Cardiovascular (Dysrhythmias, MI) Critical Care
ANS: A
ST segment elevation and elevated cardiac enzymes are seen in Q wave MI. ST segment depression with
normal cardiac enzymes is seen with unstable angina episode. ST segment depression with elevated
total CPK is seen in non Q wave MI.
The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead
electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the
process of an evolving Q wave myocardial infarction(MI)?
a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels
b. Depressed ST-segment on ECG and elevated total CPK
c. Depressed ST-segment on ECG and normal cardiac enzymes
d. Q wave on ECG with normal enzymes and troponin levels
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.
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
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.
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ANS: B
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.
,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 health care 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.
ANS: D
Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and
ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct
this abnormality. Although the other laboratory values are also abnormal, they are not likely to be the
etiology of the patient's PVCs and do not require immediate correction
Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most
important for the nurse to communicate to the health care provider?
a. Blood glucose of 243 mg/dL
c. Serum sodium of 134 mEq/L
b. Serum chloride of 92 mEq/L
d. Serum potassium of 2.9 mEq/L
ANS: B
Adenosine must be given over 1 to 2 seconds to be effective.
The RN should hold the diltiazem until discussing it with the health care provider.
The treatment for asystole is immediate CPR.
The synchronizer switch should be "off" when defibrillating
, 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?
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
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.
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
ANS: C
Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine,
and inflammatory cytokines, which causes myocyte hypertrophy and loss of contractile function in the
ANS: A
ST segment elevation and elevated cardiac enzymes are seen in Q wave MI. ST segment depression with
normal cardiac enzymes is seen with unstable angina episode. ST segment depression with elevated
total CPK is seen in non Q wave MI.
The patient is admitted with a suspected acute myocardial infarction (MI). In assessing the 12-lead
electrocardiogram (ECG) changes, which findings would indicate to the nurse that the patient is in the
process of an evolving Q wave myocardial infarction(MI)?
a. ST-segment elevation on ECG and elevated CPK-MB or troponin levels
b. Depressed ST-segment on ECG and elevated total CPK
c. Depressed ST-segment on ECG and normal cardiac enzymes
d. Q wave on ECG with normal enzymes and troponin levels
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.
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
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.
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ANS: B
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.
,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 health care 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.
ANS: D
Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and
ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct
this abnormality. Although the other laboratory values are also abnormal, they are not likely to be the
etiology of the patient's PVCs and do not require immediate correction
Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most
important for the nurse to communicate to the health care provider?
a. Blood glucose of 243 mg/dL
c. Serum sodium of 134 mEq/L
b. Serum chloride of 92 mEq/L
d. Serum potassium of 2.9 mEq/L
ANS: B
Adenosine must be given over 1 to 2 seconds to be effective.
The RN should hold the diltiazem until discussing it with the health care provider.
The treatment for asystole is immediate CPR.
The synchronizer switch should be "off" when defibrillating
, 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?
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
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.
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
ANS: C
Myocardial remodeling is a process mediated by angiotensin II, aldosterone, catecholamine, adenosine,
and inflammatory cytokines, which causes myocyte hypertrophy and loss of contractile function in the
