COMPLEX ADULT HEALTH EXAM TEST PAPER QUESTIONS SOLUTIONS GRADED A PLUS
Question:
The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart
rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and
understands that the rhythm is due to the: a. loss of sinus node activity. b. increased rate of the AV
node. c. increased rate of the SA node. d. decreased rate of the AV node.
Answer:
a
Question:
.
Answer:
Question:
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:
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.
Question:
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. if the number of PVCs are decreasing. d. if the
PVCs are wider than 0.12 seconds.
Answer:
a
Question:
The nurse notices that the patient has a first-degree AV block. Everything else about the rhythm is
normal. The nurse should: a. prepare to place the patient on a transcutaneous pacemaker. b. give the
patient atropine to shorten the PR interval. c. monitor the rhythm and patient's condition. d. give the
patient an antiarrhythmic medication.
Answer:
C First-degree AV block is a common dysrhythmia in the elderly and in patients with cardiac
disease. As the normal conduction pathway ages or becomes diseased, impulse conduction becomes
slower than normal. It is well tolerated. No treatment is required. Continue to monitor the patient
and the rhythm.
Question:
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:
C In first-degree AV block, a P wave precedes every QRS complex, which is followed by a T wave
indicating complete conduction. It is represented on the ECG as a prolonged PR interval.
Second-degree heart block refers to AV conduction that is intermittently blocked. Therefore, some P
waves are conducted and some are not. Third- degree block is often called complete heart block
because no atrial impulses are conducted through the AV node to the ventricles.
Question:
The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient
is on digitalis medication at home. The nurse should expect that: a. the patient has had an anterior
wall myocardial infarction. b. the physician will order the digitalis to be continued in the hospital. c.
a digitalis level would be ordered upon admission. d. the patient will require a transcutaneous
pacemaker.
,Answer:
C Digitalis toxicity is a major cause of this rhythm, and further digitalis doses should not be given
until a digitalis level is obtained. Other causes of Mobitz I include AV nodal blocking drugs, acute
inferior wall myocardial infarction or right ventricular infarction, ischemic heart disease, and excess
vagal response. This type of block is usually well tolerated and no treatment is indicated unless the
dropped beats occur frequently.
Question:
The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand
mode at a rate of 60 beats per minute. The nurse realizes that: a. the pacemaker will pace only if the
patient's intrinsic heart rate is less than 60 beats per minute. b. the demand mode often competes
with the patient's own rhythm. c. the demand mode places the patient at risk for the R-on-T
phenomenon. d. the fixed rate mode is safer and is the mode of choice.
Answer:
A Pacemakers can be operated in a demand mode or a fixed rate (asynchronous) mode. The demand
mode paces the heart when no intrinsic or native beat is sensed. For example, if the rate control is set
at 60 beats per minute, the pacemaker will only pace if the patient's heart rate drops to less than 60.
The fixed rate mode paces the heart at a set rate, independent of any activity the patient's heart
generates. The fixed rate mode may compete with the patient's own rhythm and deliver an impulse
on the T wave (R-on-T phenomenon), with the potential for producing ventricular tachycardia or
fibrillation. The demand mode is safer and is the mode of choice.
Question:
The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS
complexes following the spikes. The nurse realizes this as: a. normal pacemaker function. b. failure
to capture. c. failure to pace. d. failure to sense.
Answer:
B When the pacemaker generates an electrical impulse (pacer spike) and no depolarization is noted,
it is described a failure to capture. On the ECG, a pacer spike is noted, but it is not followed by a P
wave (atrial pacemaker) or a QRS complex (ventricular pacemaker). Common causes of failure to
capture include output (milliamperes) set too low, or displacement of the pacing lead wire from the
myocardium (transvenous or epicardial leads). Other causes of failure to capture include battery
failure, fracture of the pacemaker wire, or increased pacing threshold as a result of medication or
electrolyte imbalance. This is not normal pacemaker function.
, Question:
Normal sinus rhythm.
Answer:
Question:
ventricular tachycardia.
Answer:
Question:
Sinus Tachycardia.
Answer:
Question:
Sinus Bradycardia.
Answer:
Question:
Ventricular fibrillation.
Answer:
Question:
The patient's heart rhythm shows an inverted P wave with a PR interval of 0.06 seconds. The heart
rate is 54 beats per minute. The nurse recognizes the rhythm as a junctional escape rhythm, and
understands that the rhythm is due to the: a. loss of sinus node activity. b. increased rate of the AV
node. c. increased rate of the SA node. d. decreased rate of the AV node.
Answer:
a
Question:
.
Answer:
Question:
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:
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.
Question:
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. if the number of PVCs are decreasing. d. if the
PVCs are wider than 0.12 seconds.
Answer:
a
Question:
The nurse notices that the patient has a first-degree AV block. Everything else about the rhythm is
normal. The nurse should: a. prepare to place the patient on a transcutaneous pacemaker. b. give the
patient atropine to shorten the PR interval. c. monitor the rhythm and patient's condition. d. give the
patient an antiarrhythmic medication.
Answer:
C First-degree AV block is a common dysrhythmia in the elderly and in patients with cardiac
disease. As the normal conduction pathway ages or becomes diseased, impulse conduction becomes
slower than normal. It is well tolerated. No treatment is required. Continue to monitor the patient
and the rhythm.
Question:
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:
C In first-degree AV block, a P wave precedes every QRS complex, which is followed by a T wave
indicating complete conduction. It is represented on the ECG as a prolonged PR interval.
Second-degree heart block refers to AV conduction that is intermittently blocked. Therefore, some P
waves are conducted and some are not. Third- degree block is often called complete heart block
because no atrial impulses are conducted through the AV node to the ventricles.
Question:
The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I. The patient
is on digitalis medication at home. The nurse should expect that: a. the patient has had an anterior
wall myocardial infarction. b. the physician will order the digitalis to be continued in the hospital. c.
a digitalis level would be ordered upon admission. d. the patient will require a transcutaneous
pacemaker.
,Answer:
C Digitalis toxicity is a major cause of this rhythm, and further digitalis doses should not be given
until a digitalis level is obtained. Other causes of Mobitz I include AV nodal blocking drugs, acute
inferior wall myocardial infarction or right ventricular infarction, ischemic heart disease, and excess
vagal response. This type of block is usually well tolerated and no treatment is indicated unless the
dropped beats occur frequently.
Question:
The patient has a permanent pacemaker inserted. The provider has set the pacemaker to the demand
mode at a rate of 60 beats per minute. The nurse realizes that: a. the pacemaker will pace only if the
patient's intrinsic heart rate is less than 60 beats per minute. b. the demand mode often competes
with the patient's own rhythm. c. the demand mode places the patient at risk for the R-on-T
phenomenon. d. the fixed rate mode is safer and is the mode of choice.
Answer:
A Pacemakers can be operated in a demand mode or a fixed rate (asynchronous) mode. The demand
mode paces the heart when no intrinsic or native beat is sensed. For example, if the rate control is set
at 60 beats per minute, the pacemaker will only pace if the patient's heart rate drops to less than 60.
The fixed rate mode paces the heart at a set rate, independent of any activity the patient's heart
generates. The fixed rate mode may compete with the patient's own rhythm and deliver an impulse
on the T wave (R-on-T phenomenon), with the potential for producing ventricular tachycardia or
fibrillation. The demand mode is safer and is the mode of choice.
Question:
The rhythm on the cardiac monitor is showing numerous pacemaker spikes, but no P waves or QRS
complexes following the spikes. The nurse realizes this as: a. normal pacemaker function. b. failure
to capture. c. failure to pace. d. failure to sense.
Answer:
B When the pacemaker generates an electrical impulse (pacer spike) and no depolarization is noted,
it is described a failure to capture. On the ECG, a pacer spike is noted, but it is not followed by a P
wave (atrial pacemaker) or a QRS complex (ventricular pacemaker). Common causes of failure to
capture include output (milliamperes) set too low, or displacement of the pacing lead wire from the
myocardium (transvenous or epicardial leads). Other causes of failure to capture include battery
failure, fracture of the pacemaker wire, or increased pacing threshold as a result of medication or
electrolyte imbalance. This is not normal pacemaker function.
, Question:
Normal sinus rhythm.
Answer:
Question:
ventricular tachycardia.
Answer:
Question:
Sinus Tachycardia.
Answer:
Question:
Sinus Bradycardia.
Answer:
Question:
Ventricular fibrillation.
Answer:
