Question 1

A patient has been prescribed flecainide (Tambocor)for treatment of ventricular dysrhythmia.Which finding should the nurse discuss with the prescriber prior to initiating this therapy?
A)The patient has lost 6 pounds since hospital admission.
B)The patient experienced nausea while taking digoxin (Lanoxin)many years ago.
C)The patient's urine output was 20 mL over the last hour.
D)The patient's potassium level is 4.8 mEq/dL this morning.

Accepted Answer

The patient's potassium level is 4.8 mEq/dL this morning.Flecainide can cause hypokalemia, so it is important to check the patient's potassium level before initiating therapy.

Question 2

A patient is having multifocal premature ventricular contractions (PVCs).What nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
A)Administer oxygen.
B)Withhold the next digoxin dose.
C)Administer atropine.
D)Monitor the patient closely for other dysrhythmias.
E)Consult with the healthcare provider.

Accepted Answer

Administering oxygen can help improve oxygenation to the myocardium, potentially reducing PVCs. Monitoring the patient closely for other dysrhythmias is essential to detect any progression to more dangerous arrhythmias. Consulting with the healthcare provider is necessary to ensure appropriate management and treatment adjustments. Withholding digoxin or administering atropine are specific interventions that may not be universally applicable without further assessment of the underlying cause and the patient's overall clinical picture.

Question 3

A patient's admission vital signs were blood pressure 128/64 mmHg; heart rate 86 beats per minute,respirations 16,and temperature 98.6°F.The patient has spiked a temperature of 101.6°F.Which change in heart rate would the nurse anticipate?
A)Increase to 116 beats per minute
B)Increase to 100 beats per minute
C)Decrease to 76 beats per minute
D)Increase or decrease of no more than 5 beats per minute

Accepted Answer

An increase in temperature of almost 3°F (normal body temperature is considered 98.6°F) would most likely cause an increase in heart rate, and an increase to 116 beats per minute is a reasonable estimate. However, it's important to note that every patient may have a different response, and the nurse should monitor the patient closely for any changes in vital signs.

Question 4

A patient has a normal QRS complex on an electrocardiogram,which is followed by the P wave.Heart rate is 80 beats per minute and regular and the patient has no complaints.What nursing action is indicated?
A)Document presence of atrial escape rhythm.
B)Review the patient's medication history.
C)STAT page the patient's healthcare provider.
D)Notify the nurse manager that it may become necessary to call the rapid response team.

Accepted Answer

Since the electrocardiogram shows a normal QRS complex and a regular heart rate with no complaints from the patient, there is no indication of an emergency or urgent intervention. The nurse should review the patient's medication history to ensure that there are no medications that could be affecting the heart rhythm. This will help determine if any changes need to be made to the patient's treatment plan.

Question 5

A patient's electrocardiogram ST segment tracing is deflected from baseline.The nurse would conduct assessment for which condition?
A)Ventricular muscle injury
B)Atrial muscle injury
C)Respiratory acidosis
D)Hypocalcemia

Accepted Answer

Deflection of the ST segment from baseline on an electrocardiogram indicates ventricular muscle injury or ischemia. Atrial muscle injury would not affect the ST segment. Respiratory acidosis and hypocalcemia would not have a direct effect on the ST segment.

Question 6

A patient's cardiac monitor reveals a regular rhythm with a rate of 240 beats per minute.No P waves are distinguishable.The patient is alert and says,"My heart is racing." What nursing intervention is indicated?
A)Gather equipment to begin anticoagulant therapy.
B)Defibrillate the patient.
C)Prepare the patient for immediate cardioversion.
D)Ask the patient to bear down as if moving the bowels.

Accepted Answer

The patient is experiencing a supraventricular tachycardia (SVT) with a rapid heart rate and no distinguishable P waves. The patient is alert and symptomatic. A non-invasive intervention like the Valsalva maneuver (asking the patient to bear down as if moving the bowels) can help in slowing the heart rate by increasing vagal tone and possibly terminating the SVT. This is a safer initial approach compared to more invasive procedures.

Question 7

A patient in the emergency department has a cardiac rhythm strip that reveals a junctional rhythm with rate of 128,PR interval of 0.08 seconds,a normally configured QRS,and an upright T wave.The patient is awake and alert with warm,dry skin.Which nursing intervention is indicated?
A)Prepare for immediate cardioversion
B)Immediate notification of the rapid response team
C)Continued monitoring and assessment
D)Administration of potassium by slow intravenous infusion

Accepted Answer

The patient's junctional rhythm with a rate of 128 may be a normal variant or may be due to underlying conditions, such as medication toxicity, MI or digitalis toxicity. However, the patient is awake, alert and has warm, dry skin - all signs that the patient is well perfused and the cardiac output is adequate. The nursing intervention indicated in this case is continued monitoring and assessment to determine the cause of the junctional rhythm and to monitor for any changes in the patient's condition. Immediate cardioversion and notifying the rapid response team are not indicated at this time. While low potassium levels can cause rhythm disturbances, there is no evidence in this case to suggest hypokalemia as the underlying cause.

Question 8

The nurse has determined that the patient has a bundle branch block.Which condition likely exists?
A)A PR interval longer than 0.20 seconds
B)An elevated ST segment
C)A QRS segment longer than 0.12 seconds
D)A PR interval that lengthens with each beat

Accepted Answer

A bundle branch block can be identified by a widened QRS interval, typically longer than 0.12 seconds. Option A refers to a prolonged PR interval, which may indicate an atrioventricular block. Option B refers to an elevated ST segment, which may indicate myocardial infarction or ischemia. Option D refers to a varying PR interval, which may indicate a condition called Wenckebach block.

Question 9

A patient is diagnosed with hypermagnesemia.The nurse would assess for which changes on the patient's cardiac rhythm strip? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
A)Prolonged QT interval
B)Tachycardia
C)Narrow,upright QRS
D)Atrioventricular (AV)block
E)Prolonged PR interval

Accepted Answer

Hypermagnesemia can lead to cardiac conduction abnormalities, including a prolonged QT interval, atrioventricular (AV) block, and a prolonged PR interval. These changes reflect the slowing of electrical conduction in the heart due to the elevated magnesium levels.

Question 10

The nurse interpreting a patient's electrocardiogram has just examined the P waves.What is the nurse's next step?
A)Determine if each P wave is followed by a QRS complex.
B)Measure the PR interval.
C)Diagnose the rhythm.
D)Examine and measure the QRS complex.

Accepted Answer

After examining the P waves, the nurse's next step would be to measure the PR interval, which indicates the time it takes for the electrical impulse to travel from the atria to the ventricles. A and D are important steps in analyzing an ECG, but measuring the PR interval comes before checking for the presence of QRS complexes or examining those complexes. Diagnosing the rhythm would come later in the process after examining other components of the ECG.

Question 11

The nurse notes this rhythm on the patient's cardiac monitor.What is the nurse's priority intervention? 
A)Check the patient's pulse.
B)Administer oxygen.
C)Call a code blue.
D)Prepare to cardiovert the patient.

Accepted Answer

The nurse's priority intervention should be to assess the patient's pulse and determine if they have a perfusing rhythm. If there is no pulse, the nurse should begin CPR and call for a code blue. However, if the patient has a pulse, further interventions can be taken based on the specific rhythm present. Administering oxygen and preparing to cardiovert may be appropriate for certain rhythms, but determining if the patient has a pulse should always be the initial priority.

Question 12

A patient develops ventricular tachycardia on the cardiac monitor.The patient says,"My heart is racing" as the nurse determines a rapid pulse is present.What is the nurse's priority intervention?
A)Call respiratory therapy to prepare a mechanical ventilator.
B)Draw blood for arterial blood gases.
C)Prepare for a change in intravenous fluid being administered.
D)Monitor the patient for loss of consciousness.

Accepted Answer

The priority intervention when a patient develops ventricular tachycardia is to monitor the patient for loss of consciousness. Ventricular tachycardia can lead to decreased cardiac output and inadequate blood flow to important organs such as the brain. Therefore, assessing the patient's level of consciousness is crucial in determining the severity of the condition and guiding further interventions. The other options listed (A, B, and C) may be important interventions in certain situations, but they are not the priority in this scenario.

Question 13

A patient's atrial fibrillation has been refractory to treatment.The nurse would prioritize which discharge instructions?
A)Avoiding stressful situations
B)Anticoagulant therapy precautions
C)The importance of daily weights
D)How to check blood pressure at home

Accepted Answer

Anticoagulant therapy precautions are a priority because atrial fibrillation increases the patient's risk for blood clots and stroke. It is essential that the patient understands how to take their anticoagulant medication and any necessary monitoring or dietary restrictions. The other options are important as well, but not as critical in immediate post-discharge management of a patient with refractory atrial fibrillation.

Question 14

A patient has a new onset of a left bundle branch block (LBBB)seen on a 12-lead ECG.What is the nurse's primary intervention?
A)Increase oxygen.
B)Elevate the head of the bed to a 30-degree angle.
C)Ask the patient if he is having chest pain.
D)Reposition the chest leads and assess for any changes.

Accepted Answer

A new onset of left bundle branch block (LBBB) can be a sign of a serious underlying condition, such as a myocardial infarction. Asking the patient if they are experiencing chest pain is crucial for assessing the presence of acute coronary syndrome and guiding further interventions.

Question 15

A patient's cardiac monitor frequently sounds false rate alarms.Which nursing intervention is indicated?
A)Ask the patient to lie still.
B)Adjust the high and low rates on the alarm.
C)Shut the room door so the alarm will not disturb other patients.
D)Set the alarms on silent.

Accepted Answer

Adjusting the high and low rates on the alarm may help prevent false alarms. This ensures that the alarm only sounds when the patient's heart rate falls outside of the set parameters.

Question 16

A patient with a temporary pacemaker has this cardiac rhythm.What nursing intervention is indicated? 
A)Turn the impulse generator off,wait 30 seconds,and turn it back on.
B)Call for a STAT portable chest x-ray.
C)Check for a damaged lead wire.
D)Decrease the pacemaker sensitivity.

Accepted Answer

The answer of A patient with a temporary pacemaker has...

Question 17

A patient presents to the emergency department and says,"I am so dizzy that it is scaring me." Monitoring reveals the patient's blood pressure is 78/52 mmHg and heart rate is 44 beats per minutes.Which nursing intervention is indicated?
A)Administer antianxiety medication.
B)Administer atropine.
C)Instruct the patient to cough forcefully.
D)Monitor the patient while contacting the primary care provider.

Accepted Answer

The patient's symptoms and vital signs suggest bradycardia with hypotension. Atropine is indicated to increase the heart rate in symptomatic bradycardia.

Question 18

A patient has been diagnosed with premature ventricular contractions.The nurse realizes that this dysrhythmia can result from a weaker than normal stimulus during which action potential period?
A)Absolute refractory period
B)Relative refractory period
C)Supranormal period
D)Subnormal period

Accepted Answer

Premature ventricular contractions (PVCs) can occur during the supranormal period, a phase shortly after the relative refractory period in the cardiac action potential, where a weaker-than-normal stimulus can cause depolarization. This period is more susceptible to abnormal impulses, leading to PVCs.

Question 19

A patient in the emergency department has a heart rate of 140 beats per minute.Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
A)Assess the patient's temperature.
B)Administer atropine.
C)Present a calm demeanor.
D)Assess the patient for pain.
E)Prepare for intubation.

Accepted Answer

The answer of A patient in the emergency department has...

Question 20

A patient's cardiac monitor reveals heart rate of 40 beats per minute with an irregular rate.The PR intervals are constant and there are P waves with no QRS to follow.The QRS complexes are wider than normal.The patient complains of severe dizziness and nausea.Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.
A)Administer atropine.
B)Prepare to cardiovert the patient.
C)Prepare for placement of a temporary pacemaker.
D)Administer epinephrine.
E)Ask the patient to cough forcefully.

Accepted Answer

The answer of A patient's cardiac monitor reveals heart rate...

Quiz 9: Basic Cardiac Rhythm Monitoring

A patient has been prescribed flecainide (Tambocor) for treatment of ventricular dysrhythmia.Which finding should the nurse discuss with the prescriber prior to initiating this therapy?

A patient is having multifocal premature ventricular contractions (PVCs) .What nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A patient's admission vital signs were blood pressure 128/64 mmHg; heart rate 86 beats per minute,respirations 16,and temperature 98.6°F.The patient has spiked a temperature of 101.6°F.Which change in heart rate would the nurse anticipate?

A patient has a normal QRS complex on an electrocardiogram,which is followed by the P wave.Heart rate is 80 beats per minute and regular and the patient has no complaints.What nursing action is indicated?

A patient's electrocardiogram ST segment tracing is deflected from baseline.The nurse would conduct assessment for which condition?

A patient's cardiac monitor reveals a regular rhythm with a rate of 240 beats per minute.No P waves are distinguishable.The patient is alert and says,"My heart is racing." What nursing intervention is indicated?

A patient in the emergency department has a cardiac rhythm strip that reveals a junctional rhythm with rate of 128,PR interval of 0.08 seconds,a normally configured QRS,and an upright T wave.The patient is awake and alert with warm,dry skin.Which nursing intervention is indicated?

The nurse has determined that the patient has a bundle branch block.Which condition likely exists?

A patient is diagnosed with hypermagnesemia.The nurse would assess for which changes on the patient's cardiac rhythm strip? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

The nurse interpreting a patient's electrocardiogram has just examined the P waves.What is the nurse's next step?

The nurse notes this rhythm on the patient's cardiac monitor.What is the nurse's priority intervention?

A patient develops ventricular tachycardia on the cardiac monitor.The patient says,"My heart is racing" as the nurse determines a rapid pulse is present.What is the nurse's priority intervention?

A patient's atrial fibrillation has been refractory to treatment.The nurse would prioritize which discharge instructions?

A patient has a new onset of a left bundle branch block (LBBB) seen on a 12-lead ECG.What is the nurse's primary intervention?

A patient's cardiac monitor frequently sounds false rate alarms.Which nursing intervention is indicated?

A patient with a temporary pacemaker has this cardiac rhythm.What nursing intervention is indicated?

A patient presents to the emergency department and says,"I am so dizzy that it is scaring me." Monitoring reveals the patient's blood pressure is 78/52 mmHg and heart rate is 44 beats per minutes.Which nursing intervention is indicated?

A patient has been diagnosed with premature ventricular contractions.The nurse realizes that this dysrhythmia can result from a weaker than normal stimulus during which action potential period?

A patient in the emergency department has a heart rate of 140 beats per minute.Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.