced by the cardiac monitor? a. No spike, but a complete QRS complex indicating atrial depolarization b A spike followed by a QRS complex indicating ventricular depolarization c. Two spikes, followed by a QRS complex indiccating ventricular depolarization d. A spike before and after a QRS complex indicating atrial depolarization
b A spike followed by a QRS complex indicating ventricular depolarization
4. The nurse is performing the shift assessment on a cardiac patient. In order to determine if the patient has a pulse deficit, what does the nurse do? a. Take the patients BP and subtract diastolic from systolic b. Take their pulse in supine then standing positions c. Assess the apical and radial pulses for a full minute and observe for differences. d. Take the radial pulse, have pt. rest for 15 minutes, then retake pulse
d. Take the radial pulse, have pt. rest for 15 minutes, then retake pulse
69. A patient is diagnosed with torsades de pointes. The nurse prepares to administer which emergency medication? a. Magnesium sulfate b. Epinephrine (Adrenalin) c. Adesnosine (Adenocard) d. Calcium chloride
a. Magnesium sulfate
14. The nurse is reviewing preliminary ECG results of a patient admitted for mental status changes. The nurse alerts the health care provider about ST elevation or depression in the patient because it is an indication of which condition? a. Myocardial injury or ischemia b. Ventricular irritability c. Subarachnoid hemorrhage d. Prinzmetal's angina
a. Myocardial injury or ischemia
49. Based on the prevalence and risk factors for atrial fibrillation (AF), which patient group is at highest risk for AF? a. Older adults b. Diabetics c. Substance abusers d. Pediatric cardiology patients
a. Older adults
8. What is the normal position of the ST segment in an ECG? a. Isoelectric b. Elevated c. Depressed d. Biphasic
a. Isoelectric
44. Which dysrhythmia results in asynchrony of atrial contraction and decreased cardiac output? a. Sinus tachycardia b. Atrial flutter c. Atrial fibrillation d. First-degree atrioventricular block
c. Atrial fibrillation
1. What does stimulation of the sympathetic nervous system produce? a. Delayed electrical impulse that causes hypotension and bradypnea b. Contractility and dilation of coronary vessels and increased heart rate. c. Virtually no effect on the ventricles of the heart or vital signs d. A slowed AV conduction time that results in a slow heart rate
b. Contractility and dilation of coronary vessels and increased heart rate.
89. Which descriptions are characteristic of a class III antidysrhythmic? (select all that apply) a. Lengthens the absolute refractory period b. Increases the force of contraction c. Includes hypertension as a side effect d. Prolongs repolarization e. Includes bradycardia as a side effect f. Prolongs the QT interval
A, D, E
A nurse teaches a client with a new permanent pacemaker. Which instructions should the nurse include in this clients teaching? (Select all that apply.) a. Until your incision is healed, do not submerge your pacemaker. Only take showers. b. Report any pulse rates lower than your pacemaker settings. c. If you feel weak, apply pressure over your generator. d. Have your pacemaker turned off before having magnetic resonance imaging (MRI). e. Do not lift your left arm above the level of your shoulder for 8 weeks.
ANS: A, B, E The client should not submerge in water until the site has healed; after the incision is healed, the client may take showers or baths without concern for the pacemaker. The client should be instructed to report changes in heart rate or rhythm, such as rates lower than the pacemaker setting or greater than 100 beats/min. The client should be advised of restrictions on physical activity for 8 weeks to allow the pacemaker to settle in place. The client should never apply pressure over the generator and should avoid tight clothing. The client should never have MRI because, whether turned on or off, the pacemaker contains metal. The client should be advised to inform all health care providers that he or she has a pacemaker.
43. The nurse is teaching a patient with a permanent pacemaker. What information about the pacemaker does the nurse tell the patient? (select all that apply) a. Report any pulse rate lower than what is set on the pacemaker. b. If the surgical incision is near the shoulder, avoid overextending the joint. c. Keep handheld cellular phones at least 6 inches away from the generator. d. Avoid sources of strong electro magnetic fields, such as magnets. e. Avoid strenuous activities that may cause the device to discharge inappropriately f. Carry a pacemaker identification card and wear a medical alert bracelet
Acdf
48. The patient has sustained SVT and the health care provider orders IV adnosine. Which important actions must the nurse perform when this drug is given? ( select all that apply) a. Inject the drug slowly over one minute. b. Have emergency equipment at the bedside. c. Follow the drug injection with a normal saline bolus. d. Have injectable beta blocker drugs at the bedside. e. Monitor the patient for bradycardia, nuasea, and vomiting f. Prepare for synchronized cardioversion immediately after giving adenosine
B, C, E
19. A patient's ECG rhythm strip is irregular. Which method does the nurse use for an accurate assessment? a. 6-second strip method b. Memory emthod c. Big block method d. Commerical ECG rate ruler
a. 6-second strip method
57. A patient with atrial fibrillation is scheduled to have an elective cardioversion. The nurse ensures that the patient has a prescription for 4-6 week supply of which ytpe of medication? a. Anticoagulants b. Digitalis c. Diuretics d. Potassium supplements
a. Anticoagulants
5. What does the P wave in an ECG represent? a. Atrial depolorization b. Atrial repolarization c. Ventricular depolarization d. Ventricular repolarization
a. Atrial depolorization
56. A patient has an implantable cardioverter defibrillator (ICD). In cardioversion shock, the defibrillator is set in the synchronized mode to do what? a. Avoid discharging the shock during the T wave b. Discharge the shock during the R wave c. Discharge the shock during the T wave d. Avoid discharging the shock during the Q wave
a. Avoid discharging the shock during the T wave
70. In a patient's record, the nurse notes frequent episodes of bradycardia and hypotension related to unintended vagal stimulation. Which instruction for this patient's care does the nurse relay to the unlicensed assistive personnel (UAP)? a. Avoid raising the patient's arms above the head during hygiene. b. Ambulate the patient slowly and stop frequently for brief rests c. Generously lubricate rectal thermometer probes and insert very cautiously d. Monitor the heart rate and rhythm if the patient is vomiting
a. Avoid raising the patient's arms above the head during hygiene.
67. The nurse is interviewing a patient who suddenly becomes faint, immediately loses consciousness, and becomes pulseless and apneic. There is no blood pressure, and heart sounds are absent. The RN has called for help. What does the nurse do next? a. Begin compressions. b. Defibrillate the patient c. Establish or ensure IV access d. Give supplemental oxygen
a. Begin compressions.
82. A patient is found pulseless and the cardiac monitor shows a rhythm that has no recognizable deflections, but instead has coarse "waves" of varying amplitudes. What is the priority ACLS intervention for this rhythm? a. Immediate defibrillation b. Administration of epinephrine IVP c. Administration of lidocaine IVP d. Noninvasive temporary pacing
a. Immediate defibrillation
93. What beta-blocker drug approved for use in dysrhythmias is also a class III anti-dysrhythmic drug? a. Sotalol b. Esmolol c. Acebutolol d. Propanolol
a. Sotalol
85. Once ACLS resuscitation has begun after the patients cardiac arrest, what is the Med-Surg RNs role? a. To provide info about the pt including a brief summary of the patients medical condition and the events that occured up until the time of cardiac arrest b. To take the role of medication RN and admin drugs as ordered by the team leader c. To remove all unnecessary equipment and people from the room so that the ACLS interventions can be performed more effectively d. To take any family members or friends to a quiet area and remain with them offering them emotional support
a. To provide info about the pt including a brief summary of the patients medical condition and the events that occured up until the time of cardiac arrest
96. What is the heart rate from an ECG strip when there are 25 small blocks from one R wave to the next R wave? a. 50/minute b. 60/minute c. 70/minute d. 80/minute
b. 60/minute
91. The nurse is teaching a community group how to use an AED. What is the first step for using the AED that the nurse teaches? a. Rescuer presses the "analyze" button on the machine b. Place the patient on a firm, dry surface c. Rescuer stops CPR and directs anyone present to move away d. Place two large adhesive-patch electrodes on the patient's chest
b. Place the patient on a firm, dry surface
92. The nurse is interviewing a patient with spontaneous VT who may be a possible candidate for an ICD. The nurse senses that the patient is anxious. What is the nurse's most therapeutic response? a "Your feelings are natural; patients report psychological distress related to ICD." b. "ICD is similar to defibrillation, which saved your life during the last episode" c. "You seem anxious. What are your concerns about having this treatment?" d. "Would you like to talk to the doctor about the details of the procedure?"
c. "You seem anxious. What are your concerns about having this treatment?"
6. What is the normal measurement of the PR interval in an ECG? a. Less than 0.11 second b. 0.06 to 0.10 second c. 0.12 to 0.20 second d. 0.16 to 0.26 second
c. 0.12 to 0.20 second
86. A patients monitor shows new onset A-fib and the pt is scheduled for an elective cardioversion. The RN sets the biphasic defibrillator on synchronous mode to deliver how many joules? a. 40-80 b. 80-120 c. 120-200 d. 200-360
c. 120-200
30. What is the heart rate shown on a 6-second ECG strip when the number of R-R intervals is 5? What is this rhythm? a. 30/minute bradycardia b. 40/minute bradycardia c. 50/minute bradycardia d. 60/minute normal
c. 50/minute bradycardia
3. The nurse is taking vital signs ad reviewing the electrocardiogram (ECG) of a patient who is training for a marathon. The heart rate is 45 beats/min and the ECG shows sinus bradycardia. How does the nurse interpret this data? a. A rapid filling rate that lengthens diastolic filling time and leads to decreased cardiac output b. The body's attempt to compensate for a decreased stroke volume by decreasing the heart rate c. An adequate stroke volume that is associated with cardiac conditioning d. A common finding in the health adult that would be considered normal
c. An adequate stroke volume that is associated with cardiac conditioning
94. After advanced cardiac life support (ACLS) is performed, a patient who experienced VF has a return of spontaneous circulation. To protect the patient's nervous system, which intervention does the nurse anticipate with be performed? a. Neurologic checks every 4 hours b. Administration of IV mannitol c. Application of a cooling blanket d. Continuous ECG monitoring
c. Application of a cooling blanket
87. The nurse is performing external defibrillation. Which step is most vital in this procedure? a. Place the gel pads anterior over the apex and posterior for better conduction b. Do not administer a second shock for 1 minute to allow for recharging c. No-one must touch the patient at the time a shock is delivered d. Continuously ventilate the patient via endotracheal tube during the defibrillation
c. No-one must touch the patient at the time a shock is delivered
22. The nurse is assessing a patient's ECG rhythm strip and notes that occasionally the QRS complex is missing. How does the nurse interpret this finding? a. A junctional impulse b. A supraventricular impulse c. Ventricular tachycardia d. A dysrhythmia
d. A dysrhythmia
28. Which components measure ECG waveforms? a. BP and cardiac output (CO) b. Seconds and minutes c. Heart rate per minute d. Amplitude (voltage) and duration (time)
d. Amplitude (voltage) and duration (time)
17. The nurse is notified by the telemetry monitor technician about a patient's heart rate. Which method does the nurse use to confirm the technician's report? a. Count QRS complexes in a 6-second strip and multiply by 10 b. Analyze an ECG rhythm strip by using an ECG cliper c. Run an ECG rhythm strip and use the memory emthod d. Assess the patient's heart rate directly by taking an apical pulse
d. Assess the patient's heart rate directly by taking an apical pulse
95. Which medication does an adult patient with VG or pulseless VT receive? a. Propranolol (Inderal) b. Adenosine (Adenocard) c. Diltiazem hydrochloride (Cardizem) d. Epinephrine (Adrenalin chloride)
d. Epinephrine (Adrenalin chloride)
88. What effects does class IV drugs have on the cardiac conduction system? a. Stabilize membranes to decreases myocardial contractility b. Decrease HR and conduction velocity c. Lengthen the absolute refractory period and prolong repolarization d. Slow the flow of Ca into the cell during depolarization to depress automaticity
d. Slow the flow of Ca into the cell during depolarization to depress automaticity
58. Which are nursing responsibilities after the patient receives an elective cardioversion to establish a normal heart rhythm? SATA a. Maintain an open airway b. Remove O2 devices c. Assess VS and LOC d. Document results of the cardoversion e. Provide sips of water or ice chips f. Monitor for dysrhythmias
A, C, D, F
16. Which actions are the responsibilities of the monitor tech? (SATA) a. Watch the bank of monitors on a unit b. Notify the health care provider of any changes c. Print routine ECG strips d. Apply battery-operated transmitter leads to patients. e. Interpret the rhythms f. Report patient rhythm and significant changes to the nurse
A, C, E, F
31. How does the nurse interpret the measurement of the PR interval when the interval to be measured is six small boxes on the ECG strip? a. Atrium is taking longer to repolarize b. Longer-than-normal impulse time from the SA node to the ventricles is shown. c. There is a problem with the length of time the ventricles are depolarizing d. This is the normal length fo time for the P-R interval.
b. Longer-than-normal impulse time from the SA node to the ventricles is shown.
23. The student nurse is looking at a patient's ECG rhythm strip and suspects a normal sinus rhythm (NSR) Which ECG criteria are included for NSR? (SATA) a. Rate: Atrial and ventricular rates of 40 to 120 beats/min b. Rhythm: Atrial and ventricular rhythms regular c. P waves: Present, consistent configuration, one P wave before each QRS complex d. P-R interval 0.24 second e. QRS duration: 0.04 to 0.10 second and constant f. One P wave before each QRS complex
B, C, E, F
42. A patient has had a permanent pacemaker surgically implanted. What are the nursing responsibilities for the care of this patient related to the surgery? (select all that apply) a. Administer short-acting sedatives b. Assess the implantation site for bleeding, swelling, redness, tenderness, infection c. Teach about and monitor for the initial activity restrictions d. Observe for overstimulation of the chest wall, which could lead to pneumothorax e. Monitor the ECG rhythm to check that the pacemaker is working correctly f. Assess that the implantation site dressing is clean and dry
B, C, E, F
36. Which definition best describes the synchronous (demand) pacing mode? a. The pacemaker continues to fire at a fixed rate as set on the generator b. The pacemaker's sensitivity is set to sense the patient's own beats c. Electrical pulses are transmitted through two large external electrodes then transcutaneously to stimulate ventricular depolarization d. External battery-operated pulse generator on one end and wires in contact with the heart on the other end
b. The pacemaker's sensitivity is set to sense the patient's own beats
64. The cardiac monitor of a post-op pt Shows 4 successful PVCs. How does the RN interpret this finding? a. The ECG monitor is showing artifact b. The pt had an episode of non-sustained ventricular tachycardia c. The monitor is showing 2 PVC couplets in a row d. This rhythm may lead to idioventricular rhythm as seen in the dying heart
b. The pt had an episode of non-sustained ventricular tachycardia
65. The remote telemetry technician alerts the nurse to the presence of premature ventricular contractions (PVCs) in a newly admitted patient. the patients room has a new bed-side monitor. How does the nurse assess whether the premature complexes are providing perfusion to the extremities? a. Palpate peripheral arteries while observing the monitor for widened complexes. b. Auscultate for the apical heart sounds and listen for irregularities or pauses c. Check the color and temperature of extremities, and capillary refill of fingers and toes d. Assess the ECG strip for regularity and width of QRS complexes
a. Palpate peripheral arteries while observing the monitor for widened complexes.
10. The nurse is performing a 12-lead ECG on a patient with chest pain. Because the positioning of the electrodes is crucial, how does the nurse place the ECG components? a. Four leads are placed on the limbs and six are places on the chest n. The negative electrode is placed on the left arm and the positive electrode is placed on the right leg c. Four leads are placed on the limbs and four are placed on the chest d. The negative electrode is placed on the right arm and the positive electrode is placed on the left leg
a. Four leads are placed on the limbs and six are places on the chest
51. A patient with AF suddenly develops shortness of breath, chest pain, hemoptysis, and a feeling of impending doom. The nurse recognizes these symptoms as which complication? a. Pulmonary embolism b. Embolic stroke c. Absence of atrial kick d. Increased cardiac output
a. Pulmonary embolism
53. The patient has a diagnosis of paroxysmal atrial fibrillation. Which statement is most accurate about this diagnosis? a. The patient experiences an episode within 7 days that converts back to sinus rhythm b. The patient experiences episodes of AF that occur for longer than 7 days c. The patient remains in AF and a decision is made not to restore or maintain sinus rhythm d. The patient experiences AF in the absence of mitral valve disease or repair
a. The patient experiences an episode within 7 days that converts back to sinus rhythm
78. The patient with episodes of stable V-tach is scheduled to have an elective cardioversion. Which patient info will the RN report immediately to thwe HCP? a. The patient is prescribed Digoxin 0.125mg daily b. The patients urine output for the past 24 hours was 2100 c. The patients monitor shows runs of 12-20 PVCs d. The patient takes a multivitamin daily
a. The patient is prescribed Digoxin 0.125mg daily
45. Which dysrhythmia causes the ventricles to quiver, resulting in absence of cardiac output? a. Ventricular tchycardia b. Ventricular fibrillation c. Asystole d. Third-degree heart block
b. Ventricular fibrillation
2. The primary pacemaker of the heart, the sinoatrial (SA) node, is functional if a patient's pulse is at what regular rate? a. Fewer than 60 beats/min b. 60 to 100 beats/min c. 80 to 100 beats/min d. Greater than 100 beats/min
b. 60 to 100 beats/min
24. The heart monitor of a patient shows a rhythm that appears as a wandering or fuzzy baseline. What is the priority action for the nurse? a. Immediately obtain a 12-lead ECG to assess the actual rhythm b. Assess the patient to differentiate artifact from actual lethal rhythms c. Check to see if the patient has a DNR order d. Ask the patient care technician to take vital signs on the patient
b. Assess the patient to differentiate artifact from actual lethal rhythms
75. Which drug for symptomatic bradycardia does the nurse prepare to administer to a patient with bradydysrhythmia? a. Epinephrine b. Atropine c. Calcium d. Lidocaine
b. Atropine
73. A patient reports chest pain and dizziness after exertion, and the family reports a concurrent new onset of mild confusion in the patient, as well as difficulty concentrating. What is the priority problem for this patient? a. Activity intolerance b. Decreased cardiac output c. Acute confusion d. Inadequate oxygenation
b. Decreased cardiac output
26. The remote telemetry technician calls the nurse to report that a patient's ECG signal transmission is not very clear. What does the nurse do to enhance the transmission? a. Clean the skin with povidone-iodine solution before applying the electrodes b. Ensure that the area for the electrode placement is dry and nonhairy c. Apply tincture of benzoin to the electrode sites and allow it to dry d. Abrade the skin by rubbing briskly with a rough washcloth
b. Ensure that the area for the electrode placement is dry and nonhairy
80. The nurse discovers a patient is unconscious and without palpable pulses and immediately initiates CPR. For what reason is CPR started on this patient? a. To identify the underlying heart rhythm b. For the rapid return of a pulse, blood pressure, and consciousness c. To prevent rib fractures or lacerations of the liver and spleen d. To mimic cardiac function until the defibrillator arrives
b. For the rapid return of a pulse, blood pressure, and consciousness
32. The nurse hears in report that a patient has sinus arrhythmia. In order to validate that this is associated with the changes in intrathoracic pressure, what does the nurse do next? a. Count the respiratory and pulse rate at rest and then count both rates after moderate exertion b. Observe that the heart rate increases slightly during inspiration and decreases slightly during exhalation. c. Ask the patient to hold the breath and take an apical pulse; then have the patient resume normal breathing. d. Have the patient take a deep breath and count the patient apical pulse rate while the patient slowly exhales
b. Observe that the heart rate increases slightly during inspiration and decreases slightly during exhalation
20. The nurse is assessing a patient's ECG rhythm strip and checking the regularity of the atrial rhythm. What is the correct technique? a. Place one caliper point on a QRS complex; place the other point on the precise spot on the next QRS complex b. Place one caliper point on a P wave; place the other point on the precise spot on the next P Wave c. Place one caliper point at the beginning of the P wave; place the other point at the end of the P-R segment d. Place one caliper point at the beginning of the QRS complex; place and the other point where the S-T segment begins
b. Place one caliper point on a P wave; place the other point on the precise spot on the next P Wave
33. The nurse is reviewing a patient's ECG and interprets a wide distorted QRS complex of 0.14 second followed by a P wave. What does this finding indicate? a. Wide but normal complex, and no cause for concern b. Premature ventricular contraction c. Problem with the speed set on the ECG machine d. Delayed time for the electrical impulse through the ventricles
b. Premature ventricular contraction
35. The nurse is monitoring a sleeping patient. The monitor shows that the HR increases slightly during inspiration and decreases slightly during exhalation. Which cardiac dysrhythm does the nurse document? a. Normal sinus rhythm b. Sinus arrythmia c. Sinus bradycardia d. Sinus Tachycardia
b. Sinus arrythmia
77. The respiratory therapist (RT) and the medical student are ventilating a patient in cardiac arrest, while the nurse and provider are preparing the patient and equipment for intubation. At which point does the nurse intervene? a. The RT inserts an oropharyngeal airway b. The medical student sets the oxygen flow meter at 2 L/min c. The RT ventilates with a manual resuscitation bag and mask d. The medical student uses the chin-lift position on the patient
b. The medical student sets the oxygen flow meter at 2 L/min
13. A patient in the telemetry unit is having continuous ECG monitoring. The patient is scheduled for a test in the radiology department. Who is responsible for determining when monitoring can be suspended? a. Telemetry technician b. Charge nurses c. Health care provider d. Primary nurse
c. Health care provider
52. A patient scheduled to have elective cardioversion for AF will receive drug therapy for about 6 weeks before the procedure. What information about the drug therapy does the nurse teach the patient? a. Managing orthostatic hypotension b. Watching for bleeding signs c. Eating potassium-rich food sources d. Reporting muscle weakness or tremors
b. Watching for bleeding signs
68. A patient is in full cardiac arrest and CPR is in progress. The ECG monitor shows ventricular fibrillation. What does the nurse expect will be the next intervention? a. The pt will have an endotracheal tube placed b. the pt will be defibrillated using the asynchronous mode c. The HCP will insert a CL for emergency drug admin d. Family will be escorted to a waiting area and updated as needed
b. the pt will be defibrillated using the asynchronous mode
38. The provider has completed the placement of lead wires for the invasive temporary pace-maker in a patient who is asystolic. In turning on a pacing unit, which setting does the nurse use? a. Synchronous pacing mode b. Demand pacing mode c. Asynchronous pacing mode d. Temporary pacing mode
c. Asynchronous pacing mode
60. The nurse is caring for a patient with coronary artery disease. The pt reports palpitations and chest discomfort, and the RN notes a tachydysrhythmia on the ECG monitor. What does the RN do next? a. Analyze the ECG strip b. Notify the HCP c. Give supplemental O2 d. Admin a narcotic analgesic
c. Give supplemental O2
11. Cardiac dysrhythmias are abnormal rhythms of the heart's electrical system. How does this affect the heart's function? a. It cannot oxygenate the blood throughout the body b. It cannot remove carbon dioxide from the body c. It cannot effectively pump oxygenated blood throughout the body d. It cannot effectively conduct impulses with increased acitivyt
c. It cannot effectively pump oxygenated blood throughout the body
72. The nurse is caring for several patients who have dysrhythmia. What does the nurse instruct these patients to do? a. Stay at least 4 feet away from a microwave oven that is operating b. Avoid electronic metal detectors, such as those at airports c. Learn the procedure for assessing the pulse. d. Purchase an automatic external defibrillator (AED) for home use
c. Learn the procedure for assessing the pulse.
15. The nurse is reviewing ECG results of a patient admitted for fluid and electrolyte imbalances. The T waves are tall and peaked. The nurse reports this finding to the provider and obtains an order for which serum level tests? a. Sodium b. Glucose c. Potassium d. Phosphorus
c. Potassium
63. The nurse is reviewing the monitored rhythms of several patients in the cardiac stepdown unit. The patient with which cardiac anomaly has the greatest need of immediate attention? a. Chronic atrial fibrillation b. Paroxysmal supraventricular tachycardia (SVT) that is suddenly terminated c. Sustained rapid ventricular response d. Sinus tachycardia with premature atrial complexes
c. Sustained rapid ventricular response
81. AED electrodes are placed on a patient who is unconscious and pulseless. The nurse prepares to immediately defibrillate if the monitor shows which cardiac anomaly? a. Third-degree heart block b. Pulseless electrical activity c. VF d. Idioventricular rhythm
c. VF
12. The nurse is caring for several patients in the telemetry unit who are being remotely watched by a monitor technician. What is the nurse's primary responsibility in the monitoring process of these patients? a. Watching the bank of monitors on the unit b. Printing ECG rhythm strips routinely and as needed c. Interpreting rhythm d. Assessment and management of pts
d. Assessment and management of pts
62. The nurse is taking a history and vital signs on a patient who has come to the clinic for a routine checkup. The patient has a pulse rate of 50 beats/min, but denies any distress. What does the nurse do next? a. Give supplemental oxygen b. Establish IV access c. Complete the health history d. Check the blood pressure
d. Check the blood pressure
76. Which Safety precaution must be taken before defibrillation a pt with V-fib or pulse-less V-tach a. Make sure that the defibrillator is set on synchronous mode b. Disconnect the monitor leads to prevent electrical shorts c. be sure to hyperventilate the pt before defibrillation d. Command all health care team members to stand clear of the pts bed
d. Command all health care team members to stand clear of the pts bed
66. What is the primary significance in ventricular tachycardia in a cardiac patient? a. It increases ventricular filling time therefore increasing CO b. It signals that the pt needs K+ supplement for replacement c. It warrants immediate initiation of CPR d. It is commonly the initial rhythm before deterioration in to V-fib
d. It is commonly the initial rhythm before deterioration in to V-fib
39. The nurse in the telemetry unit must perform transcutaneous pacing. When should transcutaneous pacing be used? a. When a patients rhythm strip shows atrial fibrillation b. Only when a patients ECG demonstrates a bradydysrhythmia c. When a patient is experiencing syncope and dizziness d. Only as a temporary emergency measure until a more permanent pacing method can be started
d. Only as a temporary emergency measure until a more permanent pacing method can be started
47. A patient is diagnosed with *recurrent* supra-ventricular tachycardia (SVT). What does the nurse do in order to accomplish the preferred treatment? a. Place the patient on the cardiac monitor and perform carotid massage b. Give oxygen and establish IV access for antidysrhythmic drugs c. Assist the provider in attempting atrial overdrive pacing d. Provide information about radiofrequency catheter ablation therapy.
d. Provide information about radiofrequency catheter ablation therapy. Catheter ablation is used to treat abnormal heart rhythms (arrhythmias) when medicines are not tolerated or effective. Medicines help to control the abnormal heart tissue that causes arrhythmias. Catheter ablation destroys the tissue. Catheter ablation is a low-risk procedure that is successful in most people who have it.
9. What is the total time required for ventricular depolarization and repolarization as represented on the ECG? a. PR interval b. QRS complex c. ST segment d. QT interval
d. QT interval
59. The patient with A-fib is not a candidate for long-term anitcoagulation therapy. Which procedure is contraindicated for this patient? a. Biventricular pacing b. Elective cardioversion c. Transthoracic pacing d. Radiofrequency catheter ablation
d. Radiofrequency catheter ablation
55. A patient is about to undergo elective cardioversion. The nurse sets the defibrillator for synchronized mode so that the electrical shock is not delivered on the T wave. This is done to avoid which complication? a. Electrical burns to the skin b. Ventricular standstill c. Arcing from the electrodes d. Ventricular fibrillation VF
d. Ventricular fibrillation VF
25. What does the T wave on an ECG represent? A. Ventricular depolarization b. Atrial repolarization c. Atrial depolarization d. Ventricular repolarization
d. Ventricular repolarization
