n460 test 3 practice questions
A client has been living with an internal, fixed-rate pacemaker. When checking the client's readings on a cardiac monitor the nurse notices an absence of spikes. What should the nurse do? A. Double-check the monitoring equipment. B. Do nothing; there is no cause for alarm. C. Measure the client's blood pressure. D. Suggest the need for a new beta-blocker to the doctor.
a
A client is treated in the intensive care unit (ICU) following an acute myocardial infarction (MI). During the nursing assessment, the client reports shortness of breath and chest pain. In addition, the client's blood pressure (BP) is 100/60 mm Hg with a heart rate (HR) of 53 bpm, and the electrocardiogram (ECG) tracing shows more P waves than QRS complexes. Which action should the nurse complete first? a. Initiate transcutaneous pacing b. Obtain a 12-lead ECG c. Administer 1 mg of IV atropine d. Prepare for defibrillation
a
A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? a. "Spike" on the rhythm strip b. Scar on the chest c. Vibration under the skin d. Quality of the pulse
a
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
a
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 nurses 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
a
Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following? a. Atrial rate of 300 to 400 b. Normal PR interval c. Regular rhythm d. P wave resent before each QRS
a
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? A. Epinephrine 1 mg IV push B. Lidocaine 100 mg IV push C. Amiodarone 300 mg IV push D. Sodium bicarbonate 1 amp IV push
a
The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client? a. Fluttering b. Nausea c. Hypotension d. Fever
a
The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification? a. "I should ask for a handheld device search when I go through airport security." b. "I should avoid large magnetic fields, such as an MRI machine or large motors." c. "I'll watch the incision for swelling or redness and will report if either occurs." d. "I should avoid contact sports."
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.
a
The nurse recognizes which as being true of cardioversion? a. Defibrillator should be set to deliver a shock during the QRS complex. b. Amount of voltage used should exceed 400 watts/second. c. Defibrillator should be set in the non-synchronous mode so the nurse can hit the button at the right time. d. Electrical impulse can be discharged during the T wave.
a
The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately? a) Persistent cough b) Ability to sleep through the night c) Increased appetite d) Weight loss
a
Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke? a. Coumadin b. Aspirin c. Lovenox d. Plavix
a
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? a. Monitor vital signs and cardiac rhythm b. Administer every five minutes during cardiac resuscitation c. Keep the client flat for one hour after administration d. Document heart rate before and after administration
a
Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client? a. Elective electrical cardioversion b. Chemical cardioversion c. Mace procedure d. Elective electrical defibrillation
a
the nurse in the 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. begin CPR b. administer epinephrine c. administer atropine 0.5mg d. defibrillate within 360 joules
a
A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero? a) 15 minutes b) 10 minutes c) 20 minutes d) 25 minutes
b
A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient? A. Chest pain B. Bleeding at the implantation site C. Malignant hyperthermia D. Bradycardia
b
During a CPR class, a participant asks about the difference between cardioversion and defibrillation. What would be the instructors best response? A. Cardioversion is done on a beating heart; defibrillation is not. B. The difference is the timing of the delivery of the electric current. C. Defibrillation is synchronized with the electrical activity of the heart, but cardioversion is not. D. Cardioversion is always attempted before defibrillation because it has fewer risks.
b
New nurses on the telemetry unit have been paired with preceptors. One new nurse asks her preceptor to explain depolarization. What would be the best answer by the preceptor? A. Depolarization is the mechanical contraction of the heart muscles. B. Depolarization is the electrical stimulation of the heart muscles. C. Depolarization is the electrical relaxation of the heart muscles. D. Depolarization is the mechanical relaxation of the heart muscles.
b
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.
b
The nurse caring for a patient whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this patient? A. Implanted pacemaker B. Trancutaneous pacemaker C. ICD D. Asynchronous defibrillator
b
The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the resting state of the patients heart? A. P wave B. T wave C. U wave D. QRS complex
b
When planning the care of a patient with an implanted pacemaker, what assessment should the nurse prioritize? A. Core body temperature B. Heart rate and rhythm C. Blood pressure D. Oxygen saturation level
b
When the appropriate electrocardiogram (ECG) complex follows the pacing spike, it is said to be: a. triggered. b. captured. c. inhibited. d. nonsynchronous.
b
Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia? a. Document heart rate before and after administration b. Monitor vital signs and cardiac rhythm c. Keep the client flat for one hour after administration d. Administer every five minutes during cardiac resuscitation
b
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? a. Third-degree heart block b. Atrial fibrillation c. Ventricular fibrillation d. Ventricular tachycardia
c
The nurse analyzes the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The client's ECG strip demonstrates PR intervals that measure 0.24 seconds. What is the nurse's most appropriate action? a. Instruct the client to bear down as if having a bowel movement b. Apply oxygen via nasal cannula and obtain a 12-lead ECG c. Document the findings and continue to monitor the patient d. Notify the client's primary care provider of the findings
c
The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis? A. PP interval B. QT interval C. RR interval D. TP interval
c
The nurse is caring for a patient who has had a dysrhythmic event. The nurse is aware of the need to assess for signs of diminished cardiac output (CO). What change in status may signal to the nurse a decrease in cardiac output? A. Increased blood pressure B. Bounding peripheral pulses C. Changes in level of consciousness D. Skin flushing
c
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.
c
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.
c
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
c
A client in the hospital informs the nurse he ?"feels like his heart is racing and can''t catch his breath." ?What does the nurse understand occurs as a result of a tachydysrhythmia? a) It increases preload. b) It increases afterload. c) It causes a loss of elasticity in the myocardium. d) It reduces ventricular ejection volume.
d
A client is admitted to the emergency department reporting chest pain and shortness of breath. The nurse notes an irregular rhythm on the bedside electrocardiograph monitor. The nurse counts 9 RR intervals on the client's 6-second rhythm tracing. The nurse correctly identifies the client's heart rate as a. 80 bpm b. 70 bpm c. 100 bpm d. 90 bpm
d
A client with dilated cardiomyopathy is having frequent episodes of ventricular fibrillation. What medical treatment does the nurse anticipate the client will have to terminate the episode of ventricular fibrillation? a. radiofrequency ablation b. electrophysiological study c. pacemaker insertion d. internal cardioverter defibrillator insertion
d
A client's electrocardiogram (ECG) tracing reveals a atrial rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as a. Ventricular fibrillation b. Ventricular tachycardia c. Atrial fibrillation d.Atrial flutter
d
A patient who had a myocardial infarction is experiencing severe chest pain and alerts the nurse. The nurse begins the assessment but suddenly the patient becomes unresponsive, no pulse, with the monitor showing a rapid, disorganized ventricular rhythm. What does the nurse interpret this rhythm to be? a. Ventricular tachycardia b. Atrial fibrillation c. Third-degree heart block d. Ventricular fibrillation
d
The nurse hears the alarm sound on the telemetry monitor and observes a flat line. The patient is found unresponsive, without a pulse, and no respiratory effort. What is the first action by the nurse? a) Administer epinephrine 1:10,000 10 mL IV push. b) Deliver breaths with a bag-valve mask. c) Defibrillate the patient with 360 joules. d) Call for help and begin chest compressions.
d
The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment? a. A client with poor kidney perfusion b. A client with third-degree heart block c. A new myocardial infarction client d. A client with atrial dysrhythmias
d
The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education? a. "I will call the doctor if my incision becomes swollen and red." b. "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." c. "I will avoid any large magnets that may affect my pacemaker." d. "We will be getting rid of our microwave oven so it will not affect my pacemaker."
d
The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? a. "The P-R interval will be prolonged in sinus bradycardia." b. "The QRS complex will be smaller in sinus bradycardia." c. "The P waves will be shaped differently." d. "The only difference is the heart rate."
d
You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients? a. Clients with recurrent life-threatening bradycardias b. Clients with sinus tachycardia c. Clients with ventricular bradycardia d. Clients with recurrent life-threatening tachydysrhythmias
d
a patient comes to the ED with complaints of chest pain after using cocaine. the nurse assess the patient and obtains vital signs with results as follows: BP 140/92, HR 128, RR 26, O2 sat 98%. what rhythm on the monitor does the nurse anticipate viewing? a. sinus bradycardia b. ventricular tachycardia c. normal sinus rhythm d. sinus tachycardia
d
