35 Dysrhythmias Exam With Complete Answers

35: Dysrhythmias Exam With
Complete Answers.




1. To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the
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duration of the patient's
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a. P wave.
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b. Q wave.
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c. P-R interval.
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d. QRS complex. - CORRECT ANSWER✔✔A
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The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the
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atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers. The QRS
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represents ventricular depolarization. The Q wave is the first negative deflection following the P wave and
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should be narrow and short.
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, 2. The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm. Which
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j method will be best to use? j j j j j




a. Count the number of large squares in the R-R interval and divide by 300.
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b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS complexes.
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c. Calculate the number of small squares between one QRS complex and the next and divide into 1500.
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d. Use the 3-second markers to count the number of QRS complexes in 6 seconds and multiply by 10. -
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CORRECT ANSWER✔✔D
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This is the quickest way to determine the ventricular rate for a patient with a regular rhythm. All the other
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methods are accurate, but take longer.
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DIF: Cognitive Level: Apply (application) REF: 789-790
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3. A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart
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j rate of _____ beats/minute. j j j




a. 15 to 20 j j j j




b. 20 to 40 j j j j




c. 40 to 60 j j j




d. 60 to 100 - CORRECT ANSWER✔✔C
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If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at
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the normal rate of 40 to 60 beats/minute. The slower rates are typical of the bundle of His and the Purkinje
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system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60
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to 100 beats/minute.
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4. The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the
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j following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular,
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j and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patient's cardiac
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j rhythm as j




a. atrial flutter.
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b. sinus tachycardia.
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c. ventricular fibrillation.
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d. ventricular tachycardia. - CORRECT ANSWER✔✔D
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The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate
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ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter
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waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular
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and does not have a consistent QRS duration.
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5. The nurse notes that a patient's cardiac monitor shows that every other beat is earlier than expected, has
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j no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the
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j rhythm?

a. Ventricular couplets
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b. Ventricular bigeminy
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c. Ventricular R-on-T phenomenon
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d. Multifocal premature ventricular contractions - CORRECT ANSWER✔✔B
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, Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs
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of wide QRS complexes are described as ventricular couplets. There is no indication that the premature
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ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.
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6. A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the
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j P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to
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a. notify the health care provider immediately.
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b. give atropine per agency dysrhythmia protocol.
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c. prepare the patient for temporary pacemaker insertion.
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d. document the finding and continue to monitor the patient. - CORRECT ANSWER✔✔D
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First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may
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progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is
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needed. Immediate notification of the health care provider about an asymptomatic rhythm is not
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necessary.
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DIF: Cognitive Level: Apply (application) REF: 798
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7. A patient who was admitted with a myocardial infarction experiences a 45-second episode of ventricular
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j tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/minute. Which of the following
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j actions should the nurse take next?
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a. Immediately notify the health care provider.
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