Chapter 26 Quiz

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Question #1

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 RR interval

B QT interval

C PP interval

D TP interval

Question #2

A nurse evaluates a client with a temporary pacemaker. The client’s ECG tracing shows each P wave followed by the pacing spike. What is the nurse’s best response?

A Reposition the extremity and turn the client to left side

B Check the security of all connections and increase the milliamperage

C Document the findings and continue to monitor the client

D Obtain a 12-lead ECG and a portable chest x-ray

Question #3

The licensed practical nurse is monitoring the waveform pattern on the cardiac monitor ofthe client admitted following a myocardial infarction. The nurse notes that every other beat includes a premature ventricular contraction (PVC). The nurse notes which of the following in the permanent record?

A Couplets

B Bigeminy

C R-on-T phenomenon

D Multifocal PVCs

Question #4

A healthy adult client is seeing a health care provider for an annual physical examination. While the nurse is taking the client’s vital signs, the client states, “Occasionally, my heart skips a beat. Is this normal?” What is the nurse’s best response?

A Sinus tachycardia

B Ventricular fibrillation

C Premature atrial complex

D Atrial flutter

Question #5

A patient has had several episodes of recurrent tachydysrhythmias over the last 5 months and medication therapy has not been effective. What procedure should the nurse prepare the patient for?

A Insertion of a permanent pacemaker

B Catheter ablation therapy

C Insertion of an ICD

D Maze procedure

Question #6

The nurse analayzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up?

A ST segment that is isoelectric in appearance

B QT interval that is 0. 46 seconds long

C QRS complex that is 0.10 seconds long

D PR interval that is 0.18 seconds long

Question #7

Which nursing intervention must a nurse perform when administering prescribed vasopressors to a client with a cardiac dysrhythmia?

A Keep the client flat for one hour after administration

B Administer every five minutes during cardiac resuscitation

C Document heart rate before and after administration

D Monitor vital signs and cardiac rhythm

Question #8

After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension?

A Decreased cardiac output and decreased systolic and diastolic blood pressure

B Decreased blood pressure with reflex tachycardia

C Increased cardiac output and increased systolic and diastolic blood pressure

D Decreased peripheral vascular resistance

Question #9

The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0.18 seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as

A sinus tachycardia.

B normal sinus rhythm.

C first-degree atrioventricular block.

D junctional tachycardia.

Question #10

A 28-year-old client presents to the emergency department, stating severe restlessness and anxiety. Upon assessment, the client’s heart rate is 118 bpm and regular, the client’s pupils are dilated, and the client appears excitable. Which action should the nurse take next?

A Question the client about alcohol and illicit drug use.

B Place the client on supplemental oxygen.

C Instruct the client to hold the breath and bear down.

D Prepare to administer a calcium channel blocker.

Question #11

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?

A Cardioversion equipment

B A suction machine

C A defibrillator

D An ECG machine

Question #12

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 atrial dysrhythmias

B A client with third-degree heart block

C A new myocardial infarction client

D A client with poor kidney perfusion

Question #13

The nurse is preparing a client for upcoming electrophysiology (EP) studies and possible ablation for treatment of atrial tachycardia. What information will the nurse include in the teaching?

A The procedure takes less time than a cardiac catheterization.

B The procedure will occur in the operating room under general anesthesia.

C During the procedure, the dysrhythmia will be reproduced under controlled conditions.

D After the procedure, the dysrhythmia will not recur.

Question #14

A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients?

A Clients with recurrent life-threatening bradycardias

B Clients with ventricular bradycardia

C Clients with recurrent life-threatening tachydysrhythmias

D Clients with sinus tachycardia

Question #15

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? Choose all that apply.,,

A P wave

B T wave

C P-R interval

D QRT wave

E S-Q segment

Question #16

The nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II as well as a bizarre, abnormal shape to the QRS complex. The nurse has likely observed which ventricular dysrhythmia?

A Ventricular bigeminy

B Ventricular tachycardia

C Ventricular fibrillation

D Premature ventricular contraction

Question #17

Which nursing intervention is required to prepare a client with cardiac dysrhythmia for an elective electrical cardioversion?

A Monitor blood pressure every 4 hours

B Facilitate CPR until the client is prepared for cardioversion

C Instruct the client to restrict food and oral intake

D Administer digitalis and diuretics 24 hours before cardioversion

Question #18

The nurse is caring for a client with second-degree atrioventricular block, Type I with symptomatic bradycardia. What is the most likely medication the nurse will administer?

A nadolol

B diltazem

C atropine sulfate

D atenolol

Question #19

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication?

A P waves hidden within the QRS complex

B Delayed conduction, producing a prolonged PR interval

C Variable heart rate, usually fewer than 90 bpm

D Irregular rhythm

Question #20

The client asks the nurse to explain what is meant by a ventricular bigeminy cardiac rhythm. What is the best response by the nurse?

A “The heart rate is between 150 to 250 bpm.”

B “The rhythm is regular but fast.”

C “The rhythm has a normal beat, then a premature beat pattern.”

D “It is when the heart conduction is primarily from the aterioventricular node.”

Question #21

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, “I thought this was normal.” What does the nurse understand is occurring with this patient?

A Sensitivity is too low

B Faulty generator

C Lead wire dislodgement

D Fracture of the lead wire

Question #22

A client admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which electrocardiographic (ECG) characteristic is commonly associated with this laboratory finding?

A Occasional U waves

B Peaked T waves

C Prolonged QT interval

D Flattened P waves

Question #23

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 Quality of the pulse

B Scar on the chest

C “Spike” on the rhythm strip

D Vibration under the skin

Question #24

The nurse is placing electrodes for a 12-lead electrocardiogram (ECG). The nurse would be correct in placing an electrode on which area for V1?

A Left side of sternum, fourth intercostal space

B Right side of sternum, fourth intercostal space

C Mid-clavicular line, fifth intercostal space

D Midway between V2 and V4

Question #25

A client with an atrial dysrhythmia has come to the clinic for a follow-up appointment and to talk with the health care provider about options to stop this dysrhythmia. What procedure could be used to treat this client?

A Elective electrical cardioversion

B Elective electrical defibrillation

C Mace procedure

D Chemical cardioversion

Question #26

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. What order does the nurse describe?

A Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers

B AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers

C SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches

D SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers

Question #27

A client with a second-degree atrioventricular heart block, Type II is admitted to the coronary care unit. How will the nurse explain the need to monitor the client’s electrocardiogram (ECG) strip to the spouse?

A “The small box will transmit the heart rhythm to the central monitor all the time.”

B “The box is recording the heart’s electrical activity, and a physician will review the tracing later.”

C “When your spouse needs help, an alarm will go off at the desk.”

D “The heart’s electrical activity will be recorded when the heart rate exceeds 60 beats per minute.”

Question #28

Which dysrhythmia has an atrial rate between 250 and 400, with saw-toothed P waves?

A Ventricular fibrillation

B Atrial flutter

C Ventricular tachycardia

D Atrial fibrillation

Question #29

A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardigram as an indicator of sinus tachycardia?

A PR interval of 0.1 seconds

B QRS duration of 0.16 seconds

C heart rate of 118 bpm

D Q wave of 0.04 seconds

Question #30

The nurse is observing the monitor of a patient with a first-degree atrioventricular (AV) block. What is the nurse aware characterizes this block?

A A variable heart rate, usually fewer than 60 bpm

B Delayed conduction, producing a prolonged PR interval

C P waves hidden with the QRS complex

D An irregular rhythm

Question #31

The nurse is in the mall and observes a client slump to the floor. The nurse assesses the client and notes no pulse. The nurse calls for assistance to others in the mall and requests which piece of equipment?

A A stethoscope

B A blood pressure cuff

C An automatic external defibrillator

D A cell phone to call 911

Question #32

The nurse is caring for clients on a telemetry unit. Which nursing consideration best represents concerns of altered rhythmic patterns of the heart?

A Altered patterns frequently produce neurological deficits.

B Altered patterns frequently cause a variety of home safety issues.

C Altered patterns frequently turn into life-threatening arrhythmias.

D Altered patterns frequently affect the heart’s ability to pump blood effectively.

Question #33

The nurse is caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?

A Nausea

B Fever

C Fluttering

D Hypotension

Question #34

A client has a medical diagnosis of an advanced atrioventricular block, Mobitz Type II, and is symptomatic. What initial treatment will the nurse be prepared to complete?

A prepare client for a cardiac catheterization

B administer an IV bolus of furosemide

C prepare the client for a cardioversion

D administer an IV bolus of atropine

Question #35

The nurse is working with a client with a new onset of atrial fibrillation during a three-month follow-up visit. The healthcare provider is planning a cardioversion, and the client asks the nurse why there is a wait for the treatment. What is the best response by the nurse?

A “There is a long list of clients in line to be cardioverted.”

B “The doctor wants to see if your heart will switch back to its normal rhythm by itself.”

C “We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion.”

D “Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion.”

Question #36

To evaluate a client’s atrial depolarization, the nurse observes which part of the electrocardiogram waveform?

A QRS complex

B P wave

C PR interval

D T wave

Question #37

The nurse reads an athletic client’s electrocardigram. What finding will be consistent with a sinus bradycardia?

A P-to-QR ratio of 1:2.

B PR interval of 0.24 seconds.

C QR interval of 0.25 seconds.

D Heart rate of 42 beats per minute (bpm).

Question #38

A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi?

A Adenosine

B Amiodarone

C Warfarin

D Atropine

Question #39

The nurse is monitoring a patient in the postanesthesia care unit (PACU) following a coronary artery bypass graft, observing a regular ventricular rate of 82 beats/min and “sawtooth” P waves with an atrial rate of approximately 300 beat/min. How does the nurse interpret this rhythm?

A Atrial flutter

B Ventricular fibrillation

C Ventricular tachycardia

D Atrial fibrillation

Question #40

A client presents to the emergency department via ambulance with a heart rate of 210 beats/minute and a sawtooth waveform pattern per cardiac monitor. The nurse is most correct to alert the medical team of the presence of a client with which disorder?

A Atrial flutter

B Premature ventricular contraction

C Asystole

D Ventricular fibrillation

Question #41

Which is not a likely origination point for cardiac dysrhythmias?

A atria

B atrioventricular node

C bundle of His

D ventricles

Question #42

The nurse identifies which of the following as a potential cause of premature ventricular complexes (PVCs)?

A Alkalosis

B Bradycardia

C Hypokalemia

D Hypovolemia

Question #43

The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia?

A vagal stimulation

B hypothyroidism

C hypovolemia

D digoxin

Question #44

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client?

A alerting the healthcare provider of the third-degree heart block

B assessing blood pressure and heart rate frequently

C identifying a code-level status

D maintaining intravenous fluids

Question #45

When the nurse observes that the client’s heart rate increases during inspiration and decreases during expiration, the nurse reports that the client is demonstrating

A sinus tachycardia.

B normal sinus rhythm.

C sinus dysrhythmia.

D sinus bradycardia.

Question #46

A nurse is caring for a client who’s experiencing sinus bradycardia with a pulse rate of 40 beats/minute. The client’s blood pressure is 80/50 mm Hg and the client reports dizziness. Which medication does the nurse anticipate administering to treat bradycardia?

A Amiodarone

B Dobutamine

C Atropine

D Lidocaine

Question #47

A patient comes to the emergency department with reports of chest pain after using cocaine. The nurse assesses the patient and obtains vital signs with results as follows: blood pressure 140/92, heart rate 128, respiratory rate 26, and an oxygen saturation of 98%. What rhythm on the monitor does the nurse anticipate viewing?

A Sinus bradycardia

B Sinus tachycardia

C Ventricular tachycardia

D Normal sinus rhythm

Question #48

A client tells the nurse “my heart is skipping beats again; I’m having palpitations.” After completing a physical assessment, the nurse concludes the client is experiencing occasional premature atrial complexes (PACs). The nurse should instruct the client to

A request sublingual nitroglycerin.

B lie down and elevate the feet.

C avoid caffeinated beverages.

D apply supplemental oxygen.

Question #49

A nurse evaluates a client with a temporary pacemaker. The client’s ECG tracing shows each P wave followed by the pacing spike. What is the nurse’s best response?

A Reposition the extremity and turn the client to left side

B Check the security of all connections and increase the milliamperage

C Document the findings and continue to monitor the client

D Obtain a 12-lead ECG and a portable chest x-ray

Question #50

A nurse completes a shift assessment on a client admitted to the telemetry unit with a diagnosis of syncope. The client’s heart rate is 55 bpm with a blood pressure of 90/66 mm Hg. The client is also experiencing dizziness and shortness of breath. Which medication will the nurse anticipate administering to the client based on these clinical findings?

A Pronestyl

B Lidocaine

C Cardizem

D Atropine

Question #51

The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated?

A The registered nurse stating to administer digoxin

B The registered nurse stating to administer all medications except those which are cardiotonics

C The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute

D The registered nurse administering atropine sulfate intravenously

Question #52

A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching?

A “I will drink coffee with only two of my meals.”

B “I will cut back on my smoking and drinking alcohol.”

C “If I take my metoprolol daily, I will be able to control my heart rate.”

D “I will take my levothyroxine daily.”

Question #53

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 check my pulse every day and report to the doctor if the rate is below the pacemaker setting.”

B “We will be getting rid of our microwave oven so it will not affect my pacemaker.”

C “I will avoid any large magnets that may affect my pacemaker.”

D “I will call the doctor if my incision becomes swollen and red.”

Question #54

Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration?

A Atrial flutter

B Atrial fibrillation

C Sinus tachycardia

D Paroxysmal atrial tachycardia

Question #55

A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching?

A “I’ll keep a log of each time my ICD discharges.”

B “I can’t wait to get back to my football league.”

C “I need to stay at least 10 inches away from the microwave.”

D “I have an appointment for magnetic resonance imaging of my knee scheduled for next week.”

Question #56

The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client?

A Stay at least 5 feet away from microwave ovens.

B Never engage in activities that require vigorous arm and shoulder movement.

C Avoid going through airport metal detectors.

D Avoid undergoing magnetic resonance imaging (MRI).

Question #57

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. What is the priority nursing intervention for the client?

A Identifying the client’s code level status

B Maintaining the client’s intravenous fluids

C Assessing the client’s blood pressure and heart rate frequently

D Alerting the healthcare provider of the third-degree heart block

Question #58

The nurse is assessing a patient with a probable diagnosis of first-degree AV block. The nurse is aware that this dysrhythmia is evident on an ECG strip by what indication?

A Irregular rhythm

B Delayed conduction, producing a prolonged PR interval

C P waves hidden within the QRS complex

D Variable heart rate, usually fewer than 90 bpm

Question #59

A nurse provides evening care for a client wearing a continuous telemetry monitor. While the nurse is giving the client a back rub, the client ’s monitor alarm sounds and the nurse notes a flat line on the bedside monitor system. What is the nurse’s first response?

A Assess the client and monitor leads.

B Call for assistance and begin CPR.

C Administer a pericardial thump.

D Call a code and obtain the crash cart.

Question #60

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 70 bpm.

B 90 bpm.

C 100 bpm.

D 80 bpm.

Question #61

The nurse enters the client’s room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client?

A Chemical cardioversion

B IV lidocaine

C Electric cardioversion

D Immediate defibrillation

Question #62

The nurse is proving discharge instructions for a client with a new arrhythmia. Which statement should the nurse include?

A Do not be concerned if you experience symptoms of lightheadedness and dizziness.

B It is not necessary to learn how to take your own pulse.

C Your family and friends may want to take a CPR class.

D If you miss a dose of your antiarrhythmia medication, double up on the next dose.

Question #63

The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they:

A are paired with a normal beat

B occur at a rate of more than six per minute

C occur during the QRS complex

D have the same shape

Question #64

The nurse documents that a client is having a normal sinus rhythm. What characteristics of this rhythm has the nurse assessed?

A Heart rate between 60 and 150 beats per minute.

B Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 seconds.

C The sinoatrial (SA) node initiates the impulse.

D The ventricles depolarize in 0.5 seconds or less.

Question #65

The nurse is working on a telemetry unit, caring for a client who develops dizziness and a second-degree heart block, Mobitz Type 1. What will be the initial nursing intervention?

A Prepare to client for cardioversion.

B Administer an IV bolus of atropine.

C Send the client to the cardiac catheterization laboratory.

D Review the client’s medication record.

Question #66

Which dysrhythmia is common in older clients?

A Atrial fibrillation

B Ventricular tachycardia

C Sinus tachycardia

D Sinus bradycardia

Question #67

A client asks the nurse about complications associated with use of a cardiac pacemaker. What does the nurse include in their response? Select all that apply.,,

A Hiccuping

B Twiddler syndrome

C Positive Kernig’s sign

D Localized infection

E Negative Babinski reflex

Question #68

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 Do nothing; there is no cause for alarm.

B Double-check the monitoring equipment.

C Measure the client’s blood pressure.

D Suggest the need for a new beta-blocker to the doctor.

Question #69

A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have?

A heart block

B none

C atrial bradycardia

D sinus bradycardia

Question #70

The nurse knows that what PR interval presents a first-degree heart block?

A 0.24 seconds

B 0.16 seconds

C 0.18 seconds

D 0.14 seconds

Question #71

A client asks the nurse what causes the heart to be an effective pump. The nurse informs the client that this is due to the:

A sufficient blood pressure.

B inherent electrons in muscle tissue.

C inherent rhythmicity of cardiac muscle tissue.

D inherent rhythmicity of all muscle tissue.

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