1.

The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip because: A) The view of the electrical current changes in relation to the lead placement. B) Conduction of the heart differs with lead placement. C) Electrocardiogram (ECG) equipment has malfunctioned. D) The circadian rhythm has changed. Ans: A Difficulty: Moderate 2. The nurse evaluating a rhythm strip notes that the wave forms that move to the top of the strip indicate: A) The heart rate C) An isoelectric wave B) A negative deflection D) A positive deflection Ans: D Difficulty: Moderate 3. While analyzing a rhythm strip, the nurse identifies the resting state of the heart by looking at the: A) P wave B) T wave C) U wave D) QRS complex Ans: B Difficulty: Moderate 4. An adult patient has damage to the electrical conduction of the ventricles of the heart. The nurse would expect to see changes in the: A) P wave B) T wave C) QRS complex D) U wave Ans: C Difficulty: Moderate 5. To find the heart rate from an ECG strip of a patient with a normal sinus rhythm, the nurse counts 20 small boxes between two R waves. The heart rate would be: A) 75 beats/min B) 80 beats/min C) 60 beats/min D) 140 beats/min Ans: A Difficulty: Moderate 6. An adult patient being assessed in the emergency room is anxious about his health status. The ECG rhythm strip shows a heart rate of 120 beats/min. Characteristics of a sinus tachycardia rhythm are: A) P:QRS ratio of 2:1 B) P:QRS ratio of 1:1 C) Ventricular and atrial rhythm are irregular D) Atrial rhythm regular, ventricular rhythm irregular Ans: B Difficulty: Difficult 7. An adult patient with third-degree AV block is on continuous cardiac monitoring. The EKG will show which of the following rhythm characteristics? A) PP interval and RR intervals are irregular B) PP interval equal to RR interval C) Fewer QRS complexes than P waves D) PR interval constant
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Ans: C Difficulty: Difficult 8. A patient reports feeling palpitations, light-headedness, and weakness. The nurse finds a pulse deficit when doing the assessment. This may be an indicator of: A) Atrial fibrillation C) Premature atrial complex B) Sinus tachycardia D) Junctional rhythm Ans: A Difficulty: Moderate 9. When caring for a patient with a cardiac dysrhythmia, the most appropriate goal for the patient is to maintain: A) Nutritional intake B) Fluid intake C) Cardiac output D) Social contacts Ans: C Difficulty: Moderate 10. A stable patient with atrial flutter is symptomatic from the arrhythmia. The physician administers amiodarone IV in an attempt to: A) Convert the arrhythmia to a sinus rhythm B) Slow the ventricular rate C) Block the conduction of the AV node D) Slow the conduction through the AV node Ans: A Difficulty: Moderate 11. A nursing intervention to assess the hemodynamic effects of a dysrhythmia on a patient would be to: A) Obtain an ECG rhythm strip B) Obtain a blood level of drugs administered C) Assess the patient's level of anxiety D) Assess the patient's BP and pulse rate Ans: D Difficulty: Moderate 12. An adult patient experiences premature atrial complex (PAC) on occasion (once every couple of hours) but remains hemodynamically stable. The patient expresses concern over the arrhythmia developing into a more fatal arrhythmia in the future. The most appropriate nursing diagnosis for this patient is: A) Decreased cardiac output C) Anxiety related to fear of unknown B) Alteration in comfort D) Potential for injury Ans: C Difficulty: Moderate 13. The nurse notes that the ECG strip of a patient who has had a temporary pacemaker inserted indicates loss of capture. The priority nursing intervention upon identification of this problem is to:

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A) B)

Change the generator Increase sensitivity Ans: D Difficulty: Difficult

C) D)

Change the battery Turn the patient to the left side

14. The nurse should assess for which of the following potential complications in a postoperative patient with permanent pacemaker implantation? A) Decreased urinary output B) Bleeding at the generator implantation site C) Decreased respiratory rate D) Decreased pulse rate Ans: B Difficulty: Moderate 15. A patient has a permanent pacemaker implanted with the identification code beginning with VVI, which indicates: A) Ventricular paced, ventricular sensed, inhibited B) Atrial paced, ventricular sensed, inhibited C) Ventricular sensed, ventricular paced, inhibited D) Atrial sensed, atrial paced, inhibited Ans: A Difficulty: Moderate 16. An adult patient is in ventricular fibrillation; when defibrillating the patient, the nurse must: A) Maintain good contact between paddles and patient skin. B) Use ultrasound gel as a conducting agent. C) Call all clear once before discharging the defibrillator. D) Ensure the defibrillator is in the sync mode. Ans: A Difficulty: Moderate 17. An adult patient who has undergone an implantable cardioverter defibrillator (ICD) procedure asks about the purpose of this device. The nurse's best response would be: A) To detect and treat ventricular fibrillation and ventricular tachycardia B) To detect and treat bradycardia C) To detect and treat atrial fibrillation D) To shock your heart if you have a heart attack at home Ans: A Difficulty: Moderate 18. The nurse is aware that cryoablation therapy involves: A) Peeling away the area of endocardium responsible for the dysrhythmia B) Using electrical shocks directly to endocardium to eliminate the source of dysrhythmia C) Using high-frequency sound waves to eliminate the source of dysrhythmia

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D)

Using a probe cooled to a temperature of -60C (-76 F) to eliminate the source of dysrhythmia Ans: D Difficulty: Moderate

19. The nurse is caring for a patient receiving lidocaine IV. Which factor is most relevant to administration of this medication? A) Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter B) Increase in systemic blood pressure C) Presence of premature ventricular contractions (PVCs) on cardiac monitor D) Increase in intracranial pressure (ICP) Ans: C Difficulty: Moderate 20. A patient would be considered for cardiac conduction surgery if which of the following are present? A) Sinus bradycardia not responsive to other treatments B) Functional rhythms not responsive to other treatments C) Atrial and ventricular tachycardias not responsive to other treatments D) Ventricular fibrillation not responsive to other treatments Ans: C Difficulty: Moderate 21. The nurse caring for a patient on the telemetry floor who is experiencing symptomatic sinus bradycardia is aware the medication of choice for treatment of this dysrhythmia is atropine. What guidelines will the nurse following when administering atropine? A) Administer atropine 0.5 mg rapidly as an IV bolus every 3 to 5 minutes to a maximum total dose of 3 mg. B) Administer atropine 0.5 mg slowly as an IV bolus every minute to a maximum total dose of 3 mg. C) Administer atropine 1.0 mg rapidly as an IV bolus every 3 to 5 minutes to a maximum total dose of 3 mg. D) Administer atropine 1.0 mg slowly as an IV bolus every minute to a maximum total dose of 3 mg. Ans: A Difficulty: Difficult 22. A patient presenting to the emergency room is experiencing atrial flutter. The initial management of atrial flutter in a stable patient with a narrow QRS and regular R-R interval is: A) Rapid IV administration of adenosine 6 mg, followed by a 20-mL saline flush and elevation of the arm B) IV administration of a beta-blocker C) Rapid IV administration of adenosine 12 mg, repeating the drug administration if needed

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D)

IV administration of magnesium Ans: A Difficulty: Difficult

23. An unstable patient exhibiting atrioventricular nodal reentry tachycardia (AVNRT) has not responded to vagal maneuvers or drug therapy. What will the nurse anticipate as the next step in the management of this patient's dysrhythmia? A) Cardioversion C) Defibrillation B) Carotid sinus massage D) Cardiac bypass surgery Ans: A Difficulty: Moderate 24. The nurse is caring for a patient in the critical care unit who experiences ventricular tachycardia (VT). What is the drug of choice for this dysrhythmia? A) Amiodarone B) Lidocaine C) Adenosine D) Clonidine Ans: A Difficulty: Moderate 25. A patient is exhibiting ventricular tachycardia with an irregular rhythm. The nurse should expect which dysrhythmia as the cause of the ventricular tachycardia? A) Atrial fibrillation C) Premature ventricular complex B) Atrial flutter D) Sinus bradycardia Ans: A Difficulty: Moderate 26. The critical care nurse has responded to a cardiac arrest on a medical-surgical unit. The continuous electrocardiogram monitoring indicates that the patient is experiencing ventricular fibrillation. After the initial defibrillations, the next step in the management of this patient is: A) Administration of medications until an electrical rhythm is obtained B) 5 cycles of CPR alternating with a rhythm check and defibrillation C) Continuous defibrillation until an electrical rhythm is obtained D) Continuous CPR until an electrical rhythm is obtained Ans: B Difficulty: Moderate 27. A patient who has been transported to the emergency room after a motor vehicle accident is experiencing ventricular asystole. Management of ventricular asystole focuses on : A) Continuous defibrillation until an electrical rhythm is obtained B) High-quality CPR with minimal interruptions C) Cessation at resuscitation attempts after 2 minutes D) Administration of medications until an electrical rhythm is obtained Ans: B Difficulty: Difficult

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28. The nurse who is caring for a patient in ICU on a ventilator assesses a need for suctioning and is aware that the most common cardiac arrhythmia occurring during endotracheal suctioning is: A) Sinus tachycardia B) Ventricular tachycardia C) Paroxysmal supraventricular tachycardia D) Sinus bradycardia Ans: D Difficulty: Moderate 29. The nurse is caring for a patient who converts from normal sinus rhythm at 72/min to atrial fibrillation with a ventricular response at 164/min. Blood pressure is 160/76. Respiratory rate is 20/min with normal chest expansion and clear lungs bilaterally. IV heparin and cardizem are given. The nurse understands that the goal is to: A) Decrease SA node conduction C) Improve oxygenation B) Control ventricular rate D) Maintain anticoagulation Ans: B Difficulty: Moderate 30. The nurse is caring for a patient who converted to ventricular fibrillation (VF) and was defibrillated at 200 joules, 300 joules, and 360 joules respectively. The patient remains in VF. According to national standards, the nurse is aware that the following medication should be used: A) Epinephrine 1 mg IV push C) Amiodarone 300 mg IV push B) Lidocaine 100 mg IV push D) Sodium bicarbonate 1 amp IV push Ans: A Difficulty: Moderate 31. A 12-lead EKG performed on a patient 4 hours after onset of chest pain reveals ST segment elevation. The nurse recognizes that this finding indicates: A) Transient ischemia typical of unstable angina B) Lack of permanent damage to myocardial cells C) Myocardial infarction associated with prolonged and complete coronary thrombosis D) Myocardial infarction associated with transient or incomplete artery occlusion Ans: A Difficulty: Moderate 32. The nurse is caring for a patient who develops pulseless electrical activity. Upon confirmation, the nurse would immediately: A) Start CPR C) Notify the physician STAT B) Administer epinephrine D) Start an IV of NSS wide-open rate Ans: A Difficulty: Moderate 33. The nurse is caring for a patient who requires transcutaneous pacing. She sets the rate

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A) B) C) D)

to 80/min. She knows that the milliamperage setting is adequate when: She sees the pacemaker spike at a rate of 80/min. The milliamperage reaches 40. There is evidence of a paced QRS. Oxygenation has improved. Ans: C Difficulty: Moderate

34. The nurse is caring for a patient who suddenly develops bradycardia. The patient is breathing but with a decreased level of consciousness and decreased blood pressure. Which of the following treatments would be done by the nurse first? A) Begin CPR B) Administer atropine IV C) Application of a transcutaneous pacemaker D) Discontinue cardioversion Ans: C Difficulty: Moderate 35. The nurse doing discharge teaching on a patient with a newly inserted permanent pacemaker teaches the patient to: A) Start lifting the arm above the shoulder right away to prevent shoulder restriction B) Avoid cooking with a microwave oven C) Avoid exposure to high-voltage electrical generators D) Avoid walking through store and library antitheft devices Ans: C Difficulty: Moderate 36. The nurse caring for a patient with a tachydysrhythmia would teach and prepare him for which of the following procedures: A) Catheter ablation therapy C) Cardioversion B) Transubcutaneous pacemaker D) Implantable cardiac device Ans: A Difficulty: Moderate 37. The nurse caring for a patient with an arrhythmia who develops a sudden drop in blood pressure, chest pain, and decreased mentation identifies which of the following conditions related to the arrhythmia: A) Hepatomegaly C) Decreased cardiac output B) Right-sided heart failure D) Left-sided heart failure Ans: C Difficulty: Moderate 38. The nurse is caring for a patient 1 hour postoperative pacemaker implantation. Upon assessing the patient's ECG, spikes appear within the QRS complex and ST segment. This is described as: A) Failure to sense C) Pacemaker failure

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B)

Failure to capture Ans: A Difficulty: Moderate

D)

Demand pacing

39. The nurse is preparing a patient for an ECG. Which of the following should be done prior to electrode placement? A) Cleaning the skin with povidone-iodine solution prior to applying the electrodes B) Ensuring that the area for electrode placement is dry C) Applying tincture of benzoin to the electrode sites and waiting for it to become tacky D) Abrading the skin by rubbing the electrode sites briskly with a rough surface such as a clean, dry gauze or washcloth Ans: D Difficulty: Easy 40. The nurse is performing external defibrillation. Which of the following is a vital step in the procedure? A) Gel pads are placed anterior over the apex and posterior for better conduction. B) No one is to be touching the patient at the time shock is delivered. C) Continue to ventilate the patient via endotracheal tube during the procedure. D) Second shock cannot be administered for 1 minute to allow recharging. Ans: B Difficulty: Moderate 41. A nurse is assessing an ECG rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second. The overall heart rate is 60 beats/min. The nurse assesses the cardiac rhythm as: A) Normal sinus rhythm C) Sick sinus syndrome B) Sinus bradycardia D) Heart Block Ans: A Difficulty: Moderate 42. A nurse is caring for a patient on a cardiac monitor and whose rhythm suddenly changes. There are no P waves; instead she observes wavy lines. The QRS complexes measure 0.08 second and are irregular. The patient's heart rate is 120 beats/minute. The nurse interprets that this rhythm is: A) Sinus tachycardia C) Ventricular tachycardia B) Atrial fibrillation D) Ventricular fibrillation Ans: B Difficulty: Moderate

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