Question 1
The nurse and student nurse are observing a cardioversion procedure. The
nurse is correct to tell the student that electrical current will be initiated at
which time?
During ventricular depolarization
Explanation:
The electrical current is initiated at the R wave when ventricular
depolarization occurs. The electrical current completely depolarizes the
entire myocardium with the goal of restoring the normal pacemaker of the
heart.
Question 2
The nurse witnesses a client experiencing ventricular fibrillation. What is the
nurse's priority action?
defibrillation
Explanation:
Advanced cardiac life support recommends early defibrillation for witnessed
ventricular fibrillation. A cardioversion is used with a client who has a pulse.
Atropine is used for bradycardia and dobutamine is an inotropic medication
used to increased cardiac output.
Question 3
The nurse knows that what PR interval presents a first-degree heart block?
0.24 seconds
Explanation:
In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal
of 0.24 seconds would indicate a first-degree heart block.
Question 4
After performing an ECG on an adult client, the nurse reports that the PR
interval reflects normal sinus rhythm. What is the PR interval for a normal
sinus rhythm?
1
, 0.12 and 0.2 seconds.
Explanation:
The PR interval is measured from the beginning of the P wave to the
beginning of the QRS complex. It measures the time needed for conduction
through the AV node before ventricular depolarization. The normal range in
adults is 0.12 to 0.2 seconds.
Question 5
A client has been diagnosed with atrial fibrillation and has been prescribed
warfarin therapy. What should the nurse prioritize when providing health
education to the client?
The need to have regular blood levels drawn
Explanation:
One drawback of warfarin therapy is the need to have blood levels drawn on
a regular basis. The medication does not need to be taken on an empty
stomach, and the client does not have to sit upright. Adequate fluid intake is
useful in a general way, but the need for fluids is not increased by taking
warfarin.
Question 6
Which nursing intervention is required to prepare a client with cardiac
dysrhythmia for an elective electrical cardioversion?
Instruct the client to restrict food and oral intake
Explanation:
The nurse should instruct the client to restrict food and oral intake before the
cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72
hours before cardioversion. The presence of digitalis and diuretics in
myocardial cells decreases the ability to restore normal conduction and
increases the chances of a fatal dysrhythmia developing after cardioversion.
When the client is in cardiopulmonary arrest, the nurse should facilitate CPR
until the client is prepared for defibrillation and not for cardioversion.
Monitoring blood pressure every 4 hours is not required to prepare a client
with cardiac dysrhythmia.
Question 7
2
,A client is unconscious on arrival to the emergency department. The nurse in
the emergency department identifies that the client has a permanent
pacemaker due to which characteristic?
“Spike” on the rhythm strip
Explanation:
Confirmation that the client has a permanent pacemaker is the characteristic
“spike” identified by a thin, straight stroke on the rhythm strip. The scar on
the chest is suggestive of pacer implantation but not definitive. There should
be no change in pulse quality, and no vibration under the skin.
Question 8
A client has been living with an internal, fixed-rate pacemaker. When
checking the client's readings on a cardiac monitor the nurse notices an
absence of spikes. What should the nurse do?
Double-check the monitoring equipment.
Explanation:
One of the reasons for lack of pacemaker spikes is faulty monitoring
equipment.
Question 9
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves
and QRS complexes are regular. The PR interval is 0.18 seconds long, and the
QRS complexes are 0.08 seconds long. The heart rate is calculated at 70
bpm. The nurse correctly identifies this rhythm as
normal sinus rhythm.
Explanation:
The electrocardiogram (ECG) tracing shows normal sinus rhythm (NSR). NSR
has the following characteristics: ventricular and atrial rate: 60 to 100 beats
per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and
QRS shape and duration: usually normal, but may be regularly abnormal; P
wave: normal and consistent shape, always in front of the QRS; PR interval:
consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1.
Question 10
A client asks the nurse what causes the heart to be an effective pump. The
nurse informs the client that this is due to the:
3
, inherent rhythmicity of cardiac muscle tissue.
Explanation:
Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The
conduction system of the heart and the inherent rhythmicity of cardiac
muscle produce a rhythm pattern, which greatly influences the heart's ability
to pump blood effectively.
Question 11
The nurse is caring for a client who is being discharged after insertion of a
permanent pacemaker. The client, an avid tennis player, is scheduled to play
in a tournament in 1 week. What is the best advice the nurse can give
related to this activity?
"You will need to cancel this activity; you must restrict arm movement
above your head for 2 weeks."
Explanation:
It is important to restrict movement of the arm until the incision heals. The
client should not raise the arm above the head for 2 weeks afterward to
avoid dislodging the leads. The client must avoid contact sports (e.g.,
basketball, football, hockey).
Question 12
The nurse is monitoring a patient in the postanesthesia care unit (PACU)
following a coronary artery bypass graft, observing a regular ventricular rate
of 82 beats/min and “sawtooth” P waves with an atrial rate of approximately
300 beat/min. How does the nurse interpret this rhythm?
Atrial flutter
Explanation:
Atrial flutter occurs because of a conduction defect in the atrium and causes
a rapid, regular atrial rate, usually between 250 and 400 bpm and results in
P waves that are saw-toothed. Because the atrial rate is faster than the AV
node can conduct, not all atrial impulses are conducted into the ventricle,
causing a therapeutic block at the AV node. This is an important feature of
this dysrhythmia. If all atrial impulses were conducted to the ventricle, the
ventricular rate would also be 250 to 400 bpm, which would result in
ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often
occurs in patients with chronic obstructive pulmonary disease, pulmonary
hypertension, valvular disease, and thyrotoxicosis, as well as following open
heart surgery and repair of congenital cardiac defects (
4
The nurse and student nurse are observing a cardioversion procedure. The
nurse is correct to tell the student that electrical current will be initiated at
which time?
During ventricular depolarization
Explanation:
The electrical current is initiated at the R wave when ventricular
depolarization occurs. The electrical current completely depolarizes the
entire myocardium with the goal of restoring the normal pacemaker of the
heart.
Question 2
The nurse witnesses a client experiencing ventricular fibrillation. What is the
nurse's priority action?
defibrillation
Explanation:
Advanced cardiac life support recommends early defibrillation for witnessed
ventricular fibrillation. A cardioversion is used with a client who has a pulse.
Atropine is used for bradycardia and dobutamine is an inotropic medication
used to increased cardiac output.
Question 3
The nurse knows that what PR interval presents a first-degree heart block?
0.24 seconds
Explanation:
In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal
of 0.24 seconds would indicate a first-degree heart block.
Question 4
After performing an ECG on an adult client, the nurse reports that the PR
interval reflects normal sinus rhythm. What is the PR interval for a normal
sinus rhythm?
1
, 0.12 and 0.2 seconds.
Explanation:
The PR interval is measured from the beginning of the P wave to the
beginning of the QRS complex. It measures the time needed for conduction
through the AV node before ventricular depolarization. The normal range in
adults is 0.12 to 0.2 seconds.
Question 5
A client has been diagnosed with atrial fibrillation and has been prescribed
warfarin therapy. What should the nurse prioritize when providing health
education to the client?
The need to have regular blood levels drawn
Explanation:
One drawback of warfarin therapy is the need to have blood levels drawn on
a regular basis. The medication does not need to be taken on an empty
stomach, and the client does not have to sit upright. Adequate fluid intake is
useful in a general way, but the need for fluids is not increased by taking
warfarin.
Question 6
Which nursing intervention is required to prepare a client with cardiac
dysrhythmia for an elective electrical cardioversion?
Instruct the client to restrict food and oral intake
Explanation:
The nurse should instruct the client to restrict food and oral intake before the
cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72
hours before cardioversion. The presence of digitalis and diuretics in
myocardial cells decreases the ability to restore normal conduction and
increases the chances of a fatal dysrhythmia developing after cardioversion.
When the client is in cardiopulmonary arrest, the nurse should facilitate CPR
until the client is prepared for defibrillation and not for cardioversion.
Monitoring blood pressure every 4 hours is not required to prepare a client
with cardiac dysrhythmia.
Question 7
2
,A client is unconscious on arrival to the emergency department. The nurse in
the emergency department identifies that the client has a permanent
pacemaker due to which characteristic?
“Spike” on the rhythm strip
Explanation:
Confirmation that the client has a permanent pacemaker is the characteristic
“spike” identified by a thin, straight stroke on the rhythm strip. The scar on
the chest is suggestive of pacer implantation but not definitive. There should
be no change in pulse quality, and no vibration under the skin.
Question 8
A client has been living with an internal, fixed-rate pacemaker. When
checking the client's readings on a cardiac monitor the nurse notices an
absence of spikes. What should the nurse do?
Double-check the monitoring equipment.
Explanation:
One of the reasons for lack of pacemaker spikes is faulty monitoring
equipment.
Question 9
The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves
and QRS complexes are regular. The PR interval is 0.18 seconds long, and the
QRS complexes are 0.08 seconds long. The heart rate is calculated at 70
bpm. The nurse correctly identifies this rhythm as
normal sinus rhythm.
Explanation:
The electrocardiogram (ECG) tracing shows normal sinus rhythm (NSR). NSR
has the following characteristics: ventricular and atrial rate: 60 to 100 beats
per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and
QRS shape and duration: usually normal, but may be regularly abnormal; P
wave: normal and consistent shape, always in front of the QRS; PR interval:
consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1.
Question 10
A client asks the nurse what causes the heart to be an effective pump. The
nurse informs the client that this is due to the:
3
, inherent rhythmicity of cardiac muscle tissue.
Explanation:
Cardiac rhythm refers to the pattern (or pace) of the heartbeat. The
conduction system of the heart and the inherent rhythmicity of cardiac
muscle produce a rhythm pattern, which greatly influences the heart's ability
to pump blood effectively.
Question 11
The nurse is caring for a client who is being discharged after insertion of a
permanent pacemaker. The client, an avid tennis player, is scheduled to play
in a tournament in 1 week. What is the best advice the nurse can give
related to this activity?
"You will need to cancel this activity; you must restrict arm movement
above your head for 2 weeks."
Explanation:
It is important to restrict movement of the arm until the incision heals. The
client should not raise the arm above the head for 2 weeks afterward to
avoid dislodging the leads. The client must avoid contact sports (e.g.,
basketball, football, hockey).
Question 12
The nurse is monitoring a patient in the postanesthesia care unit (PACU)
following a coronary artery bypass graft, observing a regular ventricular rate
of 82 beats/min and “sawtooth” P waves with an atrial rate of approximately
300 beat/min. How does the nurse interpret this rhythm?
Atrial flutter
Explanation:
Atrial flutter occurs because of a conduction defect in the atrium and causes
a rapid, regular atrial rate, usually between 250 and 400 bpm and results in
P waves that are saw-toothed. Because the atrial rate is faster than the AV
node can conduct, not all atrial impulses are conducted into the ventricle,
causing a therapeutic block at the AV node. This is an important feature of
this dysrhythmia. If all atrial impulses were conducted to the ventricle, the
ventricular rate would also be 250 to 400 bpm, which would result in
ventricular fibrillation, a life-threatening dysrhythmia. Atrial flutter often
occurs in patients with chronic obstructive pulmonary disease, pulmonary
hypertension, valvular disease, and thyrotoxicosis, as well as following open
heart surgery and repair of congenital cardiac defects (
4
