NUR 455-Exam 5 With
Complete Solution
The nurse is analyzing a rhythm strip. What component of the ECG
corresponds to the resting state of the patient's heart?
A. P wave
B. T wave
C. U wave
D. QRS complex - ANSWER B. T wave
The T wave specifically represents ventricular muscle depolarization, also
referred to as the resting state. Ventricular muscle depolarization does not
result in the P wave, U wave, or QRS complex.
The nursing educator is presenting a case study of an adult patient who has
abnormal ventricular depolarization. This pathologic change would be most
evident in what component of the ECG?
A. P wave
B. T wave
C. QRS complex
D. U wave - ANSWER C. QRS complex
The QRS complex represents the depolarization of the ventricles and, as such,
the electrical activity of that ventricle.
,An adult patient with third-degree AV block is admitted to the cardiac care
unit and placed on continuous cardiac monitoring. What rhythm
characteristic will the ECG most likely show?
A. PP interval and RR interval are irregular.
B. PP interval is equal to RR interval.
C. Fewer QRS complexes than P waves
D. PR interval is constant. - ANSWER C. Fewer QRS complexes than P waves
In third-degree AV block, no atrial impulse is conducted through the AV node
into the ventricles. As a result, there are impulses stimulating the atria and
impulses stimulating the ventricles. Therefore, there are more P waves than
QRS complexes due to the difference in the natural pacemaker (nodes) rates
of the heart. The other listed ECG changes are not consistent with this
diagnosis.
A patient who is a candidate for an implantable cardioverter defibrillator
(ICD) asks the nurse about the purpose of this device. What would be the
nurse's best response?
A) To detect and treat dysrhythmias such as ventricular fibrillation and
ventricular tachycardia
B) To detect and treat bradycardia, which is an excessively slow heart rate
C) To detect and treat atrial fibrillation, in which your heart beats too quickly
and inefficiently
D) To shock your heart if you have a heart attack at home - ANSWER A) To
detect and treat dysrhythmias such as ventricular fibrillation and ventricular
tachycardia
,The ICD is a device that detects and terminates life-threatening episodes of
ventricular tachycardia and ventricular fibrillation. It does not treat atrial
fibrillation, MI, or bradycardia.
The nurse is caring for a patient who has just had an implantable
cardioverter-defibrillator (ICD) placed. What is the priority area for the
nurse's assessment?
A. Assessing the patient's activity level
B. Facilitating transthoracic echocardiography
C. Vigilant monitoring of the patient's ECG
D. Close monitoring of the patient's peripheral perfusion - ANSWER C.
Vigilant monitoring of the patient's ECG
After a permanent electronic device (pacemaker or ICD) is inserted, the
patient's heart rate and rhythm are monitored by ECG. This is a priority over
peripheral circulation and activity. Echocardiography is not indicated.
The nurse and the other members of the team are caring for a patient who
converted to ventricular fibrillation (VF). The patient was defibrillated
unsuccessfully and the patient remains in VF. According to national
standards, the nurse should anticipate the administration of what
medication?
A. Epinephrine 1 mg IV push
B. Lidocaine 100 mg IV push
C. Amiodarone 300 mg IV push
D. Sodium bicarbonate 1 amp IV push - ANSWER A. Epinephrine 1 mg IV
push
, Epinephrine should be administered as soon as possible after the first
unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic
medications such as amiodarone and licocaine are given if ventricular
dysrhythmia persists
A patient is brought to the ED and determined to be experiencing
symptomatic sinus bradycardia. The nurse caring for this patient is aware the
medication of choice for treatment of this dysrhythmia is the administration
of atropine. What guidelines will the nurse follow when administering
atropine?
A. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a
maximum of 3.0 mg.
B. Administer atropine as a continuous infusion until symptoms resolve.
C. Administer atropine as a continuous infusion to a maximum of 30 mg in 24
hours.
D. Administer atropine 1.0 mg sublingually. - ANSWER A. Administer
atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5
minutes to a maximum total dose of 3.0 mg is the medication of choice in
treating symptomatic sinus bradycardia. By this guideline, the other listed
options are inappropriate.
A group of nurses are participating in orientation to a telemetry unit. What
should the staff educator tell this class about ST segments?
A. They are the part of an ECG that reflects systole.
B. They are the part of an ECG used to calculate ventricular rate and rhythm.
Complete Solution
The nurse is analyzing a rhythm strip. What component of the ECG
corresponds to the resting state of the patient's heart?
A. P wave
B. T wave
C. U wave
D. QRS complex - ANSWER B. T wave
The T wave specifically represents ventricular muscle depolarization, also
referred to as the resting state. Ventricular muscle depolarization does not
result in the P wave, U wave, or QRS complex.
The nursing educator is presenting a case study of an adult patient who has
abnormal ventricular depolarization. This pathologic change would be most
evident in what component of the ECG?
A. P wave
B. T wave
C. QRS complex
D. U wave - ANSWER C. QRS complex
The QRS complex represents the depolarization of the ventricles and, as such,
the electrical activity of that ventricle.
,An adult patient with third-degree AV block is admitted to the cardiac care
unit and placed on continuous cardiac monitoring. What rhythm
characteristic will the ECG most likely show?
A. PP interval and RR interval are irregular.
B. PP interval is equal to RR interval.
C. Fewer QRS complexes than P waves
D. PR interval is constant. - ANSWER C. Fewer QRS complexes than P waves
In third-degree AV block, no atrial impulse is conducted through the AV node
into the ventricles. As a result, there are impulses stimulating the atria and
impulses stimulating the ventricles. Therefore, there are more P waves than
QRS complexes due to the difference in the natural pacemaker (nodes) rates
of the heart. The other listed ECG changes are not consistent with this
diagnosis.
A patient who is a candidate for an implantable cardioverter defibrillator
(ICD) asks the nurse about the purpose of this device. What would be the
nurse's best response?
A) To detect and treat dysrhythmias such as ventricular fibrillation and
ventricular tachycardia
B) To detect and treat bradycardia, which is an excessively slow heart rate
C) To detect and treat atrial fibrillation, in which your heart beats too quickly
and inefficiently
D) To shock your heart if you have a heart attack at home - ANSWER A) To
detect and treat dysrhythmias such as ventricular fibrillation and ventricular
tachycardia
,The ICD is a device that detects and terminates life-threatening episodes of
ventricular tachycardia and ventricular fibrillation. It does not treat atrial
fibrillation, MI, or bradycardia.
The nurse is caring for a patient who has just had an implantable
cardioverter-defibrillator (ICD) placed. What is the priority area for the
nurse's assessment?
A. Assessing the patient's activity level
B. Facilitating transthoracic echocardiography
C. Vigilant monitoring of the patient's ECG
D. Close monitoring of the patient's peripheral perfusion - ANSWER C.
Vigilant monitoring of the patient's ECG
After a permanent electronic device (pacemaker or ICD) is inserted, the
patient's heart rate and rhythm are monitored by ECG. This is a priority over
peripheral circulation and activity. Echocardiography is not indicated.
The nurse and the other members of the team are caring for a patient who
converted to ventricular fibrillation (VF). The patient was defibrillated
unsuccessfully and the patient remains in VF. According to national
standards, the nurse should anticipate the administration of what
medication?
A. Epinephrine 1 mg IV push
B. Lidocaine 100 mg IV push
C. Amiodarone 300 mg IV push
D. Sodium bicarbonate 1 amp IV push - ANSWER A. Epinephrine 1 mg IV
push
, Epinephrine should be administered as soon as possible after the first
unsuccessful defibrillation and then every 3 to 5 minutes. Antiarrhythmic
medications such as amiodarone and licocaine are given if ventricular
dysrhythmia persists
A patient is brought to the ED and determined to be experiencing
symptomatic sinus bradycardia. The nurse caring for this patient is aware the
medication of choice for treatment of this dysrhythmia is the administration
of atropine. What guidelines will the nurse follow when administering
atropine?
A. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a
maximum of 3.0 mg.
B. Administer atropine as a continuous infusion until symptoms resolve.
C. Administer atropine as a continuous infusion to a maximum of 30 mg in 24
hours.
D. Administer atropine 1.0 mg sublingually. - ANSWER A. Administer
atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum of 3.0 mg.
Atropine 0.5 mg given rapidly as an intravenous (IV) bolus every 3 to 5
minutes to a maximum total dose of 3.0 mg is the medication of choice in
treating symptomatic sinus bradycardia. By this guideline, the other listed
options are inappropriate.
A group of nurses are participating in orientation to a telemetry unit. What
should the staff educator tell this class about ST segments?
A. They are the part of an ECG that reflects systole.
B. They are the part of an ECG used to calculate ventricular rate and rhythm.
