COMPLEX ADULT HEALTH GUIDE 1 2026 FINAL
ASSESSMENT TESTED CONTENT WITH
ACCURATE SOLUTIONS
◉ 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 as a junctional escape rhythm, and
understands that 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. Answer: a
◉ . Answer:
◉ 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.. Answer: b
,The normal intrinsic rate for the AV node and junctional tissue is 40
to 60 beats per minute, but rates can accelerate. An accelerated
junctional rhythm has a rate between 60 and 100 beats per minute,
and the rate for junctional tachycardia is greater than 100 beats per
minute.
◉ 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. if the number of PVCs are decreasing.
d. if the PVCs are wider than 0.12 seconds.. Answer: a
◉ 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.. Answer: C
First-degree AV block is a common dysrhythmia in the elderly and in
patients with cardiac disease. As the normal conduction pathway
ages or becomes diseased, impulse conduction becomes slower than
normal. It is well tolerated. No treatment is required. Continue to
monitor the patient and the rhythm.
,◉ 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.. Answer: C
In first-degree AV block, a P wave precedes every QRS complex,
which is followed by a T wave indicating complete conduction. It is
represented on the ECG as a prolonged PR interval. Second-degree
heart block refers to AV conduction that is intermittently blocked.
Therefore, some P waves are conducted and some are not. Third-
degree block is often called complete heart block because no atrial
impulses are conducted through the AV node to the ventricles.
◉ 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.. Answer: C
Digitalis toxicity is a major cause of this rhythm, and further digitalis
doses should not be given until a digitalis level is obtained. Other
causes of Mobitz I include AV nodal blocking drugs, acute inferior
, wall myocardial infarction or right ventricular infarction, ischemic
heart disease, and excess vagal response. This type of block is
usually well tolerated and no treatment is indicated unless the
dropped beats occur frequently.
◉ 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.. Answer: A
Pacemakers can be operated in a demand mode or a fixed rate
(asynchronous) mode. The demand mode paces the heart when no
intrinsic or native beat is sensed. For example, if the rate control is
set at 60 beats per minute, the pacemaker will only pace if the
patient's heart rate drops to less than 60. The fixed rate mode paces
the heart at a set rate, independent of any activity the patient's heart
generates. The fixed rate mode may compete with the patient's own
rhythm and deliver an impulse on the T wave (R-on-T phenomenon),
with the potential for producing ventricular tachycardia or
fibrillation. The demand mode is safer and is the mode of choice.
ASSESSMENT TESTED CONTENT WITH
ACCURATE SOLUTIONS
◉ 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 as a junctional escape rhythm, and
understands that 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. Answer: a
◉ . Answer:
◉ 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.. Answer: b
,The normal intrinsic rate for the AV node and junctional tissue is 40
to 60 beats per minute, but rates can accelerate. An accelerated
junctional rhythm has a rate between 60 and 100 beats per minute,
and the rate for junctional tachycardia is greater than 100 beats per
minute.
◉ 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. if the number of PVCs are decreasing.
d. if the PVCs are wider than 0.12 seconds.. Answer: a
◉ 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.. Answer: C
First-degree AV block is a common dysrhythmia in the elderly and in
patients with cardiac disease. As the normal conduction pathway
ages or becomes diseased, impulse conduction becomes slower than
normal. It is well tolerated. No treatment is required. Continue to
monitor the patient and the rhythm.
,◉ 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.. Answer: C
In first-degree AV block, a P wave precedes every QRS complex,
which is followed by a T wave indicating complete conduction. It is
represented on the ECG as a prolonged PR interval. Second-degree
heart block refers to AV conduction that is intermittently blocked.
Therefore, some P waves are conducted and some are not. Third-
degree block is often called complete heart block because no atrial
impulses are conducted through the AV node to the ventricles.
◉ 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.. Answer: C
Digitalis toxicity is a major cause of this rhythm, and further digitalis
doses should not be given until a digitalis level is obtained. Other
causes of Mobitz I include AV nodal blocking drugs, acute inferior
, wall myocardial infarction or right ventricular infarction, ischemic
heart disease, and excess vagal response. This type of block is
usually well tolerated and no treatment is indicated unless the
dropped beats occur frequently.
◉ 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.. Answer: A
Pacemakers can be operated in a demand mode or a fixed rate
(asynchronous) mode. The demand mode paces the heart when no
intrinsic or native beat is sensed. For example, if the rate control is
set at 60 beats per minute, the pacemaker will only pace if the
patient's heart rate drops to less than 60. The fixed rate mode paces
the heart at a set rate, independent of any activity the patient's heart
generates. The fixed rate mode may compete with the patient's own
rhythm and deliver an impulse on the T wave (R-on-T phenomenon),
with the potential for producing ventricular tachycardia or
fibrillation. The demand mode is safer and is the mode of choice.
