Chapter 35: Dysrhythmias Lewis: Medical-Surgical Nursing, 10th
Edition Questions and Answers Graded A
To determine whether there is a delay in impulse beats/minute. The slower rates are typical of the
conduction through the ventricles, the nurse will bundle of His and Purkinje system and may be
measure the duration of the patient's seen with failure of both the SA and AV node to
a. P wave. c. PR interval. discharge. The normal SA node rate is 60 to 100
b. Q wave. d. QRS complex. - -ANS: D beats/min.
The QRS complex represents ventricular
depolarization. The P wave represents the
depolarization of the atria. The PR interval The nurse obtains a rhythm strip on a patient who
represents depolarization of the atria, has had a myocardial infarction and makes the
atrioventricular node, a bundle of His, bundle following analysis: no visible P waves, PR
branches, and the Purkinje fibers. The Q wave is interval not measurable, ventricular rate of 162,
the first negative deflection following the P wave R-R interval regular, and QRS complex wide and
and should be narrow and short. distorted, and QRS duration of 0.18 second. The
Cognitive Level: Understand nurse interprets the patient's cardiac rhythm as
(comprehension)Chapter a. atrial flutter. c. ventricular fibrillation.
b. sinus tachycardia. d. ventricular tachycardia. -
-ANS: D
The nurse needs to quickly estimate the heart The absence of P waves, wide QRS, rate greater
rate for a patient with a regular heart rhythm. than 150 beats/min, and the regularity of the
Which method will be best to use? rhythm indicate ventricular tachycardia. Atrial
a. Count the number of large squares in the R-R flutter is usually regular, has a narrow QRS
interval and divide by 300. configuration, and has flutter waves present
b. Print a 1-minute electrocardiogram (ECG) strip representing atrial activity. Sinus tachycardia has
and count the number of QRS complexes. P waves. Ventricular fibrillation is irregular and
c. Use the 3-second markers to count the does not have a consistent QRS duration.
number of QRS complexes in 6 seconds and
multiply by 10. DIF: Cognitive Level: Apply (application)
d. Calculate the number of small squares
between one QRS complex and the next and
divide into 1500. - -ANS: C The nurse notes that a patient's heart monitor
This is the quickest way to determine the shows that every other beat is earlier than
ventricular rate for a patient with a regular expected, has no visible P wave, and has a QRS
rhythm. All the other methods are accurate but complex that is wide and bizarre in shape. How
take longer. will the nurse document the rhythm?
Cognitive Level: Analyze (analysis) a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
A patient has a junctional escape rhythm on the d. Multifocal premature ventricular contractions -
monitor. The nurse will expect the patient to have -ANS: B
a heart rate of _____ beats/min. Ventricular bigeminy describes a rhythm in which
a. 15 to 20 c. 40 to 60 every other QRS complex is wide and bizarre
b. 20 to 40 d. 60 to 100 - -ANS: C looking. Pairs of wide QRS complexes are
If the sinoatrial (SA) node fails to discharge, the described as ventricular couplets. There is no
atrioventricular (AV) node will automatically indication that the premature ventricular
discharge at the normal rate of 40 to 60 contractions are multifocal or that the R-on-T
1/8
, Chapter 35: Dysrhythmias Lewis: Medical-Surgical Nursing, 10th
Edition Questions and Answers Graded A
phenomenon is occurring. Documentation and continued monitoring are not
adequate responses to this situation.
DIF: Cognitive Level: Apply (application)
DIF: Cognitive Level: Analyze (analysis)
A patient has a sinus rhythm and a heart rate of
72 beats/min. The nurse determines that the PR After the nurse gives IV atropine to a patient with
interval is 0.24 seconds. The most appropriate symptomatic type 1, second-degree
intervention by the nurse would be to atrioventricular (AV) block, which finding
a. notify the a provider immediately. indicates that the drug has been effective?
b. document the finding and monitor the patient. a. Increase in the patient's heart rate
c. give atropine per agency dysrhythmia protocol. b. Increase in strength of peripheral pulses
d. prepare the patient for temporary pacemaker c. Decrease in premature atrial contractions
insertion. - -ANS: B d. Decrease in premature ventricular contractions
First-degree atrioventricular block is - -ANS: A
asymptomatic and requires ongoing monitoring Atropine will increase the heart rate and
because it may progress to more serious forms conduction through the AV node. Because the
of heart block. The rate is normal, so there is no drug increases electrical conduction, not cardiac
indication that atropine is needed. Immediate contractility, the quality of the peripheral pulses is
notification of the health care provider about an not used to evaluate the drug effectiveness. The
asymptomatic rhythm is not necessary. patient does not have premature atrial or
ventricular contractions.
DIF: Cognitive Level: Apply (application)
DIF: Cognitive Level: Apply (application)
A patient who was admitted with a myocardial
infarction experiences a 45-second episode of A patient with dilated cardiomyopathy has new-
ventricular tachycardia, then converts to sinus onset atrial fibrillation that has been unresponsive
rhythm with a heart rate of 98 beats/min. Which to drug therapy for several days. Teaching for
action should the nurse take next? this patient would include information about
a. Immediately notify the health care provider. a. anticoagulant therapy. c. emergency
b. Document the rhythm and continue to monitor cardioversion.
the patient. b. permanent pacemakers. d. IV adenosine
c. Prepare to give IV amiodarone per agency (Adenocard). - -ANS: A
dysrhythmia protocol. Atrial fibrillation therapy that has persisted for
d. Perform synchronized cardioversion per more than 48 hours requires anticoagulant
agency dysrhythmia protocol. - -ANS: C treatment for 3 weeks before attempting
The burst of sustained ventricular tachycardia cardioversion. This is done to prevent
indicates that the patient has significant embolization of clots from the atria. Cardioversion
ventricular irritability, and antidysrhythmic may be done after several weeks of
medication administration is needed to prevent anticoagulation therapy. Adenosine is not used to
further episodes. The nurse should notify the treat atrial fibrillation. Pacemakers are routinely
health care provider after the medication is used for patients with bradydysrhythmias.
started. Cardioversion is not indicated given that Information does not indicate that the patient has
the patient has returned to a sinus rhythm. a slow heart rate.
2/8
Edition Questions and Answers Graded A
To determine whether there is a delay in impulse beats/minute. The slower rates are typical of the
conduction through the ventricles, the nurse will bundle of His and Purkinje system and may be
measure the duration of the patient's seen with failure of both the SA and AV node to
a. P wave. c. PR interval. discharge. The normal SA node rate is 60 to 100
b. Q wave. d. QRS complex. - -ANS: D beats/min.
The QRS complex represents ventricular
depolarization. The P wave represents the
depolarization of the atria. The PR interval The nurse obtains a rhythm strip on a patient who
represents depolarization of the atria, has had a myocardial infarction and makes the
atrioventricular node, a bundle of His, bundle following analysis: no visible P waves, PR
branches, and the Purkinje fibers. The Q wave is interval not measurable, ventricular rate of 162,
the first negative deflection following the P wave R-R interval regular, and QRS complex wide and
and should be narrow and short. distorted, and QRS duration of 0.18 second. The
Cognitive Level: Understand nurse interprets the patient's cardiac rhythm as
(comprehension)Chapter a. atrial flutter. c. ventricular fibrillation.
b. sinus tachycardia. d. ventricular tachycardia. -
-ANS: D
The nurse needs to quickly estimate the heart The absence of P waves, wide QRS, rate greater
rate for a patient with a regular heart rhythm. than 150 beats/min, and the regularity of the
Which method will be best to use? rhythm indicate ventricular tachycardia. Atrial
a. Count the number of large squares in the R-R flutter is usually regular, has a narrow QRS
interval and divide by 300. configuration, and has flutter waves present
b. Print a 1-minute electrocardiogram (ECG) strip representing atrial activity. Sinus tachycardia has
and count the number of QRS complexes. P waves. Ventricular fibrillation is irregular and
c. Use the 3-second markers to count the does not have a consistent QRS duration.
number of QRS complexes in 6 seconds and
multiply by 10. DIF: Cognitive Level: Apply (application)
d. Calculate the number of small squares
between one QRS complex and the next and
divide into 1500. - -ANS: C The nurse notes that a patient's heart monitor
This is the quickest way to determine the shows that every other beat is earlier than
ventricular rate for a patient with a regular expected, has no visible P wave, and has a QRS
rhythm. All the other methods are accurate but complex that is wide and bizarre in shape. How
take longer. will the nurse document the rhythm?
Cognitive Level: Analyze (analysis) a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
A patient has a junctional escape rhythm on the d. Multifocal premature ventricular contractions -
monitor. The nurse will expect the patient to have -ANS: B
a heart rate of _____ beats/min. Ventricular bigeminy describes a rhythm in which
a. 15 to 20 c. 40 to 60 every other QRS complex is wide and bizarre
b. 20 to 40 d. 60 to 100 - -ANS: C looking. Pairs of wide QRS complexes are
If the sinoatrial (SA) node fails to discharge, the described as ventricular couplets. There is no
atrioventricular (AV) node will automatically indication that the premature ventricular
discharge at the normal rate of 40 to 60 contractions are multifocal or that the R-on-T
1/8
, Chapter 35: Dysrhythmias Lewis: Medical-Surgical Nursing, 10th
Edition Questions and Answers Graded A
phenomenon is occurring. Documentation and continued monitoring are not
adequate responses to this situation.
DIF: Cognitive Level: Apply (application)
DIF: Cognitive Level: Analyze (analysis)
A patient has a sinus rhythm and a heart rate of
72 beats/min. The nurse determines that the PR After the nurse gives IV atropine to a patient with
interval is 0.24 seconds. The most appropriate symptomatic type 1, second-degree
intervention by the nurse would be to atrioventricular (AV) block, which finding
a. notify the a provider immediately. indicates that the drug has been effective?
b. document the finding and monitor the patient. a. Increase in the patient's heart rate
c. give atropine per agency dysrhythmia protocol. b. Increase in strength of peripheral pulses
d. prepare the patient for temporary pacemaker c. Decrease in premature atrial contractions
insertion. - -ANS: B d. Decrease in premature ventricular contractions
First-degree atrioventricular block is - -ANS: A
asymptomatic and requires ongoing monitoring Atropine will increase the heart rate and
because it may progress to more serious forms conduction through the AV node. Because the
of heart block. The rate is normal, so there is no drug increases electrical conduction, not cardiac
indication that atropine is needed. Immediate contractility, the quality of the peripheral pulses is
notification of the health care provider about an not used to evaluate the drug effectiveness. The
asymptomatic rhythm is not necessary. patient does not have premature atrial or
ventricular contractions.
DIF: Cognitive Level: Apply (application)
DIF: Cognitive Level: Apply (application)
A patient who was admitted with a myocardial
infarction experiences a 45-second episode of A patient with dilated cardiomyopathy has new-
ventricular tachycardia, then converts to sinus onset atrial fibrillation that has been unresponsive
rhythm with a heart rate of 98 beats/min. Which to drug therapy for several days. Teaching for
action should the nurse take next? this patient would include information about
a. Immediately notify the health care provider. a. anticoagulant therapy. c. emergency
b. Document the rhythm and continue to monitor cardioversion.
the patient. b. permanent pacemakers. d. IV adenosine
c. Prepare to give IV amiodarone per agency (Adenocard). - -ANS: A
dysrhythmia protocol. Atrial fibrillation therapy that has persisted for
d. Perform synchronized cardioversion per more than 48 hours requires anticoagulant
agency dysrhythmia protocol. - -ANS: C treatment for 3 weeks before attempting
The burst of sustained ventricular tachycardia cardioversion. This is done to prevent
indicates that the patient has significant embolization of clots from the atria. Cardioversion
ventricular irritability, and antidysrhythmic may be done after several weeks of
medication administration is needed to prevent anticoagulation therapy. Adenosine is not used to
further episodes. The nurse should notify the treat atrial fibrillation. Pacemakers are routinely
health care provider after the medication is used for patients with bradydysrhythmias.
started. Cardioversion is not indicated given that Information does not indicate that the patient has
the patient has returned to a sinus rhythm. a slow heart rate.
2/8
