Question 1

A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia,then converts to sinus rhythm with a heart rate of 98 beats/min. Which action should the nurse take next?

Accepted Answer

A)  Immediately notify the health care provider.
B)  Document the rhythm and continue to monitor the patient.
C)  Prepare to give IV amiodarone per agency dysrhythmia protocol.
D)  Perform synchronized cardioversion per agency dysrhythmia protocol. C

Question 2

A patient whose heart monitor shows sinus tachycardia,rate 132,is apneic,and has no palpable pulses. What action should the nurse take next?

Accepted Answer

A)  Perform synchronized cardioversion.
B)  Start cardiopulmonary resuscitation (CPR) .
C)  Give atropine per agency dysrhythmia protocol.
D)  Provide supplemental O2 via non-rebreather mask. B

Question 3

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/min.

Accepted Answer

A)  15 to 20
B)  20 to 40
C)  40 to 60
D)  60 to 100 C

Question 4

Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD)inserted indicates a need for more teaching about the care of patients with ICDs?

Accepted Answer

A)  The nurse administers amiodarone (Cordarone)  to the patient.
B)  The nurse helps the patient fill out the application for obtaining a Medic Alert device.
C)  The nurse encourages the patient to do active range of motion exercises for all extremities.
D)  The nurse teaches the patient that sexual activity can be resumed when the incision is healed.

Question 5

The nurse knows that discharge teaching about the management of a new permanent pacemaker has been most effective when the patient states

Accepted Answer

A)  "It will be several weeks before I can return to my usual activities."
B)  "I will avoid cooking with a microwave oven or being near one in use."
C)  "I will notify the airlines when I make a reservation that I have a pacemaker."
D)  "I won't lift the arm on the pacemaker side until I see the health care provider."

Question 6

Which nursing action can the registered nurse (RN)delegate to experienced unlicensed assistive personnel (UAP)working as telemetry technicians on the cardiac care unit?

Accepted Answer

A)  Decide whether a patient's heart rate of 116 requires urgent treatment.
B)  Observe heart rhythms for multiple patients who have telemetry monitoring.
C)  Monitor a patient's level of consciousness during synchronized cardioversion.
D)  Select the best lead for monitoring a patient admitted with acute coronary syndrome.

Question 7

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. Teaching for this patient would include information about

Accepted Answer

A)  anticoagulant therapy.
B)  permanent pacemakers.
C)  emergency cardioversion.
D)  IV adenosine (Adenocard) .

Question 8

A 20-yr-old patient has a mandatory electrocardiogram (ECG)before participating on a college soccer team and is found to have sinus bradycardia,rate 52. Blood pressure (BP)is 114/54 mm Hg,and the student denies any health problems. What action by the nurse is most appropriate?

Accepted Answer

A)  Allow the student to participate on the soccer team.
B)  Refer the student to a cardiologist for further testing.
C)  Tell the student to stop playing immediately if any dyspnea occurs.
D)  Obtain more detailed information about the student's family health history.

Question 9

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin?

Accepted Answer

A)  Explain the association between dysrhythmias and syncope.
B)  Instruct the patient to call for assistance before getting out of bed.
C)  Teach the patient about the need to avoid caffeine and other stimulants.
D)  Tell the patient about the benefits of implantable cardioverter-defibrillators.

Question 10

A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious,apneic,and pulseless. Which action should the nurse take first?

Accepted Answer

A)  Give epinephrine (Adrenalin)  IV.
B)  Perform immediate defibrillation.
C)  Prepare for endotracheal intubation.
D)  Ventilate with a bag-valve-mask device.

Question 11

Which action by a new registered nurse (RN)who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias?

Accepted Answer

A)  Prepares defibrillator settings at 360 joules for a patient whose monitor shows asystole.
B)  Injects IV adenosine (Adenocard)  over 2 seconds to a patient with supraventricular tachycardia
C)  Turns the synchronizer switch to the "on" position before defibrillating a patient with ventricular fibrillation
D)  Gives the prescribed dose of diltiazem (Cardizem)  to a patient with new-onset type II second degree AV block

Question 12

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg?

Accepted Answer

A)  Turn the synchronizer switch to the "off" position.
B)  Give a sedative before cardioversion is implemented.
C)  Set the defibrillator/cardioverter energy to 360 joules.
D)  Provide assisted ventilations with a bag-valve-mask device.

Question 13

A patient develops sinus bradycardia at a rate of 32 beats/min,has a blood pressure (BP)of 80/42 mm Hg,and is complaining of feeling faint. Which action should the nurse take next?

Accepted Answer

A)  Recheck the heart rhythm and BP in 5 minutes.
B)  Have the patient perform the Valsalva maneuver.
C)  Give the scheduled dose of diltiazem (Cardizem) .
D)  Apply the transcutaneous pacemaker (TCP)  pads.

Question 14

A patient who is complaining of a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG)tracing. 
Which action should the nurse take next?

Accepted Answer

A)  Prepare to perform electrical cardioversion.
B)  Have the patient perform the Valsalva maneuver.
C)  Obtain the patient's vital signs including O2 saturation.
D)  Prepare to give a b-blocker medication to slow the heart rate.

Question 15

After the nurse gives IV atropine to a patient with symptomatic type 1,second-degree atrioventricular (AV)block,which finding indicates that the drug has been effective?

Accepted Answer

A)  Increase in the patient's heart rate
B)  Increase in strength of peripheral pulses
C)  Decrease in premature atrial contractions
D)  Decrease in premature ventricular contractions

Question 16

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first?

Accepted Answer

A)  A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin (Coumadin)  due
B)  A patient with second-degree atrioventricular (AV)  block, type 1, rate 60, who is dizzy when ambulating
C)  A patient who is in a sinus rhythm, rate 98 and regular, recovering from an elective cardioversion 2 hours ago
D)  A patient whose implantable cardioverter-defibrillator (IC
D)   fired twice today and has a dose of amiodarone (Cordarone)  due

Question 17

A patient reports dizziness and shortness of breath for several days. During heart monitoring in the emergency department (ED),the nurse obtains the following electrocardiographic (ECG)tracing. The nurse interprets this heart rhythm as

Accepted Answer

A)  junctional escape rhythm.
B)  accelerated idioventricular rhythm.
C)  third-degree atrioventricular (AV)  block.
D)  sinus rhythm with premature atrial contractions (PACs) .

Question 18

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use?

Accepted Answer

A)  Count the number of large squares in the R-R interval and divide by 300.
B)  Print a 1-minute electrocardiogram (ECG)  strip and count the number of QRS complexes.
C)  Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10.
D)  Calculate the number of small squares between one QRS complex and the next and divide into 1500.

Question 19

A patient who is on the telemetry unit develops atrial flutter,rate 150,with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first?

Accepted Answer

A)  Obtain a 12-lead electrocardiogram (ECG) .
B)  Notify the health care provider of the change in rhythm.
C)  Give supplemental O2 at 2 to 3 L/min via nasal cannula.
D)  Assess the patient's vital signs including O2 saturation.

Question 20

When preparing to defibrillate a patient,in which order will the nurse perform the following steps? (Put a comma and a space between each answer choice [A,B,C,D,E].)

Accepted Answer

A)  Turn the defibrillator on.
B)  Deliver the electrical charge.
C)  Select the appropriate energy level.
D)  Place the hands-free, multifunction defibrillator pads on the patient's chest.
E)  Check the location of other staff and call out "all clear."

Exam 35: Dysrhythmias

A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular tachycardia,then converts to sinus rhythm with a heart rate of 98 beats/min. Which action should the nurse take next?

A patient whose heart monitor shows sinus tachycardia,rate 132,is apneic,and has no palpable pulses. What action should the nurse take next?

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/min.

Which intervention by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more teaching about the care of patients with ICDs?

The nurse knows that discharge teaching about the management of a new permanent pacemaker has been most effective when the patient states

Which nursing action can the registered nurse (RN) delegate to experienced unlicensed assistive personnel (UAP) working as telemetry technicians on the cardiac care unit?

A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unresponsive to drug therapy for several days. Teaching for this patient would include information about

A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a college soccer team and is found to have sinus bradycardia,rate 52. Blood pressure (BP) is 114/54 mm Hg,and the student denies any health problems. What action by the nurse is most appropriate?

Which action will the nurse include in the plan of care for a patient who was admitted with syncopal episodes of unknown origin?

A patient's heart monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious,apneic,and pulseless. Which action should the nurse take first?

Which action by a new registered nurse (RN) who is orienting to the telemetry unit indicates a good understanding of the treatment of heart dysrhythmias?

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg?

A patient develops sinus bradycardia at a rate of 32 beats/min,has a blood pressure (BP) of 80/42 mm Hg,and is complaining of feeling faint. Which action should the nurse take next?

A patient who is complaining of a "racing" heart and feeling "anxious" comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next?

After the nurse gives IV atropine to a patient with symptomatic type 1,second-degree atrioventricular (AV) block,which finding indicates that the drug has been effective?

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first?

A patient reports dizziness and shortness of breath for several days. During heart monitoring in the emergency department (ED) ,the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as

The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which method will be best to use?

A patient who is on the telemetry unit develops atrial flutter,rate 150,with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first?

When preparing to defibrillate a patient,in which order will the nurse perform the following steps? (Put a comma and a space between each answer choice [A,B,C,D,E].)