What should the nurse measure to determine whether there is a delay in impulse conduc-
tion through the patient's ventricles? - ANSWER QRS complex
The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm.
Which method will be fastest to use? - ANSWER Print a 1-minute electrocardiogram
(ECG) strip and count the number of QRS
complexes.
A patient has a junctional escape rhythm on the monitor. What heart rate should the nurse
expect the patient to have? - ANSWER 40 to 60.
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and
makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate
of 162, R-R interval regular, QRS complex wide and distorted, and QRS duration of 0.18 sec-
ond. How should the nurse interpret this cardiac rhythm? - ANSWER Ventricular tachycar-
dia
A patient's heart monitor shows that every other beat is earlier than expected, has no visible
P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse docu-
ment the rhythm? - ANSWER Ventricular bigeminy
A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that
the PR interval is 0.24 seconds. Which action would the nurse take? - ANSWER Document
the finding and monitor the patient
A patient who was admitted with a myocardial infarction has a 45-second episode of ventric-
ular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which
1
,action would the nurse take next? - ANSWER Prepare to give IV amiodarone per agency
dysrhythmia protocol.
After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrio-
ventricular (AV) block, which finding indicates that the drug has been effective? - AN-
SWER Increase in the patient's heart rate.
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unre-
sponsive to drug therapy for four days. Which topic would the nurse plan to include in pa-
tient teaching? - ANSWER Anticoagulant therapy
Which information will the nurse include when teaching a patient with atrial flutter who is
scheduled for a radiofrequency catheter ablation? - ANSWER The procedure uses electri-
cal energy to destroy areas of the conduction system.
Which patient statement indicates that discharge teaching about the management of a new
permanent pacemaker was effective? - ANSWER "I won't lift the arm on the incision side
until I see the health care provider."
Which action by a nurse caring for a patient after an implantable cardioverter-defibrillator
(ICD) insertion indicates a need for more teaching about the care of patients with ICDs? -
ANSWER The nurse encourages the patient to do active range-of-motion exercises for all
extremities.
A patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66
mm Hg is being prepared for cardioversion. Which action should the nurse expect to take? -
ANSWER Give a sedative before cardioversion is implemented.
A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a col-
lege soccer team. The patient is found to have sinus bradycardia, rate 52 and blood pressure
(BP) 114/54 mm Hg. The student denies any health problems. Which action would the nurse
take? - ANSWER Approve the student to participate on the soccer team.
2
,Which finding from a newly admitted adult patient's electrocardiogram (ECG) requires fur-
ther investigation by the nurse? - ANSWER QRS interval of 0.14 second
Which laboratory result for a patient with multifocal premature ventricular contractions
(PVCs) is most important for the nurse to communicate to the health care provider? - AN-
SWER Serum potassium of 2.9 mEq/L
A patient's heart monitor shows a pattern of undulations of varying contours and amplitude
with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which
action would the nurse take first? - ANSWER Perform immediate defibrillation.
A patient's heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at
1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action would the
nurse take first? - ANSWER Hold the scheduled metoprolol (Lopressor) and call the health
care provider.
A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of
80/42 mm Hg, and reports feeling faint. Which action would the nurse take? - ANSWER
Apply the transcutaneous pacemaker (TCP) pads.
A 19-year-old student comes to the student health center at the end of the semester stating,
"My heart is skipping beats." An electrocardiogram (ECG) shows occasional unifocal prema-
ture ventricular contractions (PVCs). What action would the nurse take next? - ANSWER
Ask the patient about current stress level and caffeine use.
The nurse has received change-of-shift report about the following patients on the progres-
sive care unit. Which patient would the nurse see first? - ANSWER A patient whose im-
plantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due
3
, A patient on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and
chest pain. Which action in the agency dysrhythmia protocol would the nurse take first? -
ANSWER Give supplemental O at 2 to 3 L/min via nasal cannula.
A patient is apneic and has no palpable pulses. The heart monitor shows sinus tachycardia,
rate 132. Which action would the nurse take next? - ANSWER Start cardiopulmonary re-
suscitation (CPR).
Which action will the nurse include in the plan of care for a patient who was admitted with
syncopal episodes of unknown origin? - ANSWER Instruct the patient to call for help be-
fore getting out of bed.
Which nursing action can the registered nurse (RN) delegate to experienced assistive person-
nel (AP) working as telemetry technicians on the cardiac care unit? - ANSWER Observe
heart rhythms for multiple patients who have telemetry monitoring.
Which action by a registered nurse (RN) who is orienting to the telemetry unit indicates a
good understanding of the treatment of heart dysrhythmias? - ANSWER Injects IV adeno-
sine (Adenocard) over 2 seconds for a patient with supraventricular tachycardia.
When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart
rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates
the patient's heart rate as . - ANSWER 50
A patient reports dizziness and shortness of breath for several days. During heart monitoring
in the emergency department (ED), the nurse obtains the following electrocardiographic
(ECG) tracing. How does the nurse interpret this heart rhythm? - ANSWER Third-degree
atrioventricular (AV) block.
A patient who reports a "racing" heart and feeling "anxious" comes to the emergency de-
partment. The nurse places the patient on a heart monitor and obtains the following electro-
cardiographic (ECG) tracing. Which action should the nurse take next? - ANSWER Obtain
the patient's vital signs including O2 saturation.
4
tion through the patient's ventricles? - ANSWER QRS complex
The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm.
Which method will be fastest to use? - ANSWER Print a 1-minute electrocardiogram
(ECG) strip and count the number of QRS
complexes.
A patient has a junctional escape rhythm on the monitor. What heart rate should the nurse
expect the patient to have? - ANSWER 40 to 60.
The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and
makes the following analysis: no visible P waves, PR interval not measurable, ventricular rate
of 162, R-R interval regular, QRS complex wide and distorted, and QRS duration of 0.18 sec-
ond. How should the nurse interpret this cardiac rhythm? - ANSWER Ventricular tachycar-
dia
A patient's heart monitor shows that every other beat is earlier than expected, has no visible
P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse docu-
ment the rhythm? - ANSWER Ventricular bigeminy
A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that
the PR interval is 0.24 seconds. Which action would the nurse take? - ANSWER Document
the finding and monitor the patient
A patient who was admitted with a myocardial infarction has a 45-second episode of ventric-
ular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which
1
,action would the nurse take next? - ANSWER Prepare to give IV amiodarone per agency
dysrhythmia protocol.
After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrio-
ventricular (AV) block, which finding indicates that the drug has been effective? - AN-
SWER Increase in the patient's heart rate.
A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been unre-
sponsive to drug therapy for four days. Which topic would the nurse plan to include in pa-
tient teaching? - ANSWER Anticoagulant therapy
Which information will the nurse include when teaching a patient with atrial flutter who is
scheduled for a radiofrequency catheter ablation? - ANSWER The procedure uses electri-
cal energy to destroy areas of the conduction system.
Which patient statement indicates that discharge teaching about the management of a new
permanent pacemaker was effective? - ANSWER "I won't lift the arm on the incision side
until I see the health care provider."
Which action by a nurse caring for a patient after an implantable cardioverter-defibrillator
(ICD) insertion indicates a need for more teaching about the care of patients with ICDs? -
ANSWER The nurse encourages the patient to do active range-of-motion exercises for all
extremities.
A patient with supraventricular tachycardia who is alert and has a blood pressure of 110/66
mm Hg is being prepared for cardioversion. Which action should the nurse expect to take? -
ANSWER Give a sedative before cardioversion is implemented.
A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a col-
lege soccer team. The patient is found to have sinus bradycardia, rate 52 and blood pressure
(BP) 114/54 mm Hg. The student denies any health problems. Which action would the nurse
take? - ANSWER Approve the student to participate on the soccer team.
2
,Which finding from a newly admitted adult patient's electrocardiogram (ECG) requires fur-
ther investigation by the nurse? - ANSWER QRS interval of 0.14 second
Which laboratory result for a patient with multifocal premature ventricular contractions
(PVCs) is most important for the nurse to communicate to the health care provider? - AN-
SWER Serum potassium of 2.9 mEq/L
A patient's heart monitor shows a pattern of undulations of varying contours and amplitude
with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which
action would the nurse take first? - ANSWER Perform immediate defibrillation.
A patient's heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at
1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action would the
nurse take first? - ANSWER Hold the scheduled metoprolol (Lopressor) and call the health
care provider.
A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of
80/42 mm Hg, and reports feeling faint. Which action would the nurse take? - ANSWER
Apply the transcutaneous pacemaker (TCP) pads.
A 19-year-old student comes to the student health center at the end of the semester stating,
"My heart is skipping beats." An electrocardiogram (ECG) shows occasional unifocal prema-
ture ventricular contractions (PVCs). What action would the nurse take next? - ANSWER
Ask the patient about current stress level and caffeine use.
The nurse has received change-of-shift report about the following patients on the progres-
sive care unit. Which patient would the nurse see first? - ANSWER A patient whose im-
plantable cardioverter-defibrillator (ICD) fired twice today and has a dose of amiodarone due
3
, A patient on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea and
chest pain. Which action in the agency dysrhythmia protocol would the nurse take first? -
ANSWER Give supplemental O at 2 to 3 L/min via nasal cannula.
A patient is apneic and has no palpable pulses. The heart monitor shows sinus tachycardia,
rate 132. Which action would the nurse take next? - ANSWER Start cardiopulmonary re-
suscitation (CPR).
Which action will the nurse include in the plan of care for a patient who was admitted with
syncopal episodes of unknown origin? - ANSWER Instruct the patient to call for help be-
fore getting out of bed.
Which nursing action can the registered nurse (RN) delegate to experienced assistive person-
nel (AP) working as telemetry technicians on the cardiac care unit? - ANSWER Observe
heart rhythms for multiple patients who have telemetry monitoring.
Which action by a registered nurse (RN) who is orienting to the telemetry unit indicates a
good understanding of the treatment of heart dysrhythmias? - ANSWER Injects IV adeno-
sine (Adenocard) over 2 seconds for a patient with supraventricular tachycardia.
When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart
rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates
the patient's heart rate as . - ANSWER 50
A patient reports dizziness and shortness of breath for several days. During heart monitoring
in the emergency department (ED), the nurse obtains the following electrocardiographic
(ECG) tracing. How does the nurse interpret this heart rhythm? - ANSWER Third-degree
atrioventricular (AV) block.
A patient who reports a "racing" heart and feeling "anxious" comes to the emergency de-
partment. The nurse places the patient on a heart monitor and obtains the following electro-
cardiographic (ECG) tracing. Which action should the nurse take next? - ANSWER Obtain
the patient's vital signs including O2 saturation.
4
