CARDIAC DYSRHYTHMIAS/ARRHYTHMIAS

Text Mode – Text version of the exam

1. A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes
are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The
overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as:

A. Normal sinus rhythm

B. Sinus bradycardia
C. Sick sinus syndrome
D. First-degree heart block.
2. A nurse notices frequent artifact on the ECG monitor for a client whose leads are
connected by cable to a console at the bedside. The nurse examines the client to determine
the cause. Which of the following items is unlikely to be responsible for the artifact?

A. Frequent movement of the client

B. Tightly secured cable connections
C. Leads applied over hairy areas
D. Leads applied to the limbs
3. A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes.
There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but
over 100. The nurse determines that the client is experiencing:

A. Premature ventricular contractions

B. Ventricular tachycardia
C. Ventricular fibrillation
D. Sinus tachycardia
4. A nurse is viewing the cardiac monitor in a client’s room and notes that the client has just
gone into ventricular tachycardia. The client is awake and alert and has good skin color. The
nurse would prepare to do which of the following?

A. Immediately defibrillate
B. Prepare for pacemaker insertion
C. Administer amiodarone (Cordarone) intravenously
D. Administer epinephrine (Adrenaline) intravenously
5. A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the
client to do which of the following, if prescribed, during an episode of ventricular
tachycardia?

A. Breathe deeply, regularly, and easily.

B. Inhale deeply and cough forcefully every 1 to 3 seconds.
C. Lie down flat in bed
D. Remove any metal jewelry
6. A client is having frequent premature ventricular contractions. A nurse would place
priority on assessment of which of the following items?

A. Blood pressure and peripheral perfusion

B. Sensation of palpitations
C. Causative factors such as caffeine
D. Precipitating factors such as infection
7. A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute.
A nurse assesses the client for:

A. Hypotension and dizziness

B. Nausea and vomiting
C. Hypertension and headache
D. Flat neck veins
8. A nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There
are no P waves; instead there are wavy lines. The QRS complexes measure 0.08 second, but
they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as:

A. Sinus tachycardia
B. Atrial fibrillation
C. Ventricular tachycardia
D. Ventricular fibrillation
9. A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform
carotid massage. The nurse responds that this procedure may stimulate the:

A. Vagus nerve to slow the heart rate

B. Vagus nerve to increase the heart rate; overdriving the rhythm.
C. Diaphragmic nerve to slow the heart rate
D. Diaphragmic nerve to overdrive the rhythm
10. A nurse notes that a client with sinus rhythm has a premature ventricular contraction
that falls on the T wave of the preceding beat. The client’s rhythm suddenly changes to one
with no P waves or definable QRS complexes. Instead there are coarse wavy lines of varying
amplitude. The nurse assesses this rhythm to be:

A. Ventricular tachycardia
B. Ventricular fibrillation
C. Atrial fibrillation
D. Asystole
11. While caring for a client who has sustained an MI, the nurse notes eight PVCs in one
minute on the cardiac monitor. The client is receiving an IV infusion of D 5W and oxygen at 2
L/minute. The nurse’s first course of action should be to:
A. Increase the IV infusion rate
B. Notify the physician promptly
C. Increase the oxygen concentration
D. Administer a prescribed analgesic
12. The adaptations of a client with complete heart block would most likely include:

A. Nausea and vertigo

B. Flushing and slurred speech
C. Cephalalgia and blurred vision
D. Syncope and low ventricular rate
13. A client with a bundle branch block is on a cardiac monitor. The nurse should expect to
observe:

A. Sagging ST segments
B. Absence of P wave configurations
C. Inverted T waves following each QRS complex
D. Widening of QRS complexes to 0.12 second or greater.
14. When ventricular fibrillation occurs in a CCU, the first person reaching the client should:
 A. Administer oxygen
B. Defibrillate the client
C. Initiate CPR
D. Administer sodium bicarbonate intravenously
15. What criteria should the nurse use to determine normal sinus rhythm for a client on a
cardiac monitor? Check all that apply.
A. The RR intervals are relatively consistent
B. One P wave precedes each QRS complex
C. Four to eight complexes occur in a 6 second strip
D. The ST segment is higher than the PR interval
E. The QRS complex ranges from 0.12 to 0.20 second.
16. When auscultating the apical pulse of a client who has atrial fibrillation, the nurse
would expect to hear a rhythm that is characterized by:

A. The presence of occasional coupled beats

B. Long pauses in an otherwise regular rhythm
C. A continuous and totally unpredictable irregularity
D. Slow but strong and regular beats
Answers and Rationales

1. A. measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second,
respectively.
2. B. Motion artifact, or “noise,” can be caused by frequent client movement, electrode
placement on limbs, and insufficient adhesion to the skin, such as placing electrodes
over hairy areas of the skin. Electrode placement over bony prominences also should be
avoided. Signal interference can also occur with electrode removal and cable
disconnection.
3. B. Ventricular tachycardia is characterized by the absence of P waves, wide QRS
complexes (usually greater than 0.14 second), and a rate between 100 and 250
impulses per minute. The rhythm is usually regular.
4. C. First-line treatment of ventricular tachycardia in a client who is hemodynamically
stable is the use of anti-dysrhythmics such as amiodarone (Cordarone), lidocaine
(Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct
the rhythm (cardioversion is recommended for stable ventricular tachycardia).
Defibrillation is used with pulseless ventricular tachycardia. Epinephrine would stimulate
and already excitable ventricle and is contraindicated.
5. B. Cough cardiopulmonary resuscitation (CPR) sometimes is used in the client with
unstable ventricular tachycardia. The nurse tells the client to use cough CPR, if
prescribed, by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR
may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a
short time until other measures can be implemented.
6. A. Premature ventricular contractions can cause hemodynamic compromise. The
shortened ventricular filling time with the ectopic beats leads to decreased stroke
volume and, if frequent enough, to decreased cardiac output. The client may be
asymptomatic or may feel palpations. PVCs can be caused by cardiac disorders or by
any number of physiological stressors, such as infection, illness, surgery, or trauma, and
by the intake of caffeine, alcohol, or nicotine.
7. A. The client with uncontrolled atrial fibrillation with a ventricular rate more than 150
beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse
assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit,
fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.
8. B. Atrial fibrillation is characterized by a loss of P waves; an undulating, wavy
baseline; QRS duration that is often within normal limits; and an irregular ventricular
rate, which can range from 60 to 100 beats per minute (when controlled with
medications) to 100 to 160 beats per minute (when uncontrolled).
9. A. Carotid sinus massage is one of the maneuvers used for vagal stimulation to
decrease a rapid heart rate and possibly terminate a tachydysrhythmia. The others
include inducing the gag reflex and asking the client to strain or bear down. Medication
therapy often is needed as an adjunct to keep the rate down or maintain the normal
rhythm.
10. B. Ventricular fibrillation is characterized by irregular, chaotic undulations of varying
amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or
QRS complexes and results from electrical chaos in the ventricles.
11. B. PVCs are often a precursor of life-threatening dysrhythmias, including ventricular
tachycardia and ventricular fibrillation. An occasional PVC is not considered dangerous,
but if PVCs occur at a rate greater than 5 or 6 per minute in the post MI client, the
physician should be notified immediately. More than 6 PVCs per minute is considered
serious and usually calls for decreasing ventricular irritability by administering
medications such as lidocaine. Increasing the IV infusion rate would not decrease the
number of PVCs. Increasing the oxygen concentration should not be the nurse’s first
course of action; rather, the nurse should notify the physician promptly. Administering a
prescribed analgesic would not decrease ventricular irritability.
12. D. In complete atrioventricular block, the ventricles take over the pacemaker function
in the heart but at a much slower rate than that of the SA node. As a result there is
decreased cerebral circulation, causing syncope.
13. D. Bundle branch block interferes with the conduction of impulses from the AV node
to the ventricle supplied by the affected bundle. Conduction through the ventricles is
delayed, as evidenced by a widened QRS complex.
14. B. Ventricular fibrillation is a death-producing dysrhythmia and, once identified, must
be terminated immediately by precordial shock (defibrillation). This is usually a standing
physician’s order in a CCU.
15. A, B. The consistency of the RR interval indicates regular rhythm. A normal P wave
before each complex indicates the impulse originated in the SA node. The number of
complexes in a 6 second strip is multiplied by 10 to approximate the heart rate; normal
sinus rhythm is 60 to 100. Elevation of the ST segment is a sign of cardiac ischemia and
is unrelated to the rhythm. The QRS duration should be less than 0.12 second; the PR
interval should be 0.12 to 0.20 second.
16. C. In atrial fibrillation, multiple ectopic foci stimulate the atria to contract. The AV
node is unable to transmit all of these impulses to the ventricles, resulting in a pattern
of highly irregular ventricular contractions.