RN 61 FINAL UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS
Question:
1. One of the functions of the atrioventricular (AV) node is to
a. pace the heart if the ventricles fail.
b. slow the impulse arriving from the SA node.
c. send the impulse to the SA node.
d. allow for ventricular filling during systole.
Answer:
ANS: B The impulse from the SA node quickly reaches the atrioventricular (AV) node located in the area
called the AV junction, between the atria and the ventricles. Here the impulse is slowed to allow time for
ventricular filling during relaxation or ventricular diastole. The AV node has pacemaker properties and can
discharge an impulse if the SA node (not the ventricle) fails. The electrical impulse is then rapidly
conducted through the bundle of His to the ventricles (not the SA node) via the left and right bundle
branches.
Question:
2. The nurse notices sinus bradycardia on the patient's cardiac monitor. The nurse should
a. give atropine to increase heart rate.
b. begin transcutaneous pacing of the patient.
c. start a dopamine infusion to stimulate heart function.
d. assess for hemodynamic instability.
Answer:
ANS: D Sinus bradycardia may be a normal heart rhythm for some individuals such as athletes, or it may
occur during sleep. Assess for hemodynamic instability related to the bradycardia. If the patient is
symptomatic, interventions include administration of atropine. If atropine is not effective in increasing
heart rate, then transcutaneous pacing, dopamine infusion, or epinephrine infusion may be administered.
Atropine is avoided for treatment of bradycardia associated with hypothermia.
Question:
3. The patient's heart rate is 165 beats per minute. The 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 mm Hg to 78/30 mm Hg. The patient's skin is cold and diaphoretic, and the patient 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.
,Answer:
ANS: 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. Beta blockers are a possibility if the patient is not symptomatic. Atropine is used in the
treatment of bradycardia. If atropine is not effective in increasing heart rate, then transcutaneous pacing is
implemented.
Question:
4. The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular
and that there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is
hemodynamically stable. The nurse realizes that the patient's rhythm is
a. atrial fibrillation.
b. atrial flutter.
c. atrial flutter with rapid ventricular response.
d. junctional escape rhythm.
Answer:
ANS: A Atrial fibrillation arises from multiple ectopic foci in the atria, causing chaotic quivering of the
atria and ineffectual atrial contraction. No discernible P waves can be identified, resulting in a wavy
baseline and an extremely irregular ventricular response. Atrial flutter arises from a single irritable focus in
the atria. The atrial focus fires at an extremely rapid, regular rate, between 240 and 320 beats per minute.
The P waves are called flutter waves and may have a sawtooth appearance. Atrial flutter with rapid
ventricular response occurs when atrial impulses cause a ventricular response greater than 100 beats per
minute. A junctional escape rhythm is a ventricular rate between 40 and 60 beats per minute with a regular
rhythm. P waves may be absent, inverted, or follow the QRS complex. QRS complex is normal.
Question:
5. 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:
ANS: 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. If P wave precedes QRS, it is
inverted or upside down; the P wave may not be visible, or it may follow the QRS. If a P wave is present
before the QRS, the PR interval is shortened less than 0.12 milliseconds. Atrial fibrillation arises from
multiple ectopic foci in the atria, causing chaotic quivering of the atria and ineffectual atrial contraction.
The AV node is bombarded with hundreds of atrial impulses and conducts these impulses in an
unpredictable manner to the ventricles.
,Question:
6. 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. whether the number of PVCs is decreasing.
d. whether the PVCs are wider than 0.12 seconds.
Answer:
A. the proximity of the R wave of the PVC to the T wave of a normal beat.
Question:
7. 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:
ANS: C Third-degree block is often called complete heart block because no atrial impulses are conducted
through the AV node to the ventricles. Normally every P wave is conducted to the ventricles. If some of
the P waves are conducted but others are not, further assessment is needed to determine the type of block
present. A prolonged PR interval is a first-degree AV block, and is well tolerated and requires no
treatment.
Question:
8. Sole 4
Answer:
....
Question:
9. A 75-year-old patient, who suffered a massive stroke 3 weeks ago, has been unresponsive and has
required ventilatory support since the time of the stroke. The physician has approached the spouse
regarding placement of a permanent feeding tube. The spouse states that the patient never wanted to be
kept alive by tubes and personally didn't want what was being done. After holding a family conference
with the spouse, the medical team concurs, and the feeding tube is not placed. This situation is an example
of
a. euthanasia.
b. palliative care.
c. withdrawal of life support.
d. withholding life support.
Answer:
ANS: D Because the tube feeding had not been yet placed in the care of this patient, this scenario is an
example of withholding of life support. Withholding of life support does not constitute euthanasia.
Withdrawal of life support involves the discontinuation of previously established therapies in a terminally
ill patient.
, Question:
10. What were the findings of the Study to Understand Prognoses and Preferences for Outcomes and Risks
of Treatment (SUPPORT)?
a. Clear communication is typical in the relationships between most patients and health care providers.
b. Critical care units often meet the needs of dying patients and their families.
c. Disparities exist between patients' care preferences and the actual care provided.
d. Pain and suffering of patients at end of life is well controlled in the hospital.
Answer:
ANS: C Disparities and lack of communication are common in the relationships between patients and
health care providers. Critical care units are often poorly equipped to meet the needs of dying patients. The
SUPPORT study demonstrated that pain and suffering are widespread in hospitals.
Question:
11. To prevent any unwanted resuscitation after life-sustaining treatments have been withdrawn, the nurse
should ensure that:
a. "do not resuscitate" (DNR) orders are written before the discontinuation of the treatments.
b. the family is not allowed to visit until the death occurs.
c. DNR orders are written as soon as possible after the discontinuation of the treatments.
d. the change-of-shift report includes the information that the patient is not to be resuscitated.
Answer:
ANS: A DNR orders should be written before withdrawal of life support; this will prevent any unfortunate
errors in unwanted resuscitation during the time period between initiation of withdrawal and the actual
death.
Question:
12. The patient's spouse tells the nurse that there is no point in continuing to visit at the bedside because
the patient is unresponsive. The best response by the nurse is
a. "You're right. Your loved one is not aware of anything now."
b. "This seems to be very difficult for you."
c. "I'll call you if she starts responding again."
d. "Why don't you check to see if any other family member would like to visit?"
Answer:
ANS: B The most therapeutic response by the nurse is to acknowledge the distress of the spouse.
Question:
13. Which of the following statements about palliative care is accurate?
a. Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal
community.
b. Reducing distressing symptoms is the primary? goal of palliative care.
c. Only the patient can determine what constitutes palliative care for him or her.
d. Withdrawing life-sustaining treatments is considered euthanasia in most states.
Answer:
ANS: B The goal of palliative care is to reduce the distressing symptoms many patients experience due to
serious illnesses.
CORRECT ANSWERS
Question:
1. One of the functions of the atrioventricular (AV) node is to
a. pace the heart if the ventricles fail.
b. slow the impulse arriving from the SA node.
c. send the impulse to the SA node.
d. allow for ventricular filling during systole.
Answer:
ANS: B The impulse from the SA node quickly reaches the atrioventricular (AV) node located in the area
called the AV junction, between the atria and the ventricles. Here the impulse is slowed to allow time for
ventricular filling during relaxation or ventricular diastole. The AV node has pacemaker properties and can
discharge an impulse if the SA node (not the ventricle) fails. The electrical impulse is then rapidly
conducted through the bundle of His to the ventricles (not the SA node) via the left and right bundle
branches.
Question:
2. The nurse notices sinus bradycardia on the patient's cardiac monitor. The nurse should
a. give atropine to increase heart rate.
b. begin transcutaneous pacing of the patient.
c. start a dopamine infusion to stimulate heart function.
d. assess for hemodynamic instability.
Answer:
ANS: D Sinus bradycardia may be a normal heart rhythm for some individuals such as athletes, or it may
occur during sleep. Assess for hemodynamic instability related to the bradycardia. If the patient is
symptomatic, interventions include administration of atropine. If atropine is not effective in increasing
heart rate, then transcutaneous pacing, dopamine infusion, or epinephrine infusion may be administered.
Atropine is avoided for treatment of bradycardia associated with hypothermia.
Question:
3. The patient's heart rate is 165 beats per minute. The 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 mm Hg to 78/30 mm Hg. The patient's skin is cold and diaphoretic, and the patient 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.
,Answer:
ANS: 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. Beta blockers are a possibility if the patient is not symptomatic. Atropine is used in the
treatment of bradycardia. If atropine is not effective in increasing heart rate, then transcutaneous pacing is
implemented.
Question:
4. The nurse is reading the cardiac monitor and notes that the patient's heart rhythm is extremely irregular
and that there are no discernible P waves. The ventricular rate is 90 beats per minute, and the patient is
hemodynamically stable. The nurse realizes that the patient's rhythm is
a. atrial fibrillation.
b. atrial flutter.
c. atrial flutter with rapid ventricular response.
d. junctional escape rhythm.
Answer:
ANS: A Atrial fibrillation arises from multiple ectopic foci in the atria, causing chaotic quivering of the
atria and ineffectual atrial contraction. No discernible P waves can be identified, resulting in a wavy
baseline and an extremely irregular ventricular response. Atrial flutter arises from a single irritable focus in
the atria. The atrial focus fires at an extremely rapid, regular rate, between 240 and 320 beats per minute.
The P waves are called flutter waves and may have a sawtooth appearance. Atrial flutter with rapid
ventricular response occurs when atrial impulses cause a ventricular response greater than 100 beats per
minute. A junctional escape rhythm is a ventricular rate between 40 and 60 beats per minute with a regular
rhythm. P waves may be absent, inverted, or follow the QRS complex. QRS complex is normal.
Question:
5. 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:
ANS: 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. If P wave precedes QRS, it is
inverted or upside down; the P wave may not be visible, or it may follow the QRS. If a P wave is present
before the QRS, the PR interval is shortened less than 0.12 milliseconds. Atrial fibrillation arises from
multiple ectopic foci in the atria, causing chaotic quivering of the atria and ineffectual atrial contraction.
The AV node is bombarded with hundreds of atrial impulses and conducts these impulses in an
unpredictable manner to the ventricles.
,Question:
6. 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. whether the number of PVCs is decreasing.
d. whether the PVCs are wider than 0.12 seconds.
Answer:
A. the proximity of the R wave of the PVC to the T wave of a normal beat.
Question:
7. 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:
ANS: C Third-degree block is often called complete heart block because no atrial impulses are conducted
through the AV node to the ventricles. Normally every P wave is conducted to the ventricles. If some of
the P waves are conducted but others are not, further assessment is needed to determine the type of block
present. A prolonged PR interval is a first-degree AV block, and is well tolerated and requires no
treatment.
Question:
8. Sole 4
Answer:
....
Question:
9. A 75-year-old patient, who suffered a massive stroke 3 weeks ago, has been unresponsive and has
required ventilatory support since the time of the stroke. The physician has approached the spouse
regarding placement of a permanent feeding tube. The spouse states that the patient never wanted to be
kept alive by tubes and personally didn't want what was being done. After holding a family conference
with the spouse, the medical team concurs, and the feeding tube is not placed. This situation is an example
of
a. euthanasia.
b. palliative care.
c. withdrawal of life support.
d. withholding life support.
Answer:
ANS: D Because the tube feeding had not been yet placed in the care of this patient, this scenario is an
example of withholding of life support. Withholding of life support does not constitute euthanasia.
Withdrawal of life support involves the discontinuation of previously established therapies in a terminally
ill patient.
, Question:
10. What were the findings of the Study to Understand Prognoses and Preferences for Outcomes and Risks
of Treatment (SUPPORT)?
a. Clear communication is typical in the relationships between most patients and health care providers.
b. Critical care units often meet the needs of dying patients and their families.
c. Disparities exist between patients' care preferences and the actual care provided.
d. Pain and suffering of patients at end of life is well controlled in the hospital.
Answer:
ANS: C Disparities and lack of communication are common in the relationships between patients and
health care providers. Critical care units are often poorly equipped to meet the needs of dying patients. The
SUPPORT study demonstrated that pain and suffering are widespread in hospitals.
Question:
11. To prevent any unwanted resuscitation after life-sustaining treatments have been withdrawn, the nurse
should ensure that:
a. "do not resuscitate" (DNR) orders are written before the discontinuation of the treatments.
b. the family is not allowed to visit until the death occurs.
c. DNR orders are written as soon as possible after the discontinuation of the treatments.
d. the change-of-shift report includes the information that the patient is not to be resuscitated.
Answer:
ANS: A DNR orders should be written before withdrawal of life support; this will prevent any unfortunate
errors in unwanted resuscitation during the time period between initiation of withdrawal and the actual
death.
Question:
12. The patient's spouse tells the nurse that there is no point in continuing to visit at the bedside because
the patient is unresponsive. The best response by the nurse is
a. "You're right. Your loved one is not aware of anything now."
b. "This seems to be very difficult for you."
c. "I'll call you if she starts responding again."
d. "Why don't you check to see if any other family member would like to visit?"
Answer:
ANS: B The most therapeutic response by the nurse is to acknowledge the distress of the spouse.
Question:
13. Which of the following statements about palliative care is accurate?
a. Withholding and withdrawing life-sustaining treatment are distinctly different in the eyes of the legal
community.
b. Reducing distressing symptoms is the primary? goal of palliative care.
c. Only the patient can determine what constitutes palliative care for him or her.
d. Withdrawing life-sustaining treatments is considered euthanasia in most states.
Answer:
ANS: B The goal of palliative care is to reduce the distressing symptoms many patients experience due to
serious illnesses.
