Chapter 35 Dysrhythmias Exam With Questions And
Verified Detailed Answers
1. To determine if impulses are delayed in their conduction through the atria, the nurse
will measure the duration of the patient's
a. P wave.
b. Q wave.
c. P-R interval.
d. QRS complex - ANSWER A
The P wave represents depolarization of the atria. The P-R interval represents
depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches,
and the Purkinje fibers. The QRS represents ventricular depolarization. The Q wave is
the first negative deflection following the P wave and should be narrow and short.
DIF: Cognitive Level: Understand (comprehension) REF: 791
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
2. A patient's heart rate needs to be estimated quickly, and the patient has a regular
heart rhythm. Which one of the following techniques is most appropriate to use?
a. Count the number of large squares in the R-R interval and divide by 300.
b. Print a 1-minute ECG strip and count the number of QRS complexes.
c. Count the number of small squares between one QRS complex and the next and
divide into 1500.
d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and
multiply by 10. - ANSWER D
This is the quickest way to determine the ventricular rate for a patient with a regular
rhythm. All the other methods are accurate, but take longer.
DIF: Cognitive Level: Apply (application) REF: 789-790
,TOP: Nursing Process: Assessment MSC:
Physiological Integrity
3. A patient has a junctional escape rhythm on the monitor. The nurse will expect the
patient to have a heart rate of _____ beats/minute.
a. 15 to 20
b. 20 to 40
c. 40 to 60
d. 60 to 100 ANSWER C
If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will
automatically discharge at the normal rate of 40 to 60 beats/minute. The slower rates
are typical of the bundle of His and the Purkinje system and may be seen with failure of
both the SA and AV node to discharge. The normal SA node rate is 60 to 100
beats/minute.
DIF: Cognitive Level: Understand (comprehension) REF: 797
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
4. The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and
makes the following analysis: no visible P waves, P-R interval not measurable,
ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS
duration 0.18 second. The nurse interprets the patient's cardiac rhythm as
a. atrial flutter.
b. sinus tachycardia.
c. ventricular fibrillation.
d. ventricular tachycardia. - ANSWER D
The absence of P waves, widened QRS, rate >150 beats/minute, and the regularity of the
rhythm point to this being ventricular tachycardia. Atrial flutter is usually regular with a
narrow QRS complex and has flutter waves present reflecting atrial activity. Sinus
, tachycardia has P waves. Ventricular fibrillation is irregular with no regular QRS width.
DIF: Cognitive Level: Apply (application) REF: 794
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
5. The nurse recognizes that a patient's cardiac monitor demonstrates that every other
beat is premature and the visible P wave is absent, with a QRS complex that is wide and
bizarre in configuration. What does the nurse document the rhythm as?
a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
d. Multifocal premature ventricular contractions - ANSWER B
Ventricular bigeminy is a rhythm where every other QRS complex is wide and bizarre in
appearance. Two consecutive wide QRS complexes are called a ventricular couplet.
There is no indication of either multifocal PVCs or the R-on-T phenomenon.
DIF: Cognitive Level: Apply (application) REF: 799
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
6. A patient has a normal cardiac rhythm with a heart rate of 72 beats/minute. The nurse
interprets the P-R interval as 0.24 seconds. Which of the following nursing responses is
most appropriate?
a. Notify the health care provider immediately.
b. Administer atropine per agency dysrhythmia protocol.
c. Prepare the patient for temporary pacemaker insertion.
Verified Detailed Answers
1. To determine if impulses are delayed in their conduction through the atria, the nurse
will measure the duration of the patient's
a. P wave.
b. Q wave.
c. P-R interval.
d. QRS complex - ANSWER A
The P wave represents depolarization of the atria. The P-R interval represents
depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches,
and the Purkinje fibers. The QRS represents ventricular depolarization. The Q wave is
the first negative deflection following the P wave and should be narrow and short.
DIF: Cognitive Level: Understand (comprehension) REF: 791
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
2. A patient's heart rate needs to be estimated quickly, and the patient has a regular
heart rhythm. Which one of the following techniques is most appropriate to use?
a. Count the number of large squares in the R-R interval and divide by 300.
b. Print a 1-minute ECG strip and count the number of QRS complexes.
c. Count the number of small squares between one QRS complex and the next and
divide into 1500.
d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and
multiply by 10. - ANSWER D
This is the quickest way to determine the ventricular rate for a patient with a regular
rhythm. All the other methods are accurate, but take longer.
DIF: Cognitive Level: Apply (application) REF: 789-790
,TOP: Nursing Process: Assessment MSC:
Physiological Integrity
3. A patient has a junctional escape rhythm on the monitor. The nurse will expect the
patient to have a heart rate of _____ beats/minute.
a. 15 to 20
b. 20 to 40
c. 40 to 60
d. 60 to 100 ANSWER C
If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will
automatically discharge at the normal rate of 40 to 60 beats/minute. The slower rates
are typical of the bundle of His and the Purkinje system and may be seen with failure of
both the SA and AV node to discharge. The normal SA node rate is 60 to 100
beats/minute.
DIF: Cognitive Level: Understand (comprehension) REF: 797
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
4. The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and
makes the following analysis: no visible P waves, P-R interval not measurable,
ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS
duration 0.18 second. The nurse interprets the patient's cardiac rhythm as
a. atrial flutter.
b. sinus tachycardia.
c. ventricular fibrillation.
d. ventricular tachycardia. - ANSWER D
The absence of P waves, widened QRS, rate >150 beats/minute, and the regularity of the
rhythm point to this being ventricular tachycardia. Atrial flutter is usually regular with a
narrow QRS complex and has flutter waves present reflecting atrial activity. Sinus
, tachycardia has P waves. Ventricular fibrillation is irregular with no regular QRS width.
DIF: Cognitive Level: Apply (application) REF: 794
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
5. The nurse recognizes that a patient's cardiac monitor demonstrates that every other
beat is premature and the visible P wave is absent, with a QRS complex that is wide and
bizarre in configuration. What does the nurse document the rhythm as?
a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
d. Multifocal premature ventricular contractions - ANSWER B
Ventricular bigeminy is a rhythm where every other QRS complex is wide and bizarre in
appearance. Two consecutive wide QRS complexes are called a ventricular couplet.
There is no indication of either multifocal PVCs or the R-on-T phenomenon.
DIF: Cognitive Level: Apply (application) REF: 799
TOP: Nursing Process: Assessment MSC:
Physiological Integrity
6. A patient has a normal cardiac rhythm with a heart rate of 72 beats/minute. The nurse
interprets the P-R interval as 0.24 seconds. Which of the following nursing responses is
most appropriate?
a. Notify the health care provider immediately.
b. Administer atropine per agency dysrhythmia protocol.
c. Prepare the patient for temporary pacemaker insertion.
