Dysrhythmias
A patient with atrial fibrillation is at highest risk for which complication?
Answer: What is a Stroke
Rationale:
In atrial fibrillation, the atria do not contract effectively, causing blood to pool and increasing the risk for clot formation. These clots can travel to the brain and cause a stroke.
When interpreting a cardiac rhythm strip, which action should the nurse perform FIRST?
A. Measure the PR interval
B. Determine the ventricular rhythm
C. Look for the presence of P waves
D. Assess the ST segment
Answer: C. Look for the presence of P waves
Rationale:
A systematic rhythm interpretation begins with assessing whether P waves are present and whether they are normal in appearance. This helps determine the origin of the rhythm.
Which question is MOST important for the nurse to ask when analyzing a dysrhythmia?
A. What medications does the patient prefer?
B. Is the patient hemodynamically stable?
C. How long has the patient been hospitalized?
D. Does the patient have insurance coverage?
Answer: B. Is the patient hemodynamically stable?
Rationale:
The patient’s clinical condition is more important than the rhythm alone. Stability determines urgency and treatment.
1. A patient with sinus tachycardia reports chest pain and shortness of breath. What is the nurse’s PRIORITY intervention?
A. Prepare for defibrillation
B. Assess for causes such as pain or hypovolemia
C. Administer atropine
D. Restrict fluids immediately
Answer: B. Assess for causes such as pain or hypovolemia
Rationale:
Sinus tachycardia is usually caused by an underlying condition such as pain, fever, anxiety, or hypovolemia. Treatm
The nurse recognizes which rhythm as complete heart block?
A. First-degree AV block
B. Wenckebach
C. Third-degree AV block
D. Sinus bradycardia
Answer: C. Third-degree AV block
Rationale:
Third-degree AV block occurs when there is complete dissociation between atrial and ventricular activity. It commonly causes decreased cardiac output and often requires a pacemaker.
2. The nurse identifies ventricular fibrillation on the monitor. What is the priority action?
A. Give atropine
B. Start oxygen
C. Defibrillate immediately
D. Obtain blood pressure
Answer: C. Defibrillate immediately
Rationale:
Ventricular fibrillation is a life-threatening rhythm with no effective cardiac output. Immediate CPR and defibrillation are the priority interventions to restore perfusion
The nurse notes that there is one P wave before every QRS complex. What does this finding suggest?
A. Ventricular tachycardia
B. Normal atrial conduction
C. Complete heart block
D. Ventricular fibrillation
Answer: B. Normal atrial conduction
Rationale:
A normal relationship between P waves and QRS complexes indicates that impulses are being conducted appropriately from the atria to the ventricles.
The nurse notices absent P waves and an irregular rhythm on the monitor. Which dysrhythmia should the nurse suspect?
A. Sinus bradycardia
B. Atrial fibrillation
C. First-degree AV block
D. Ventricular tachycardia
Answer: B. Atrial fibrillation
Rationale:
Atrial fibrillation is characterized by absent discernible P waves and an irregularly irregular rhythm.
A telemetry monitor shows frequent PVCs. The nurse notes the patient is receiving diuretics. What should the nurse do FIRST?
A. Prepare for cardioversion
B. Assess electrolyte levels
C. Initiate CPR
D. Place the patient flat in bed
Answer: B. Assess electrolyte levels
Rationale:
Electrolyte imbalances, especially hypokalemia and hypomagnesemia, are common causes of PVCs and must be corrected
Which finding is expected with atrial fibrillation?
A. Regular rhythm
B. Slow ventricular rate only
C. Irregular pulse
D. Wide QRS complexes only
Answer: C. Irregular pulse
Rationale:
Atrial fibrillation causes an irregularly irregular rhythm because atrial impulses fire chaotically and inconsistently conduct through the AV node.
Which medication is commonly used for symptomatic sinus bradycardia?
A. Adenosine
B. Diltiazem
C. Atropine
D. Lidocaine
Answer: C. Atropine
Rationale:
Atropine increases the heart rate by blocking parasympathetic stimulation to the heart. It is a first-line medication for symptomatic sinus bradycardia.
Which PR interval finding should the nurse recognize as abnormal?
A. PR interval consistently 0.16 seconds
B. PR interval progressively lengthens
C. PR interval remains constant
D. PR interval followed by QRS complexes
Answer: B. PR interval progressively lengthens
Rationale:
A progressively lengthening PR interval is characteristic of second-degree AV block type I (Wenckebach).
Which ECG component represents ventricular depolarization?
A. P wave
B. PR interval
C. QRS complex
D. T wave
Answer: C. QRS complex
Rationale:
The QRS complex represents ventricular depolarization, which leads to ventricular contraction.
The nurse is caring for a patient with tachy dysrhythmia who becomes restless with cool skin and syncope. What does the nurse recognize?
A. Improved cardiac output
B. Decreased tissue perfusion
C. Stable condition
D. Medication side effect only
Answer: B. Decreased tissue perfusion
Rationale:
Restlessness, cool skin, chest pain, and syncope are signs of decreased cardiac output and poor perfusion associated with tachydysrhythmias.
What is the priority treatment for pulseless ventricular tachycardia?
A. Oxygen only
B. Atropine
C. CPR and defibrillation
D. Vagal maneuvers
Answer: C. CPR and defibrillation
Rationale:
Pulseless ventricular tachycardia is treated as cardiac arrest. Immediate CPR and rapid defibrillation are necessary to attempt restoration of circulation.
A patient with PSVT suddenly becomes unstable and hypotensive. What intervention should the nurse anticipate?
A. CPR
B. Cardioversion
C. Defibrillation
D. Pacemaker insertion
Answer: B. Cardioversion
Rationale:
Unstable PSVT causing hypotension requires synchronized cardioversion to restore normal rhythm quickly and improve cardiac output.
A nurse identifies a widened QRS complex on the ECG. Which condition may this indicate?
A. Delayed ventricular conduction
B. Atrial flutter
C. Sinus rhythm
D. Normal ventricular depolarization
Answer: A. Delayed ventricular conduction
Rationale:
A widened QRS complex suggests abnormal or delayed ventricular conduction, often seen in ventricular dysrhythmias or bundle branch blocks.
A prolonged QT interval places the patient at risk for which complication?
A. Torsades de pointes
B. Sinus tachycardia
C. Atrial flutter
D. First-degree AV block
Answer: A. Torsades de pointes
Rationale:
A prolonged QT interval increases the risk for dangerous ventricular dysrhythmias such as torsades de pointes.
A patient with PSVT becomes pale, diaphoretic, and hypotensive. Which intervention should the nurse prepare for?
A. Synchronized cardioversion
B. Defibrillation
C. Pacemaker insertion
D. CPR only
Answer: A. Synchronized cardioversion
Rationale:
Unstable PSVT with signs of poor perfusion requires synchronized cardioversion.
A patient reports feeling like the heart is “skipping beats.” The nurse suspects:
A. PACs or PVCs
B. Asystole
C. Third-degree heart block
D. Ventricular fibrillation
Answer: A. PACs or PVCs
Rationale:
Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) are commonly described by patients as a “skipped beat” or palpitations.
Which assessment finding is most concerning in a patient with ventricular tachycardia?
A. Heart rate 110
B. BP 84/50
C. anxiety
D. Temperature 101.0
Answer: B. BP 84/50
Rationale:
Hypotension indicates decreased cardiac output and hemodynamic instability. Ventricular tachycardia can rapidly deteriorate into cardiac arrest if perfusion decreases.
The nurse observes ST-segment elevation on a patient’s ECG. What is the priority interpretation?
A. Normal repolarization
B. Possible myocardial injury or infarction
C. Electrolyte imbalance only
D. Sinus bradycardia
Answer: B. Possible myocardial injury or infarction
Rationale:
ST-segment elevation may indicate acute myocardial injury or myocardial infarction and requires immediate evaluation.
Which assessment finding would indicate decreased cardiac output related to a dysrhythmia?
A. Warm skin
B. Bounding pulses
C. Hypotension and dizziness
D. Blood pressure 160/80 mm Hg
Answer: C. Hypotension and dizziness
Rationale:
Hypotension and dizziness suggest poor perfusion and decreased cardiac output caused by an ineffective rhythm.
A patient suddenly develops ventricular fibrillation and becomes unresponsive. What is the nurse’s PRIORITY action?
A. Administer atropine
B. Start chest compressions and defibrillate
C. Obtain a 12-lead ECG
D. Check blood glucose
Answer: B. Start chest compressions and defibrillate
Rationale:
Ventricular fibrillation is a pulseless, life-threatening rhythm requiring immediate CPR and defibrillation.
Which rhythm commonly requires a pacemaker?
A. Sinus tachycardia
B. Mobitz II
C. PACs
D. PVCs
Answer: B. Mobitz II
Rationale:
Second-degree AV block type II (Mobitz II) is more serious because impulses are unexpectedly blocked, decreasing cardiac output and increasing the risk for progression to complete heart block. Pacemaker therapy is commonly required.