DYSRHYTHMIAS PRACTICE QUESTIONS AND ANSWERS #6
1. You are the nurse working on the telemetry unit and you have finally got- ten to sit down to work
on some charting. Suddenly the heart monitors at the station start beeping. Patient in room 18 is
showing this rhythm on the monitor. The medical team advances together into the room and finds
them unconscious. What is priority action by the nurse?
A) Prepare to administer adenosine to the patient
B) Begin chest compressions
C) Prepare for defibrillation
D) Check for a pulse: Answer: D
A pulse would be assessed for first. Then the patient will be defibrillized and chest
compressions will begin immediately.
2. The patient who has recently been experiencing runs of ventricular tachy- cardia suddenly loses
consciousness. The patient is defibrillated, and the rate returns as the following. What should the
nurse do first?
A) Begin compressions
B) Shock the client again immediately
C) Prepare for intubation
D) Administer adenosine: Answer: A
Following defibrillation, CPR is immediately initiated if a perfusable rhythm is not initiated.
The client may need to be shocked again, but chest compressions must begin first.
3. The patient with a history of hypertension and diabetes has the following rhythm strip. The
patient's vitals are as follows: BP 145/89, HR 90, SpO2 95%, RR 19. Which of the following does the
nurse expect to do at this time?
a) Prepare the client for cardioversion STAT
b) Begin administering anticoagulants
c) Grab the crash cart for administration of adenosine
d) Teach the client about possibility of pacemaker installation: A nswer:
B
Atrial flutter places the client at high risk for development of clot formation in the atria. Because
the client is stable at this time, cardioversion or adenosine would not be performed at this time.
Before cardioversion can occur in a patient, anticoagulant therapy should be begun at least 48
hours beforehand if possible.
4. The nurse is preparing to administer adenosine to the patient with the following rhythm which is
symptomatic. What should the nurse plan on having in the patient room? Select All That Apply:
a) Physician
,DYSRHYTHMIAS PRACTICE QUESTIONS AND ANSWERS #6
b) Crash cart
c) IV pump
d) EKG monitor
e) Lidocaine: Answer: A, B, and D
Adenosine is administered as a very quick IV push. The physician must be present in the room
and the crash cart must be on hand. An ekg monitor should be in the room to monitor the
effectiveness of the medication.
5. The nurse has just administered adenosine via IV push and sees the follow- ing rhythm on the
monitor. What is the nurse's priority intervention?
a) Apply conductive gel and defibrillate the patient
b) Document the findings and continue to monitor
c) Administer another mg of the medication
d) Begin chest compressions: Answer: B
This finding would be expected upon administration of adenosine. The rhythm should then begin
again in some other rhythm, hopefully normal sinus rhythm. It would be important to document
the exact time of this change and continue to monitor the change back to NSR. If this change
does not occur, or if another rhythm is produced, appropriate action would then be taken based
on the result.
6. A group of nursing students are discussing atrial flutter. These students recognize that which
of the following are seen with atrial flutter? Select all that apply:
1) Ventricular rate of 220-300 bpm.
2) Regular rhythm
3) Saw-tooth pattern
4) Measurable PR interval
5) Long QRS interval: Answer(s): 2, 3
The ATRIAL rate is 250-400 bpm. Ventricular is about 75-150. The rhythm is regular, with the P
wave appearing as little flutter or a "saw tooth pattern". The PR interval is not measurable r/t
this saw-tooth P wave. The QRS is normal.
7. A nursing student is aware that which of the following is the treatment for unstable atrial flutter?
1) Adenosine (Adenocard) 6 mg rapid IVP.
2) Cardioversion with adjacent Heparin therapy
3) Defibrillation STAT followed by CPR.
4) Altemose 3 mg IVP over 1-2 seconds.: Answer: 2
, DYSRHYTHMIAS PRACTICE QUESTIONS AND ANSWERS #6
Cardioversion is used if the patient is unstable. Anticoagulants are used if the arrhythmia has
stuck around for 48 hr +. Adenosine may be used with a narrow QRS and regular RR interval
8. A nurse working on a CVT unit receives report from day shift. After receiving report, which patient
should the nurse see first?
1) A 23-year-old professional tennis player with a HR of 47 bpm.
2) A 69-year-old male with atrial fibrillation who has new onset confusion.
3) A 72-year-old female with atrial flutter who reports feeling unusually tired today and yesterday.
4) A 33-year-old female with sinus tachycardia who is asking for her at-home Metoprolol.: Answer: 2
Patients with a-fib are at risk for pulmonary and systemic emboli, and new onset of confusion
may indicate a stroke in this patient. Patients with atrial flutter may feel more tired some days
than others.
9. A nurse on a CVT unit views the monitor and sees the patient in room 452 has just begun having
occasional PVCs. Which action should the nurse take first?
1) Check on the patient
2) Check last magnesium and potassium levels
3) Document the occurrence and watch for further PVCs
4) Contact the physician: Answer: 1
Although electrolytes are likely the culprit, the nurse first needs to first assess the patient. Then,
the nurse should look in the patient's chart and evaluate or request an order for electrolyte
levels. This may eventually need to be documented, but the nurse can be held liable for neglect
if he/she does not assess the patient first. The physician may or may not need to be contacted.
10.Which of the following does the nursing student realize is the treatment for a stable patient
presenting with QRS intervals above 0.12 seconds with a regular rhythm and a rate of 100-250 bpm?
1) Atropine
2) Defibrillation
3) Amiodarone
4) Adenosine: Answer: 3
This is describing ventricular tachycardia (QRS is a giveaway), and the treatment for a stable
patient is Amiodarone or cardioversion. If the patient were unstable, we'd go ahead and
defibrillate.
1. You are the nurse working on the telemetry unit and you have finally got- ten to sit down to work
on some charting. Suddenly the heart monitors at the station start beeping. Patient in room 18 is
showing this rhythm on the monitor. The medical team advances together into the room and finds
them unconscious. What is priority action by the nurse?
A) Prepare to administer adenosine to the patient
B) Begin chest compressions
C) Prepare for defibrillation
D) Check for a pulse: Answer: D
A pulse would be assessed for first. Then the patient will be defibrillized and chest
compressions will begin immediately.
2. The patient who has recently been experiencing runs of ventricular tachy- cardia suddenly loses
consciousness. The patient is defibrillated, and the rate returns as the following. What should the
nurse do first?
A) Begin compressions
B) Shock the client again immediately
C) Prepare for intubation
D) Administer adenosine: Answer: A
Following defibrillation, CPR is immediately initiated if a perfusable rhythm is not initiated.
The client may need to be shocked again, but chest compressions must begin first.
3. The patient with a history of hypertension and diabetes has the following rhythm strip. The
patient's vitals are as follows: BP 145/89, HR 90, SpO2 95%, RR 19. Which of the following does the
nurse expect to do at this time?
a) Prepare the client for cardioversion STAT
b) Begin administering anticoagulants
c) Grab the crash cart for administration of adenosine
d) Teach the client about possibility of pacemaker installation: A nswer:
B
Atrial flutter places the client at high risk for development of clot formation in the atria. Because
the client is stable at this time, cardioversion or adenosine would not be performed at this time.
Before cardioversion can occur in a patient, anticoagulant therapy should be begun at least 48
hours beforehand if possible.
4. The nurse is preparing to administer adenosine to the patient with the following rhythm which is
symptomatic. What should the nurse plan on having in the patient room? Select All That Apply:
a) Physician
,DYSRHYTHMIAS PRACTICE QUESTIONS AND ANSWERS #6
b) Crash cart
c) IV pump
d) EKG monitor
e) Lidocaine: Answer: A, B, and D
Adenosine is administered as a very quick IV push. The physician must be present in the room
and the crash cart must be on hand. An ekg monitor should be in the room to monitor the
effectiveness of the medication.
5. The nurse has just administered adenosine via IV push and sees the follow- ing rhythm on the
monitor. What is the nurse's priority intervention?
a) Apply conductive gel and defibrillate the patient
b) Document the findings and continue to monitor
c) Administer another mg of the medication
d) Begin chest compressions: Answer: B
This finding would be expected upon administration of adenosine. The rhythm should then begin
again in some other rhythm, hopefully normal sinus rhythm. It would be important to document
the exact time of this change and continue to monitor the change back to NSR. If this change
does not occur, or if another rhythm is produced, appropriate action would then be taken based
on the result.
6. A group of nursing students are discussing atrial flutter. These students recognize that which
of the following are seen with atrial flutter? Select all that apply:
1) Ventricular rate of 220-300 bpm.
2) Regular rhythm
3) Saw-tooth pattern
4) Measurable PR interval
5) Long QRS interval: Answer(s): 2, 3
The ATRIAL rate is 250-400 bpm. Ventricular is about 75-150. The rhythm is regular, with the P
wave appearing as little flutter or a "saw tooth pattern". The PR interval is not measurable r/t
this saw-tooth P wave. The QRS is normal.
7. A nursing student is aware that which of the following is the treatment for unstable atrial flutter?
1) Adenosine (Adenocard) 6 mg rapid IVP.
2) Cardioversion with adjacent Heparin therapy
3) Defibrillation STAT followed by CPR.
4) Altemose 3 mg IVP over 1-2 seconds.: Answer: 2
, DYSRHYTHMIAS PRACTICE QUESTIONS AND ANSWERS #6
Cardioversion is used if the patient is unstable. Anticoagulants are used if the arrhythmia has
stuck around for 48 hr +. Adenosine may be used with a narrow QRS and regular RR interval
8. A nurse working on a CVT unit receives report from day shift. After receiving report, which patient
should the nurse see first?
1) A 23-year-old professional tennis player with a HR of 47 bpm.
2) A 69-year-old male with atrial fibrillation who has new onset confusion.
3) A 72-year-old female with atrial flutter who reports feeling unusually tired today and yesterday.
4) A 33-year-old female with sinus tachycardia who is asking for her at-home Metoprolol.: Answer: 2
Patients with a-fib are at risk for pulmonary and systemic emboli, and new onset of confusion
may indicate a stroke in this patient. Patients with atrial flutter may feel more tired some days
than others.
9. A nurse on a CVT unit views the monitor and sees the patient in room 452 has just begun having
occasional PVCs. Which action should the nurse take first?
1) Check on the patient
2) Check last magnesium and potassium levels
3) Document the occurrence and watch for further PVCs
4) Contact the physician: Answer: 1
Although electrolytes are likely the culprit, the nurse first needs to first assess the patient. Then,
the nurse should look in the patient's chart and evaluate or request an order for electrolyte
levels. This may eventually need to be documented, but the nurse can be held liable for neglect
if he/she does not assess the patient first. The physician may or may not need to be contacted.
10.Which of the following does the nursing student realize is the treatment for a stable patient
presenting with QRS intervals above 0.12 seconds with a regular rhythm and a rate of 100-250 bpm?
1) Atropine
2) Defibrillation
3) Amiodarone
4) Adenosine: Answer: 3
This is describing ventricular tachycardia (QRS is a giveaway), and the treatment for a stable
patient is Amiodarone or cardioversion. If the patient were unstable, we'd go ahead and
defibrillate.
