HIGH ACUITY EXAM 1 | QUESTIONS AND ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTION.
To determine whether there is a delay in impulse conduction through the ventricles, the nurse will
measure the duration of the patient's
a. P wave. c. PR interval.
b. Q wave. d. QRS complex. - (ANSWER)ANS: D
The QRS complex represents ventricular depolarization. The P wave represents the depolarization of the
atria. The PR interval represents depolarization of the atria, atrioventricular node, a bundle of His,
bundle branches, and the Purkinje fibers. The Q wave is the first negative deflection following the P
wave and should be narrow and short.
Cognitive Level: Understand (comprehension)Chapter
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. 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. -
(ANSWER)ANS: C
This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the
other methods are accurate but take longer.
Cognitive Level: Analyze (analysis)
A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a
heart rate of _____ beats/min.
a. 15 to 20 c. 40 to 60
b. 20 to 40 d. 60 to 100 - (ANSWER)ANS: C
If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge
at the normal rate of 40 to 60 beats/minute. The slower rates are typical of the bundle of His and
Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA
node rate is 60 to 100 beats/min.
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the
following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval
,HIGH ACUITY EXAM 1 | QUESTIONS AND ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTION.
regular, and QRS complex wide and distorted, and QRS duration of 0.18 second. The nurse interprets the
patient's cardiac rhythm as
a. atrial flutter. c. ventricular fibrillation.
b. sinus tachycardia. d. ventricular tachycardia. - (ANSWER)ANS: D
The absence of P waves, wide QRS, rate greater than 150 beats/min, and the regularity of the rhythm
indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has
flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is
irregular and does not have a consistent QRS duration.
DIF: Cognitive Level: Apply (application)
The nurse notes that a patient's heart monitor shows that every other beat is earlier than expected, has
no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse
document the rhythm?
a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
d. Multifocal premature ventricular contractions - (ANSWER)ANS: B
Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking.
Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the
premature ventricular contractions are multifocal or that the R-on-T phenomenon is occurring.
DIF: Cognitive Level: Apply (application)
A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval
is 0.24 seconds. The most appropriate intervention by the nurse would be to
a. notify the a provider immediately.
b. document the finding and monitor the patient.
c. give atropine per agency dysrhythmia protocol.
d. prepare the patient for temporary pacemaker insertion. - (ANSWER)ANS: B
,HIGH ACUITY EXAM 1 | QUESTIONS AND ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTION.
First-degree atrioventricular block is asymptomatic and requires ongoing monitoring because it may
progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine
is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not
necessary.
DIF: Cognitive Level: Apply (application)
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. 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. - (ANSWER)ANS: C
The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular
irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The
nurse should notify the health care provider after the medication is started. Cardioversion is not
indicated given that the patient has returned to a sinus rhythm. Documentation and continued
monitoring are not adequate responses to this situation.
DIF: Cognitive Level: Analyze (analysis)
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?
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 - (ANSWER)ANS: A
Atropine will increase the heart rate and conduction through the AV node. Because the drug increases
electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to
evaluate the drug effectiveness. The patient does not have premature atrial or ventricular contractions.
, HIGH ACUITY EXAM 1 | QUESTIONS AND ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTION.
DIF: Cognitive Level: Apply (application)
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. anticoagulant therapy. c. emergency cardioversion.
b. permanent pacemakers. d. IV adenosine (Adenocard). - (ANSWER)ANS: A
Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for
3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria.
Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to
treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information
does not indicate that the patient has a slow heart rate.
DIF: Cognitive Level: Apply (application)
Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency
catheter ablation for treatment of atrial flutter?
a. The procedure prevents or minimizes the risk for sudden cardiac death.
b. The procedure uses cold therapy to stop the formation of the flutter waves.
c. The procedure uses electrical energy to destroy areas of the conduction system.
d. The procedure stimulates the growth of new conduction pathways between the atria. -
(ANSWER)ANS: C
Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the
conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and
tachydysrhythmias. All other statements regarding the procedure are incorrect.
DIF: Cognitive Level: Apply (application)
The nurse knows that discharge teaching about the management of a new permanent pacemaker has
been most effective when the patient states
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."
SOLUTION.
To determine whether there is a delay in impulse conduction through the ventricles, the nurse will
measure the duration of the patient's
a. P wave. c. PR interval.
b. Q wave. d. QRS complex. - (ANSWER)ANS: D
The QRS complex represents ventricular depolarization. The P wave represents the depolarization of the
atria. The PR interval represents depolarization of the atria, atrioventricular node, a bundle of His,
bundle branches, and the Purkinje fibers. The Q wave is the first negative deflection following the P
wave and should be narrow and short.
Cognitive Level: Understand (comprehension)Chapter
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. 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. -
(ANSWER)ANS: C
This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the
other methods are accurate but take longer.
Cognitive Level: Analyze (analysis)
A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a
heart rate of _____ beats/min.
a. 15 to 20 c. 40 to 60
b. 20 to 40 d. 60 to 100 - (ANSWER)ANS: C
If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge
at the normal rate of 40 to 60 beats/minute. The slower rates are typical of the bundle of His and
Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA
node rate is 60 to 100 beats/min.
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the
following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162, R-R interval
,HIGH ACUITY EXAM 1 | QUESTIONS AND ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTION.
regular, and QRS complex wide and distorted, and QRS duration of 0.18 second. The nurse interprets the
patient's cardiac rhythm as
a. atrial flutter. c. ventricular fibrillation.
b. sinus tachycardia. d. ventricular tachycardia. - (ANSWER)ANS: D
The absence of P waves, wide QRS, rate greater than 150 beats/min, and the regularity of the rhythm
indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has
flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is
irregular and does not have a consistent QRS duration.
DIF: Cognitive Level: Apply (application)
The nurse notes that a patient's heart monitor shows that every other beat is earlier than expected, has
no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse
document the rhythm?
a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
d. Multifocal premature ventricular contractions - (ANSWER)ANS: B
Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking.
Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the
premature ventricular contractions are multifocal or that the R-on-T phenomenon is occurring.
DIF: Cognitive Level: Apply (application)
A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval
is 0.24 seconds. The most appropriate intervention by the nurse would be to
a. notify the a provider immediately.
b. document the finding and monitor the patient.
c. give atropine per agency dysrhythmia protocol.
d. prepare the patient for temporary pacemaker insertion. - (ANSWER)ANS: B
,HIGH ACUITY EXAM 1 | QUESTIONS AND ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTION.
First-degree atrioventricular block is asymptomatic and requires ongoing monitoring because it may
progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine
is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not
necessary.
DIF: Cognitive Level: Apply (application)
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. 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. - (ANSWER)ANS: C
The burst of sustained ventricular tachycardia indicates that the patient has significant ventricular
irritability, and antidysrhythmic medication administration is needed to prevent further episodes. The
nurse should notify the health care provider after the medication is started. Cardioversion is not
indicated given that the patient has returned to a sinus rhythm. Documentation and continued
monitoring are not adequate responses to this situation.
DIF: Cognitive Level: Analyze (analysis)
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?
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 - (ANSWER)ANS: A
Atropine will increase the heart rate and conduction through the AV node. Because the drug increases
electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to
evaluate the drug effectiveness. The patient does not have premature atrial or ventricular contractions.
, HIGH ACUITY EXAM 1 | QUESTIONS AND ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTION.
DIF: Cognitive Level: Apply (application)
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. anticoagulant therapy. c. emergency cardioversion.
b. permanent pacemakers. d. IV adenosine (Adenocard). - (ANSWER)ANS: A
Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant treatment for
3 weeks before attempting cardioversion. This is done to prevent embolization of clots from the atria.
Cardioversion may be done after several weeks of anticoagulation therapy. Adenosine is not used to
treat atrial fibrillation. Pacemakers are routinely used for patients with bradydysrhythmias. Information
does not indicate that the patient has a slow heart rate.
DIF: Cognitive Level: Apply (application)
Which information will the nurse include when teaching a patient who is scheduled for a radiofrequency
catheter ablation for treatment of atrial flutter?
a. The procedure prevents or minimizes the risk for sudden cardiac death.
b. The procedure uses cold therapy to stop the formation of the flutter waves.
c. The procedure uses electrical energy to destroy areas of the conduction system.
d. The procedure stimulates the growth of new conduction pathways between the atria. -
(ANSWER)ANS: C
Radiofrequency catheter ablation therapy uses electrical energy to "burn" or ablate areas of the
conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus rhythm) and
tachydysrhythmias. All other statements regarding the procedure are incorrect.
DIF: Cognitive Level: Apply (application)
The nurse knows that discharge teaching about the management of a new permanent pacemaker has
been most effective when the patient states
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."
