LEWIS EXAMINATION TEST 2026 QUESTIONS
SOLUTIONS ALREADY PASSED
◉ The nurse is watching the cardiac monitor, and a client's rhythm
suddenly changes. There are no P waves; instead, there are
fibrillatory waves before each QRS complex. How should the nurse
correctly interpret the client's heart rhythm?
1.Atrial fibrillation
2.Sinus tachycardia
3.Ventricular fibrillation
4.Ventricular tachycardia. Answer: 1.
Atrial fibrillation is characterized by a loss of P waves and
fibrillatory waves before each QRS complex. The atria quiver, which
can lead to thrombus formation.
◉ The nurse is assisting to defibrillate a client in ventricular
fibrillation. After placing the paddles on the client's chest and before
discharging them, which intervention should be done?
1.Ensure that the client has been intubated.
2.Set the defibrillator to the "synchronize" mode.
3.Administer an amiodarone bolus intravenously.
,4.Confirm that the rhythm is actually ventricular fibrillation..
Answer: 4.
Until the defibrillator is attached and charged, the client is
resuscitated by using cardiopulmonary resuscitation. Once the
defibrillator has been attached, the electrocardiogram is checked to
verify that the rhythm is ventricular fibrillation or pulseless
ventricular tachycardia. Leads also are checked for any loose
connections. A nitroglycerin patch, if present, is removed. The client
does not have to be intubated to be defibrillated. The machine is not
set to the synchronous mode because there is no underlying rhythm
with which to synchronize. Amiodarone may be given subsequently
but is not required before defibrillation.
◉ A client in ventricular fibrillation is about to be defibrillated. A
nurse knows that to convert this rhythm effectively, the monophasic
defibrillator machine should be set at which energy level (in joules,
J) for the first delivery?
1.50 J
2.120 J
3.200 J
4.360 J. Answer: 4.
The energy level used for all defibrillation attempts with a
monophasic defibrillator is 360 joules.
,◉ The nurse would evaluate that defibrillation of a client was most
successful if which observation was made?
1.Arousable, sinus rhythm, BP 116/72 mm Hg
2.Nonarousable, sinus rhythm, BP 88/60 mm Hg
3.Arousable, marked bradycardia, BP 86/54 mm Hg
4.Nonarousable, supraventricular tachycardia, BP 122/60 mm Hg.
Answer: 1.
After defibrillation, the client requires continuous monitoring of
electrocardiographic rhythm, hemodynamic status, and neurological
status. Respiratory and metabolic acidosis develop during
ventricular fibrillation because of lack of respiration and cardiac
output. These can cause cerebral and cardiopulmonary
complications. Arousable status, adequate blood pressure, and a
sinus rhythm indicate successful response to defibrillation.
◉ The nurse is evaluating a client's response to cardioversion.
Which observation would be of highest priority to the nurse?
1.Blood pressure
2.Status of airway
3.Oxygen flow rate
4.Level of consciousness. Answer: 2.
, Nursing responsibilities after cardioversion include maintenance
first of a patent airway, and then oxygen administration, assessment
of vital signs and level of consciousness, and dysrhythmia detection.
◉ The nurse is caring for a client who has just had implantation of
an automatic internal cardioverter-defibrillator. The nurse
immediately would assess which item based on priority?
1.Anxiety level of the client and family
2.Presence of a Medic-Alert card for the client to carry
3.Knowledge of restrictions of postdischarge physical activity
4.Activation status of the device, heart rate cutoff, and number of
shocks it is programmed to deliver. Answer: 4.
The nurse who is caring for the client after insertion of an automatic
internal cardioverter-defibrillator needs to assess device settings,
similar to after insertion of a permanent pacemaker. Specifically, the
nurse needs to know whether the device is activated, the heart rate
cutoff above which it will fire, and the number of shocks it is
programmed to deliver. The remaining options are also nursing
interventions but are not the priority.
◉ A client's electrocardiogram strip shows atrial and ventricular
rates of 110 beats/minute. The PR interval is 0.14 second, the QRS
complex measures 0.08 second, and the PP and RR intervals are
regular. How should the nurse correctly interpret this rhythm?
SOLUTIONS ALREADY PASSED
◉ The nurse is watching the cardiac monitor, and a client's rhythm
suddenly changes. There are no P waves; instead, there are
fibrillatory waves before each QRS complex. How should the nurse
correctly interpret the client's heart rhythm?
1.Atrial fibrillation
2.Sinus tachycardia
3.Ventricular fibrillation
4.Ventricular tachycardia. Answer: 1.
Atrial fibrillation is characterized by a loss of P waves and
fibrillatory waves before each QRS complex. The atria quiver, which
can lead to thrombus formation.
◉ The nurse is assisting to defibrillate a client in ventricular
fibrillation. After placing the paddles on the client's chest and before
discharging them, which intervention should be done?
1.Ensure that the client has been intubated.
2.Set the defibrillator to the "synchronize" mode.
3.Administer an amiodarone bolus intravenously.
,4.Confirm that the rhythm is actually ventricular fibrillation..
Answer: 4.
Until the defibrillator is attached and charged, the client is
resuscitated by using cardiopulmonary resuscitation. Once the
defibrillator has been attached, the electrocardiogram is checked to
verify that the rhythm is ventricular fibrillation or pulseless
ventricular tachycardia. Leads also are checked for any loose
connections. A nitroglycerin patch, if present, is removed. The client
does not have to be intubated to be defibrillated. The machine is not
set to the synchronous mode because there is no underlying rhythm
with which to synchronize. Amiodarone may be given subsequently
but is not required before defibrillation.
◉ A client in ventricular fibrillation is about to be defibrillated. A
nurse knows that to convert this rhythm effectively, the monophasic
defibrillator machine should be set at which energy level (in joules,
J) for the first delivery?
1.50 J
2.120 J
3.200 J
4.360 J. Answer: 4.
The energy level used for all defibrillation attempts with a
monophasic defibrillator is 360 joules.
,◉ The nurse would evaluate that defibrillation of a client was most
successful if which observation was made?
1.Arousable, sinus rhythm, BP 116/72 mm Hg
2.Nonarousable, sinus rhythm, BP 88/60 mm Hg
3.Arousable, marked bradycardia, BP 86/54 mm Hg
4.Nonarousable, supraventricular tachycardia, BP 122/60 mm Hg.
Answer: 1.
After defibrillation, the client requires continuous monitoring of
electrocardiographic rhythm, hemodynamic status, and neurological
status. Respiratory and metabolic acidosis develop during
ventricular fibrillation because of lack of respiration and cardiac
output. These can cause cerebral and cardiopulmonary
complications. Arousable status, adequate blood pressure, and a
sinus rhythm indicate successful response to defibrillation.
◉ The nurse is evaluating a client's response to cardioversion.
Which observation would be of highest priority to the nurse?
1.Blood pressure
2.Status of airway
3.Oxygen flow rate
4.Level of consciousness. Answer: 2.
, Nursing responsibilities after cardioversion include maintenance
first of a patent airway, and then oxygen administration, assessment
of vital signs and level of consciousness, and dysrhythmia detection.
◉ The nurse is caring for a client who has just had implantation of
an automatic internal cardioverter-defibrillator. The nurse
immediately would assess which item based on priority?
1.Anxiety level of the client and family
2.Presence of a Medic-Alert card for the client to carry
3.Knowledge of restrictions of postdischarge physical activity
4.Activation status of the device, heart rate cutoff, and number of
shocks it is programmed to deliver. Answer: 4.
The nurse who is caring for the client after insertion of an automatic
internal cardioverter-defibrillator needs to assess device settings,
similar to after insertion of a permanent pacemaker. Specifically, the
nurse needs to know whether the device is activated, the heart rate
cutoff above which it will fire, and the number of shocks it is
programmed to deliver. The remaining options are also nursing
interventions but are not the priority.
◉ A client's electrocardiogram strip shows atrial and ventricular
rates of 110 beats/minute. The PR interval is 0.14 second, the QRS
complex measures 0.08 second, and the PP and RR intervals are
regular. How should the nurse correctly interpret this rhythm?
