MED SURG PRACTICE QUESTIONS AND ANSWERS

A client is experiencing an alteration in heart rate. The nurse realizes this client is experiencing a disorder of which part of the heart? 1. Atrioventricular node 2. Bundle branches 3. Purkinje fibers 4. Sinoatrial node ANS: 4 The sinoatrial node is the dominant pacemaker of the heart. The sinoatrial node has an inherent rate of 60 to 100 bpm. The atrioventricular node has an intrinsic rate of 40 to 60 bpm. The impulse enters the right and left bundle branches and then enters the Purkinje fibers. Impulses at this level are at 15 to 40 times per minute. 2.A client is suspected of having cardiac damage. The nurse realizes that which of the following diagnostic tests is most commonly used to help diagnose this clients possible cardiac damage or disease? 1.12-lead electrocardiogram 2. Arterial blood gases 3. Cardiac angiogram 4. Cardiac enzymes ANS: 1 A 12-lead electrocardiogram is a quick and accurate diagnostic tool used to evaluate heart damage and disease. The other diagnostic tests require a longer time for results and/or are invasive procedures requiring some preparation. 3.The nurse is analyzing a clients electrocardiogram tracing. Which of the following complexes is not normally seen on an electrocardiogram tracing? 1.P wave 2.QRS complex 3.T wave 4.U wave ANS: 4 A U wave is not always seen and can be very small. It can indicate electrolyte imbalance, medication effects, and ischemia. The P wave, QRS complex, and T wave are normally seen in the electrocardiogram tracing. 4. The nurse is analyzing a clients electrocardiogram tracing and realizes that each small square on the paper is equal to: 1.0.04 second. 2.0.12 second. 3.0.20 second. 4.0.40 second. ANS: 1 The small square on the ECG graph paper equals 0.04 second. The large square equals 0.20 second. The PR interval is 0.12 to 0.20 second. Two large squares would be equal to 0.40 second. 5. The nurse is reading an ECG rhythm strip and notes that there are nine QRS complexes in a 6-second strip. The heart rate is: 1.36. 2.54. 3.81. 4.90. ANS: 4 A heart rate can be determined by multiplying the QRS complexes in a 6-second strip by 10. The heart rate is 90. This method of calculating the heart rate is the most common method used because it is quick and can be used when the heart rate is irregular. 6.The nurse notes that on a clients electrocardiogram tracing, there is one P wave for every QRS complex and a delay in the impulse transmission at the AV node. This regular rhythm is identified as: 1. first-degree AV block. 2. second-degree AV block type I. 3. second-degree AV block type II. 4. complete heart block. ANS: 1 First-degree atrioventricular (AV) block occurs when there is a delay in the impulse transmission at the AV node. This delay occurs with every impulse and can be seen on every beat on the recorded rhythm strip. Second-degree and complete heart block have differences with the P wave and the associated QRS complexes. 7.A client is unresponsive and has no pulse. The nurse notes that the electrocardiogram tracing shows continuous large and bizarre QRS complexes measured greater than 0.12 each. This rhythm is identified as: 1. premature ventricular complexes. 2. torsades de pointes. 3. ventricular fibrillation. 4. ventricular tachycardia. ANS: 4