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A healthy heartbeat requires the coordination of electrical conduction and mechanical contraction. What is the primary purpose of the mechanical component?
A.Regulating the heart rate
B.Generating the initial impulse
C.Depolarizing the atria
D.Pumping blood to the body
D.
Pumping blood to the body
That's right!
Mechanical contraction is the physical act of the heart muscle squeezing to move blood through the circulatory system, which produces cardiac output.
On EKG graph paper, a nurse measures a specific interval that spans 3 large boxes. How much time does this represent?
A.0.12 seconds
B.3.00 seconds
C.0.60 seconds
D.0.04 seconds
C.
0.60 seconds
That's right!
Since each large box represents 0.20 seconds, three large boxes equate to 0.60 seconds (3×0.20).
Which of the following EKG measurements would be considered abnormal and indicative of a ventricular conduction problem?
A. QRS duration of 0.14 seconds
B.PR interval of 0.16 seconds
C.Heart rate of 75 bpm
D.QT interval of 0.44 seconds
A.
QRS duration of 0.14 seconds
That's right!
A normal QRS duration is 0.06 to 0.10 seconds; a measurement greater than 0.10 seconds suggests delayed or abnormal conduction through the ventricles
Why does the risk of dysrhythmias increase as a person ages?
A.
Atrial depolarization takes less time to complete
B.
There is a decrease in pacemaker cells in the SA node
C.
The heart muscle becomes thinner and more flexible
D.
The AV node becomes more efficient at conduction
B.
There is a decrease in pacemaker cells in the SA node
That's right!
A reduction in the number of functional pacemaker cells in the SA node makes the heart's natural timing less reliable.
A nurse is caring for a patient in Supraventricular Tachycardia (SVT) with a heart rate of 180 bpm. When preparing to administer Adenosine, which safety precaution is most important?
A.Administer the drug via a slow IV drip over 30 minutes
B.Position the patient in a prone position
C.Ensure a crash cart is nearby as it may cause brief asystole
D.Check the patient's blood glucose levels first
C.
Ensure a crash cart is nearby as it may cause brief asystole
That's right!
Adenosine slows conduction through the AV node so significantly that it often causes a short period of asystole; emergency equipment must be ready if the heart does not restart.
A nurse identifies three Premature Ventricular Contractions (PVCs) in a row on a patient's cardiac monitor. What should be the nurse's very first action?
A.Check the patient for a pulse
B.Administer Atropine 0.5 mg IV
C.Immediately deliver a defibrillation shock
D.Document the rhythm and continue to monitor
A.
Check the patient for a pulse
That's right!
The first priority when VTach is suspected is to determine if the patient has a pulse, as this dictates the entire treatment algorithm.
Why is a blockage in the Right Coronary Artery (RCA) a significant risk factor for the development of heart blocks?
A.Blockage of the RCA increases the number of SA node pacemaker cells
B.The RCA provides the main blood supply to the ventricles' Purkinje fibers
C.The RCA supplies blood to the AV node in most people
D.The RCA is responsible for the mechanical contraction of the left atrium
C.
The RCA supplies blood to the AV node in most people
Right answer
Ischemia or blockage of the RCA directly impacts the AV node's ability to conduct electrical impulses, leading to various types of heart blocks.
A nurse identifies a rapid rhythm with a narrow QRS and a rate of 180 bpm where P waves are buried. Which intervention should be prepared if the patient is symptomatic?.
A.Atropine administration
B.Observe and monitor for 24 hours
C.Defibrillation
D.Adenosine administered via rapid IV push
D.
Adenosine administered via rapid IV push
Right answer
Adenosine is the standard treatment for SVT to slow the conduction through the AV node and restore normal rhythm.
A patient's EKG shows a chaotic, quivering baseline with no organized QRS complexes and no cardiac output. What is the priority treatment?
A.Synchronized Cardioversion
B.Administration of Epinephrine without CPR
C.Atropine administration
D.CPR and Defibrillation
D.
CPR and Defibrillation
That's right!
Ventricular Fibrillation (VFib) is a lethal rhythm that requires immediate electrical shock and chest compressions to restore a rhythm.
A patient in the emergency department has an EKG showing a heart rate of 190 bpm with narrow QRS complexes and non-visible P waves. The patient is short of breath and hypotensive. What is the priority nursing intervention?
A.Prepare for a permanent pacemaker insertion
B.Begin chest compressions
C.Prepare for administration of Adenosine
D.Administer Atropine 0.5 mg IV
C.
Prepare for administration of Adenosine
That's right!
Adenosine is the treatment of choice for symptomatic supraventricular tachycardia (SVT) to rapidly slow the heart rate.
A 68-year-old patient presents with dizziness and fatigue. Telemetry shows:
Regular rhythm
HR: 48 bpm
P wave before every QRS
PR interval: 0.16 sec
BP: 92/58 mmHg
Patient reports lightheadedness.
What is the nurse’s priority action?
A. Observe and reassess in 4 hours
B. Prepare for immediate cardioversion
C. Administer atropine as ordered
D. Start IV beta blockers
Your Answer: C ✅
Correct Answer: C — Administer atropine
Rationale:
This patient has symptomatic sinus bradycardia (HR 48 + dizziness + low BP).
First-line treatment is atropine IV to increase heart rate.
👉 Key:
Brady + symptoms = Treat
A patient with pneumonia is on continuous monitoring. The rhythm shows:
Early beats
Irregular rhythm
Normal QRS width
Pause after early beat
The patient reports drinking 6 cups of coffee daily.
Which rhythm is most likely present?
A. Atrial flutter
B. Premature atrial contractions
C. Ventricular tachycardia
D. Junctional rhythm
Correct Answer: B — Premature Atrial Contractions (PACs)
Rationale:
PACs cause:
Early beats
Irregular rhythm
Compensatory pause
Triggered by caffeine
This patient drinks lots of coffee → classic PAC trigger.
A 75-year-old with hypertension reports palpitations and fatigue. Telemetry shows:
No visible P waves
Irregular rhythm
Narrow QRS
HR: 132 bpm
What complication is this patient at highest risk for?
A. Pulmonary embolism
B. Stroke
C. Heart failure
D. Cardiac tamponade
Correct Answer: B — Stroke
Rationale:
This rhythm = Atrial Fibrillation with RVR
AFib → atria quiver → blood pools → clots → embolize → stroke
👉 Always think:
AFib = Anticoag + Stroke risk
A patient suddenly develops this rhythm:
HR: 178 bpm
Regular rhythm
Narrow QRS
P waves not visible
Patient is dizzy and hypotensive
What medication should the nurse anticipate first?
A. Amiodarone
B. Digoxin
C. Adenosine
D. Epinephrine
Correct Answer: C — Adenosine
Rationale:
This is SVT:
HR >150
Narrow QRS
Regular
No visible P waves
First-line for symptomatic SVT = Adenosine
A patient with chronic kidney disease develops:
Wide QRS
HR: 160 bpm
5 PVCs in a row
Has a pulse
BP: 84/50 mmHg
What is the first nursing action?
A. Administer atropine
B. Check for a pulse and assess stability
C. Start chest compressions
D. Give adenosine
Correct Answer: B — Check pulse and assess stability
Rationale:
This is VTach with a pulse.
First step with VTach:
ALWAYS assess pulse, BP, LOC
Before meds → assess stability.
The nurse on a cardiac unit hears the monitor alarm and sees that a patient that she is not assigned to is in ventricular tachycardia. What should be the nurse’s next action?
Run to the room and assess the patient.
Find the assigned nurse and let them know.
Walk to the room and assess the patient.
Silence the alarm and walk away.
Run to the room and assess the patient.
The nurse is caring for a patient newly diagnosed with atrial fibrillation with a ventricular response of 130 beats per minute. What medication should the nurse consider requesting when communicating with the provider? Select all that apply.
Anticoagulant
Beta blocker
Calcium channel blocker
Digoxin
Aspirin
Anticoagulant
Beta blocker
Calcium channel blocker
Digoxin
The nurse finds the patient unresponsive and without a pulse. The rhythm on the monitor is wide and bizarre. What is the priority action?
Insert a pacemaker
Intubate
Apply oxygen
Defibrillation
Defibrillation
A nurse overhears another team member saying that atrial fibrillation begins in the atrioventricular (AV) node of the heart. Which action should the nurse take?
Stop the team member and correct their comment.
Allow them to finish their comments as they are correct.
Share with another colleague what you overheard.
Confirm the information as being accurate with an internet search.
Stop the team member and correct their comment.
its a multiple areas of firing throughout the atria of the heart
Which statement is true regarding a third-degree atrioventricular (AV) or complete heart block? Select all that apply.
The P waves will be equal to the QRS complexes.
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
The P waves march throughout the rhythm strip at an irregular rate.
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
The nurse is caring for a patient who suddenly develops dizziness and sweating. He has had similar symptoms in the past and has fainted. Which type of heart block would the nurse suspect is causing these symptoms?
First-degree atrioventricular block (AVB)
Second-degree, type I, atrioventricular block (AVB), asymptomatic
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
Third-degree complete heart block, asymptomatic
The atrial rate is between 60 and 100 bpm and the ventricular rate is less than or equal to 40 bpm.
A patient with an irregular pulse is admitted for the sudden onset of right-sided weakness and slurred speech. Which dysrhythmia is the likely cause of these symptoms?
Arial fibrillation (AF)
Complete heart block (CHB)
Bigeminal premature ventricular contractions (PVCs)
Ventricular fibrillation (VF)
Arial fibrillation (AF) bc increase risk of stroke
Which patient, showing inverted P waves on electrocardiogram (ECG), is most likely to have junctional tachycardia?
Patient with heart rate of 60 beats per minute
Patient with heart rate of 75 beats per minute
Patient with heart rate of 90 beats per minute
Patient with heart rate of 105 beats per minute
Patient with heart rate of 105 beats per minute
When caring for a patient asking about the difference between defibrillation and cardioversion, which response by the nurse would be correct?
“Only defibrillation involves use of an electrical shock.”
“Cardioversion is used for patents with ventricular fibrillation.”
“The maximum amount of energy that can be used for defibrillation is 300 joules.”
“Cardioversion can be used to treat atrial fibrillation and SVT.”
“Cardioversion can be used to treat atrial fibrillation and SVT.”
Which nursing intervention would be priority for a patient experiencing bradycardia?
Determine if the patient is symptomatic
Administer 1 mg atropine IV push
Prepare the patient for pacemaker placement
Administer oxygen via nasal cannula
Determine if the patient is symptomatic