Deck 7: Dysrhythmia Interpretation and Management

Question 1

The nurse is caring for a patient who is on a cardiac monitor.The nurse realizes that the sinus node is the pacemaker of the heart because it is

A) the fastest pacemaker cell in the heart.
B) the only pacemaker cell in the heart.
C) the only cell that does not affect the cardiac cycle.
D) located in the left side of the heart.

Answer 1

the fastest pacemaker cell in the heart.

Question 2

The nurse notices ventricular tachycardia on the heart monitor.When the patient is assessed,the patient is found to be unresponsive with no pulse.The nurse should

A) treat with intravenous amiodarone or lidocaine.
B) begin cardiopulmonary resuscitation and advanced life support.
C) provide electrical cardioversion.
D) ignore the rhythm because it is benign.

Answer 2

begin cardiopulmonary resuscitation and advanced life support.

Question 3

The patient's heart rate is 165 beats per minute.The cardiac monitor shows a rapid rate with narrow QRS complexes.The P waves cannot be seen,but the rhythm is regular.The patient's blood pressure has dropped from 124/62 mm Hg to 78/30 mm Hg.The patient's skin is cold and diaphoretic,and the patient is complaining of nausea.The nurse prepares the patient for

A) administration of beta blockers.
B) administration of atropine.
C) transcutaneous pacemaker insertion.
D) emergent cardioversion.

Answer 3

emergent cardioversion.

Question 4

The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P waves are upright and look the same except one that has a different shape and is inverted.The nurse realizes that the P wave with the abnormal shape is probably

A) from the SA node because all P waves come from the SA node.
B) from some area in the atria other than the SA node.
C) indicative of ventricular depolarization.
D) normal even though it is inverted in lead II.

Question 5

One of the functions of the atrioventricular (AV)node is to

A) pace the heart if the ventricles fail.
B) slow the impulse arriving from the SA node.
C) send the impulse to the SA node.
D) allow for ventricular filling during systole.

Question 6

The patient is admitted with sinus pauses causing periods of loss of consciousness.The patient is asymptomatic,awake and alert,but fatigued.He solve questions appropriately.When admitting this patient,the nurse should first

A) prepare the patient for temporary pacemaker insertion.
B) prepare the patient for permanent pacemaker insertion.
C) assess the patient's medication profile.
D) apply transcutaneous pacemaker paddles.

Question 7

The patient is admitted with a condition that requires cardiac rhythm monitoring.To apply the monitoring electrodes,the nurse must first

A) apply a moist gel to the chest.
B) make certain that the electrode gel is dry.
C) avoid soaps to avoid skin irritation.
D) clip chest hair if needed.

Question 8

The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds.The heart rate is 54 beats per minute.The nurse recognizes the rhythm is due to the

A) loss of sinus node activity.
B) increased rate of the AV node.
C) increased rate of the SA node.
D) decreased rate of the AV node.

Question 9

The nurse caring for patients on cardiac monitors assesses the patient with a prolonged QT interval for

A) electrolyte disturbances such as hypokalemia.
B) symptomatic bradycardias.
C) the development of lethal dysrhythmias.
D) difficulty maintaining the blood pressure.

Question 10

The patient is admitted with a fever and rapid heart rate.The patient's temperature is 103° F ( 39.4° C ).The nurse places the patient on a cardiac monitor and finds the patient's atrial and ventricular rates are above 105 beats per minute.P waves are clearly seen and appear normal in configuration.QRS complexes are normal in appearance and 0.08 seconds wide.The rhythm is regular,and blood pressure is normal.The nurse should focus on providing:

A) medications to lower heart rate.
B) treatment to lower temperature.
C) treatment to lower cardiac output.
D) treatment to reduce heart rate.

Question 11

The patient has an irregular heart rhythm.To determine an accurate heart rate,the nurse would first

A) identify the markers on the ECG paper that indicate a 6-second strip.
B) count the number of small boxes between two consecutive P waves.
C) count the number of small boxes between two consecutive QRS complexes.
D) divides the number of complexes in a 6-second strip by 10.

Question 12

The normal rate for the SA node when the patient is at rest is

A) 40 to 60 beats per minute.
B) 60 to 100 beats per minute.
C) 20 to 40 beats per minute.
D) more than100 beats per minute.

Question 13

The nurse using cardiac monitoring understands that each horizontal box on the electrocardiogram (ECG)paper indicates

A) 200 milliseconds or 0.20 seconds duration.
B) 40 milliseconds or 0.04 seconds duration.
C) 3 seconds duration.
D) millivolts of amplitude.

Question 14

The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular and that there are no discernible P waves.The ventricular rate is 90 beats per minute,and the patient is hemodynamically stable.The nurse realizes that the patient's rhythm is

A) atrial fibrillation.
B) atrial flutter.
C) atrial flutter with rapid ventricular response.
D) junctional escape rhythm.

Question 15

The patient is having premature ventricular contractions (PVCs).The nurse's greatest concern should be:

A) the proximity of the R wave of the PVC to the T wave of a normal beat.
B) the fact that PVCs are occurring, because they are so rare.
C) whether the number of PVCs is decreasing.
D) whether the PVCs are wider than 0.12 seconds.

Question 16

The patient's heart rate is 70 beats per minute,but the P waves come after the QRS complex.The nurse correctly determines that the patient's heart rhythm is

A) a normal junctional rhythm.
B) an accelerated junctional rhythm.
C) a junctional tachycardia.
D) atrial fibrillation.

Question 17

Which of the following is true about a patient diagnosed with sinus arrhythmia?

A) The heart rate varies, dependent on vagal tone and respiratory pattern.
B) Immediate treatment is essential to prevent death.
C) Sinus arrhythmia is not well tolerated by most patients.
D) PR and QRS interval measurements are prolonged.

Question 18

The nurse is calculating the rate for a regular rhythm.There are 20 small boxes between each P wave and 20 small boxes between each R wave.What is the ventricular rate?

A) 50 beats/min
B) 75 beats/min
C) 85 beats/min
D) 100 beats/min

Question 19

The nurse notices sinus bradycardia on the patient's cardiac monitor.The nurse should

A) give atropine to increase heart rate.
B) begin transcutaneous pacing of the patient.
C) start a dopamine infusion to stimulate heart function.
D) assess for hemodynamic instability.

Question 20

The nurse caring for patients with cardiac monitoring understands that when an electrical signal is aimed directly at the positive electrode,the inflection will be:

A) negative.
B) upside down.
C) upright.
D) equally positive and negative.

Question 21

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with bigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Question 22

The patient has a permanent pacemaker inserted.The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute.The nurse realizes that

A) the pacemaker will pace only if the patient's intrinsic heart rate is less than 60 beats per minute.
B) the demand mode often competes with the patient's own rhythm.
C) the demand mode places the patient at risk for the R-on-T phenomenon.
D) the fixed-rate mode is safer and is the mode of choice.

Question 23

The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I.The patient is on digitalis medication at home.The nurse should expect that

A) the patient has had an anterior wall myocardial infarction.
B) the physician will order the digitalis to be continued in the hospital.
C) a digitalis level would be ordered upon admission.
D) the patient will require a transcutaneous pacemaker.

Question 24

Interpret the following rhythm:

A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) Sinus arrhythmia

Question 25

The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min.The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes.The nurse recognizes this as:

A) normal pacemaker function.
B) failure to capture.
C) failure to pace.
D) failure to sense.

Question 26

Interpret the following rhythm:

A) Atrial flutter with variable conduction
B) Ventricular fibrillation
C) Atrial fibrillation
D) Atrial flutter with RVR (rapid ventricular response)

Question 27

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with bigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Question 28

Interpret the following rhythm:

A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) Sinus arrhythmia

Question 29

The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex.The nurse should

A) defibrillate the patient immediately.
B) initiate basic life support.
C) initiate advanced life support.
D) assess the patient and the electrical leads.

Question 30

Interpret the following rhythm:

A) Atrial fibrillation
B) Atrial flutter
C) Atrial flutter with RVR
D) Junctional escape rhythm

Question 31

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with trigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Question 32

The rhythm on the cardiac monitor is showing numerous pacemaker spikes,but no P waves or QRS complexes following the spikes.The nurse recognizes this as:

A) normal pacemaker function.
B) failure to capture.
C) failure to pace.
D) failure to sense.

Question 33

The nurse notices that the patient has a first-degree AV block.Everything else about the rhythm is normal.The nurse should

A) prepare to place the patient on a transcutaneous pacemaker.
B) give the patient atropine to shorten the PR interval.
C) monitor the rhythm and patient's condition.
D) give the patient an antiarrhythmic medication.

Question 34

The nurse understands that in a third-degree AV block

A) every P wave is conducted to the ventricles.
B) some P waves are conducted to the ventricles.
C) none of the P waves are conducted to the ventricles.
D) the PR interval is prolonged.

Question 35

The patient is scheduled to have a permanent pacemaker implanted.The patient asks the nurse,"How long will the battery in this thing last?" The nurse should solve,

A) "Life expectancy is about 1 year.Then it will need to be replaced."
B) "Pacemaker batteries can last up to 25 years with constant use."
C) "Battery life varies depending on usage, but it can last up to 10 years."
D) "Pacemakers are used to treat temporary problems, so the batteries don't last long."

Question 36

Interpret the following rhythm:

A) Sinus rhythm with PACs
B) Normal sinus rhythm
C) Sinus tachycardia
D) Sinus bradycardia

Question 37

Interpret the following rhythm:

A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) Sinus arrhythmia

Question 38

The patient is in chronic junctional escape rhythm with no atrial activity noted.Studies have demonstrated normal AV node function.This patient may be a candidate for which type of pacing?

A) Atrial pacing
B) Ventricular pacing
C) Dual-chamber pacing
D) Transcutaneous pacing

Question 39

Interpret the following rhythm:

A) Junctional rhythm
B) An accelerated junctional rhythm
C) A junctional tachycardia
D) Atrial fibrillation

Question 40

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with bigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Question 41

Which of the following are common causes of sinus tachycardia? (Select all that apply.)

A) Hyperthyroidism
B) Hypovolemia
C) Hypothyroidism
D) Heart Failure
E) Sleep

Question 42

The patient is alert and talking when the nurse notices the following rhythm.The patient's blood pressure is 90/44 mm Hg.The nurse should

A) defibrillate immediately.
B) begin basic life support.
C) begin advanced life support.
D) treat with intravenous amiodarone or lidocaine.

Question 43

Interpret the following rhythm:

A) R-on-T phenomenon leading to ventricular fibrillation
B) Sinus rhythm with multifocal premature ventricular contractions
C) Nonsustained ventricular tachycardia
D) Sinus rhythm with bigeminal premature ventricular contractions

Question 44

The nurse is caring for a patient who has atrial fibrillation.Sequelae that place the patient at greater risk for mortality/morbidity include which of the following? (Select all that apply.)

A) Stroke
B) Ashman beats
C) Pulmonary emboli
D) Prolonged PR interval
E) Decreased cardiac output

Question 45

The normal width of the QRS complex is which of the following? (Select all that apply.)

A) 0.06 to 0.10 seconds.
B) 0.12 to 0.20 seconds.
C) 1.5 to 2.5 small boxes.
D) 3.0 to 5.0 small boxes.
E) 0.04 seconds or greater.

Question 46

Interpret the following rhythm:

A) Normal sinus rhythm
B) Sinus rhythm with second-degree AV block
C) Complete heart block
D) Sinus rhythm with first-degree AV block

Question 47

Interpret the following rhythm:

A) Idioventricular rhythm
B) Accelerated idioventricular rhythm
C) Ventricular tachycardia
D) Ventricular fibrillation

Question 48

Interpret the following rhythm:

A) Normal pacemaker function
B) Failure to capture
C) Failure to pace
D) Failure to sense

Question 49

Interpret the following rhythm:

A) First-degree AV block
B) Second-degree AV block Mobitz I (Wenckebach phenomenon)
C) Second-degree AV block Mobitz II
D) Third-degree AV block (complete heart block)

Question 50

Interpret the following rhythm:

A) Atrial pacing
B) Ventricular pacing
C) Dual-chamber pacing
D) Transcutaneous pacing

Question 51

Interpret the following rhythm:

A) First-degree AV block
B) Second-degree AV block Mobitz I (Wenckebach phenomenon)
C) Second-degree AV block Mobitz II
D) Third-degree AV block (complete heart block)

Question 52

The possible P waveforms that are associated with junctional rhythms include which of the following? (Select all that apply.)

A) No P wave
B) Inverted P wave
C) Shortened PR interval
D) P wave after the QRS complex
E) Normal P wave and PR interval

Question 53

Sinus bradycardia is a symptom of which of the following? (Select all that apply.)

A) Calcium channel blocker medication
B) Beta blocker medication
C) Athletic conditioning
D) Hypothermia
E) Hyperthyroidism

Question 54

The nurse notes the following rhythm on the heart monitor.The patient is unresponsive and not breathing.The nurse should

A) treat with intravenous amiodarone or lidocaine.
B) provide emergent basic and advanced life support.
C) provide electrical cardioversion.
D) ignore the rhythm because it is benign.

Question 55

Interpret the following rhythm:

A) Normal pacemaker function
B) Failure to capture
C) Failure to pace
D) Failure to sense

Question 56

Interpret the following rhythm:

A) Atrial pacing
B) Ventricular pacing
C) Dual-chamber pacing
D) Transcutaneous pacing

Question 57

Interpret the following rhythm:

A) First-degree AV block
B) Second-degree AV block Mobitz I (Wenckebach phenomenon)
C) Second-degree AV block Mobitz II
D) Third-degree AV block (complete heart block)

Question 58

Interpret the following rhythm:

A) Atrial pacing
B) Ventricular pacing
C) Dual-chamber pacing
D) Transcutaneous pacing

Question 59

The patient is in third-degree heart block (complete heart block)and is symptomatic.The treatment for this patient is which of the following? (Select all that apply.)

A) Transcutaneous pacemaker
B) Atropine IV
C) Temporary transvenous pacemaker
D) Permanent pacemaker
E) Amiodarone IV