Nr 341 exam 1 QUESTIONS
AND VERIFIED CORRECT
ANSWERS LATEST 2026-2027
When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to
understand that the electrical activity is viewed in relation to the positive electrode of that
particular lead. When an electrical signal is aimed directly at the positive electrode, the
inflection will be:
a. negative.
b. upside down.
c. upright.
d. equally positive and negative. - CORRECT ANSWER-c
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P
waves are upright and look the same except one that has a different shape and is inverted. The
nurse realizes that the P wave with the abnormal shape is probably:
a. from the SA node since all P waves come from the SA node.
,b. from some area in the atria other than the SA node.
c. indicative of ventricular depolarization.
d. normal even though it is inverted in lead II. - CORRECT ANSWER-b
Normally a P wave indicates that the SA node initiated the impulse that depolarized the atrium.
However, a change in the shape of the P wave may indicate that the impulse arose from a site in
the atria other than the SA node. The P wave represents atrial depolarization. It is usually
upright in leads I and II and has a rounded, symmetrical shape. The amplitude of the P wave is
measured at the center of the waveform and normally does not exceed three boxes, or 3
millimeters, in height.
The QT interval is the total time taken for ventricular depolarization and repolarization.
Prolongation of the QT interval:
a. decreases the risk of lethal dysrhythmias.
b. usually occurs when heart rate increases.
c. increases the risk of lethal dysrhythmias.
d. can only be measured with irregular rhythms. - CORRECT ANSWER-c
The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse first:
a. identifies the markers on the ECG paper that indicate a 6-second strip.
b. counts the number of large boxes between two consecutive P waves.
c. counts the number of small boxes between two consecutive QRS complexes.
d. divides the number of complexes in a 6-second strip by 10. - CORRECT ANSWER-A
Six-second method: A quick and easy estimate of heart rate can be accomplished by counting
the number of P waves or QRS waves within a 6-second strip to obtain atrial and ventricular
heart rates per minute. This is the optimal method for irregular rhythms. Identify the lines
above the ECG paper that represent 6 seconds, and count the number of P waves within the
lines; then add a zero (multiply by 10) to identify the atrial heart rate estimate for 1 minute.
Next, identify the number of QRS waves in the 6-second strip and again add a zero to identify
the ventricular rate.
,The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P
wave and 20 small boxes between each R wave. What is the ventricular rate?
a. 50 beats/min
b. 75 beats/min
c. 85 beats/min
d. 100 beats/min - CORRECT ANSWER-B
The rule of 1500 is used to calculate the exact rate of a regular rhythm. The number of small
boxes between the highest points of two consecutive R waves is counted, and that number of
small boxes is divided into 1500 to determine the ventricular rate. 1500/20 = 75 beats/min. This
method is accurate only if the rhythm is regular
The patient is admitted with a fever and rapid heart rate. The patient's temperature is 103° F
(39.4° C).The nurse places the patient on a cardiac monitor and finds the patient's atrial and
ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in
configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is
regular, and blood pressure is normal. The nurse should focus on providing:
a. medications to lower heart rate.
b. treatment to lower temperature.
c. treatment to lower cardiac output.
d. treatment to reduce heart rate. - CORRECT ANSWER-B
Sinus tachycardia results when the SA node fires faster than 100 beats per minute. Sinus
tachycardia is a normal response to stimulation of the sympathetic nervous system. Sinus
tachycardia is also a normal finding in children younger than 6 years. Both atrial and ventricular
rates are greater than 100 beats per minute, up to 160 beats per minute, but may be as high as
180 beats per minute. Sinus tachycardia is regular or essentially regular. PR interval is 0.12 to
0.20 seconds. QRS interval is 0.06 to 0.10 seconds. P and QRS waves are consistent in shape. P
waves are small and rounded. A P wave precedes every QRS complex, which is then followed by
a T wave.
Which of the following is true about a patient diagnosed with sinus arrhythmia?
a. The heart rate varies, dependent on vagal tone and respiratory pattern.
, b. Immediate treatment is essential to prevent death.
c. Sinus arrhythmia is not well tolerated by most patients.
d. PR and QRS interval measurements are prolonged. - CORRECT ANSWER-A
Sinus arrhythmia is a cyclical change in heart rate that is associated with respiration. The heart
rate increases slightly during inspiration and slows slightly during exhalation because of changes
in vagal tone. The ECG tracing demonstrates an alternating pattern of faster and slower heart
rate that changes with the respiratory cycle.
The patient is admitted with sinus pauses causing periods of loss of consciousness. The patient
is asymptomatic, awake and alert, but fatigued. He answers questions appropriately. When
admitting this patient, the nurse should first:
a. prepare the patient for temporary pacemaker insertion.
b. prepare the patient for permanent pacemaker insertion.
c. assess the patient's medication profile.
d. apply transcutaneous pacemaker paddles. - CORRECT ANSWER-c
The patient's heart rate is 165 beats per minute. His cardiac monitor shows a rapid rate with
narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patient's
blood pressure has dropped from 124/62 to 78/30. His skin is cold and diaphoretic and he is
complaining of nausea. The nurse prepares the patient for:
a. administration of beta-blockers.
b. administration of atropine.
c. transcutaneous pacemaker insertion.
d. emergent cardioversion. - CORRECT ANSWER-D
If an abnormal P wave cannot be visualized on the ECG but the QRS complex is narrow, the term
supraventricular tachycardia (SVT) is often used. This is a generic term that describes any
tachycardia that is not ventricular in origin; it is also used when the source above the ventricles
cannot be identified, usually because the rate is too fast. Treatment is directed at assessing the
patient's tolerance of the tachycardia. If the rate is higher than 150 beats per minute and the
patient is symptomatic, emergent cardioversion is considered. Cardioversion is the delivery of a
synchronized electrical shock to the heart by an external defibrillator.
AND VERIFIED CORRECT
ANSWERS LATEST 2026-2027
When assessing the 12-lead electrocardiogram (ECG) or a rhythm strip, it is helpful to
understand that the electrical activity is viewed in relation to the positive electrode of that
particular lead. When an electrical signal is aimed directly at the positive electrode, the
inflection will be:
a. negative.
b. upside down.
c. upright.
d. equally positive and negative. - CORRECT ANSWER-c
The nurse is examining the patient's cardiac rhythm strip in lead II and notices that all of the P
waves are upright and look the same except one that has a different shape and is inverted. The
nurse realizes that the P wave with the abnormal shape is probably:
a. from the SA node since all P waves come from the SA node.
,b. from some area in the atria other than the SA node.
c. indicative of ventricular depolarization.
d. normal even though it is inverted in lead II. - CORRECT ANSWER-b
Normally a P wave indicates that the SA node initiated the impulse that depolarized the atrium.
However, a change in the shape of the P wave may indicate that the impulse arose from a site in
the atria other than the SA node. The P wave represents atrial depolarization. It is usually
upright in leads I and II and has a rounded, symmetrical shape. The amplitude of the P wave is
measured at the center of the waveform and normally does not exceed three boxes, or 3
millimeters, in height.
The QT interval is the total time taken for ventricular depolarization and repolarization.
Prolongation of the QT interval:
a. decreases the risk of lethal dysrhythmias.
b. usually occurs when heart rate increases.
c. increases the risk of lethal dysrhythmias.
d. can only be measured with irregular rhythms. - CORRECT ANSWER-c
The patient has an irregular heart rhythm. To determine an accurate heart rate, the nurse first:
a. identifies the markers on the ECG paper that indicate a 6-second strip.
b. counts the number of large boxes between two consecutive P waves.
c. counts the number of small boxes between two consecutive QRS complexes.
d. divides the number of complexes in a 6-second strip by 10. - CORRECT ANSWER-A
Six-second method: A quick and easy estimate of heart rate can be accomplished by counting
the number of P waves or QRS waves within a 6-second strip to obtain atrial and ventricular
heart rates per minute. This is the optimal method for irregular rhythms. Identify the lines
above the ECG paper that represent 6 seconds, and count the number of P waves within the
lines; then add a zero (multiply by 10) to identify the atrial heart rate estimate for 1 minute.
Next, identify the number of QRS waves in the 6-second strip and again add a zero to identify
the ventricular rate.
,The nurse is calculating the rate for a regular rhythm. There are 20 small boxes between each P
wave and 20 small boxes between each R wave. What is the ventricular rate?
a. 50 beats/min
b. 75 beats/min
c. 85 beats/min
d. 100 beats/min - CORRECT ANSWER-B
The rule of 1500 is used to calculate the exact rate of a regular rhythm. The number of small
boxes between the highest points of two consecutive R waves is counted, and that number of
small boxes is divided into 1500 to determine the ventricular rate. 1500/20 = 75 beats/min. This
method is accurate only if the rhythm is regular
The patient is admitted with a fever and rapid heart rate. The patient's temperature is 103° F
(39.4° C).The nurse places the patient on a cardiac monitor and finds the patient's atrial and
ventricular rates are above 105 beats per minute. P waves are clearly seen and appear normal in
configuration. QRS complexes are normal in appearance and 0.08 seconds wide. The rhythm is
regular, and blood pressure is normal. The nurse should focus on providing:
a. medications to lower heart rate.
b. treatment to lower temperature.
c. treatment to lower cardiac output.
d. treatment to reduce heart rate. - CORRECT ANSWER-B
Sinus tachycardia results when the SA node fires faster than 100 beats per minute. Sinus
tachycardia is a normal response to stimulation of the sympathetic nervous system. Sinus
tachycardia is also a normal finding in children younger than 6 years. Both atrial and ventricular
rates are greater than 100 beats per minute, up to 160 beats per minute, but may be as high as
180 beats per minute. Sinus tachycardia is regular or essentially regular. PR interval is 0.12 to
0.20 seconds. QRS interval is 0.06 to 0.10 seconds. P and QRS waves are consistent in shape. P
waves are small and rounded. A P wave precedes every QRS complex, which is then followed by
a T wave.
Which of the following is true about a patient diagnosed with sinus arrhythmia?
a. The heart rate varies, dependent on vagal tone and respiratory pattern.
, b. Immediate treatment is essential to prevent death.
c. Sinus arrhythmia is not well tolerated by most patients.
d. PR and QRS interval measurements are prolonged. - CORRECT ANSWER-A
Sinus arrhythmia is a cyclical change in heart rate that is associated with respiration. The heart
rate increases slightly during inspiration and slows slightly during exhalation because of changes
in vagal tone. The ECG tracing demonstrates an alternating pattern of faster and slower heart
rate that changes with the respiratory cycle.
The patient is admitted with sinus pauses causing periods of loss of consciousness. The patient
is asymptomatic, awake and alert, but fatigued. He answers questions appropriately. When
admitting this patient, the nurse should first:
a. prepare the patient for temporary pacemaker insertion.
b. prepare the patient for permanent pacemaker insertion.
c. assess the patient's medication profile.
d. apply transcutaneous pacemaker paddles. - CORRECT ANSWER-c
The patient's heart rate is 165 beats per minute. His cardiac monitor shows a rapid rate with
narrow QRS complexes. The P waves cannot be seen, but the rhythm is regular. The patient's
blood pressure has dropped from 124/62 to 78/30. His skin is cold and diaphoretic and he is
complaining of nausea. The nurse prepares the patient for:
a. administration of beta-blockers.
b. administration of atropine.
c. transcutaneous pacemaker insertion.
d. emergent cardioversion. - CORRECT ANSWER-D
If an abnormal P wave cannot be visualized on the ECG but the QRS complex is narrow, the term
supraventricular tachycardia (SVT) is often used. This is a generic term that describes any
tachycardia that is not ventricular in origin; it is also used when the source above the ventricles
cannot be identified, usually because the rate is too fast. Treatment is directed at assessing the
patient's tolerance of the tachycardia. If the rate is higher than 150 beats per minute and the
patient is symptomatic, emergent cardioversion is considered. Cardioversion is the delivery of a
synchronized electrical shock to the heart by an external defibrillator.
