Adamswk 1 quizz review. Graded A
Adams Week 1
What is the heart rate on the below rhythm strip:
[x] beats per
minute Correct
answer is 75
Rationale:
You determine the heart rate by the number of boxes between two R waves.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 717
Which assessment communicated to the health care provider from the RN that
would temporarily stop an elective cardioversion?
Correct Answer: The client has a medication patch on the left chest wall.
Rationale:
Answer A - Medication patches should be removed from the chest where paddles will be
placed.
Answer B – If the reason for the cardioversion is atrial fibrillation, the client should be receiving
anticoagulation. This is not a contraindication to cardioversion.
Answer C – The conduction pads should be positioned anterioposterior.
Answer D – The defibrillator should be set to synchronized mode for an elective cardioversion.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 737-738 & Chart 26-6
The RN analyzes risk factors for the following clients and determines which one is at the most
risk for coronary artery disease?
Correct Answer: 50-year-old African-American male with a blood pressure of 170/90.
Rationale:
Answer B – Hypertension, African-American male and over age 45 has the greatest risk for CAD.
Answer A – African-American is the only risk; central obesity is a risk factor – waist
circumference of more than 35 inches for a female.
Answer C – Being male and having an elevated serum cholesterol put him at risk but less risk
than B
Answer D – Age, gender,t family member . Less risk than Choice B
Resource: Hinkle & Cheever, 14th edition, Chapter 27, p. 752-753, (Chart 27-1)
,Adamswk 1 quizz review. Graded A
The RN is admitting a client with a new onset of atrial fibrillation and no previous cardiac
history. Which medical order would cue the RN to call the primary care provider?
Correct Answer: Place the client as NPO for six hours.
Rationale: This client has no history of cardiac disease so ablation is not indicated unless the
dysrhythmia is recurrent.; thus does not need to be NPO.
Answers A, B and C should not be questioned.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 723-725
Which evidence-based practice interventions would the RN implement to help prevent alarm
fatigue? Select all that apply.
Correct Answer:
• Individualize ECG alarm parameters for each patient.
• Change electrodes every 24 hours.
• Select the two leads that provide the best ECG tracing.
• Inspect the electrical equipment in use around the patient regularly.
Rationale: Clinical alarm systems are designed to alert clinicians to potential patient issues. Staf
may become desensitized to alarms which may compromise patient safety. Suggested actions
include:
Answer A – Customize the alarm parameters for the
individual. Answer B – Electrodes should be changed every 24
hours.
Answer D – Two leads should be used to decrease the amount of artifact.
Answer E – Improperly functioning electrical equipment may cause false alarms from artifact
Answer C – Alarms should be paused during patient care.
Resource: Hinkle & Cheever, 14th edition, Chapter 25, pp. 698-699
Which outcome would the RN identify for the client with a new cardiac dysrhythmia and a
nursing diagnosis of Anxiety?
Correct Answer: Express a positive attitude about living with the dysrhythmia.
Rationale:
Answer A is an outcome for the client experiencing anxiety.
Answers B and D are outcomes for the client who requires teaching at the time of discharge.
Answer C is an outcome for decreased cardiac output.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, p. 736
,Adamswk 1 quizz review. Graded A
The client, who is one day postoperative following a major abdominal procedure, has a rhythm
on the telemetry that is regular, with a P wave in front of each QRS complex and the rate is
112 beats per minute. The blood pressure is 130/80. Which interventions will the RN
implement? Select all that apply.
Correct Answer:
• Calculate 24-hour intake and output.
• Assess the client for pain.
• Assess the client’s temperature.
Rationale: Pain, fever and hypovolemia can be causes of sinus tachycardia.
Answer D – The client is not hypotensive.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 719-720
Which statement made by the client with a new implantable cardiac device demonstrates to the
RN that client teaching has been efective?
Correct Answer: “I can resume driving when my doctor tells me.”
Rationale:
Answer c – Discussion of safety of activities such as driving need to be done with the primary
provider.
Answer a – There is no need to avoid using a microwave.
Answer b – Exercise of the arm on the side of the implantable device needs to be limited until
the incision heals and the arm cannot be lifted over the head for 2 weeks.
Answer d – The incision should be uncovered.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, p. 747
Which nursing intervention is a priority for the client immediately after the placement of a
permanent pacemaker?
Correct Answer: Initiate continuous ECG monitoring.
Rationale:
Answer A – The RN should initiate continuous ECG monitoring to ensure function of the
pacemaker.
Answer B – An analgesic may be needed but it is not the priority.
Answer C – A chest x-ray is necessary but it is not an immediate
priority.
Answer D – The arm should be immobilized to prevent lead dislodgment but it is not an
immediate priority
Resource: Hinkle & Cheever, 14th edition, Chapter 26, p. 746
, Adamswk 1 quizz review. Graded A
A client comes to the emergency room reporting retrosternal chest pain and shortness of breath.
His blood pressure is 110/70; pulse rate 100 and irregular; respirations 28. After attaching a cardiac
monitor, which order should the RN implement first?
Correct Answer: Administer oxygen per nasal prongs.
Rationale: The client with a suspected MI should receive supplemental oxygen via nasal cannula
immediately.
Resource: Hinkle & Cheever, 14th edition, Chapter 25, pg.681
The RN explains to a client why the primary care provider has prescribed nitroglycerin. Which statement
by the client demonstrates that the teaching was successful?
Correct Answer: “The medication will reduce my heart’s workload.”
Rationale: Nitroglycerin is a vasodilator that improves blood flow to the heart muscle and relieves pain.
Resource: Hinkle & Cheever, 14th edition, Chapter 25, pg. 681
A client reports having light headedness and palpitations. The RN administers oxygen and obtains a 12
lead EKG. Which EKG findings confirms a suspicion of a possible atrial fibrillation?
Correct Answer: absent p-waves
Rationale: Atrial fibrillation has the following characteristics: heart rate 120-200, irregular rhythm, QRS is
usually normal, absent P-wave.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pg. 722
The RN is teaching the LPN how to properly assess for orthostatic hypotension. Place the steps
in the correct sequence:
3. Reposition the client to a sitting position.
1. Position the client supine for 10 minutes.
2. Take the initial blood pressure and heart rate.
5. Assist the client to a standing position.
4. Take second set of vital signs.
Correct Answer: 1, 2, 3, 4, 5
Rationale: Start with the patient in a lying position for 10 minutes, then take initial b/p and pulse. Have
patient sit up with leg dependent, wait 2 minutes then retake B/P and pulse. If patient is
asymptomatic, have the patient stand and take B/P and pulse yet again.
Adams Week 1
What is the heart rate on the below rhythm strip:
[x] beats per
minute Correct
answer is 75
Rationale:
You determine the heart rate by the number of boxes between two R waves.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 717
Which assessment communicated to the health care provider from the RN that
would temporarily stop an elective cardioversion?
Correct Answer: The client has a medication patch on the left chest wall.
Rationale:
Answer A - Medication patches should be removed from the chest where paddles will be
placed.
Answer B – If the reason for the cardioversion is atrial fibrillation, the client should be receiving
anticoagulation. This is not a contraindication to cardioversion.
Answer C – The conduction pads should be positioned anterioposterior.
Answer D – The defibrillator should be set to synchronized mode for an elective cardioversion.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 737-738 & Chart 26-6
The RN analyzes risk factors for the following clients and determines which one is at the most
risk for coronary artery disease?
Correct Answer: 50-year-old African-American male with a blood pressure of 170/90.
Rationale:
Answer B – Hypertension, African-American male and over age 45 has the greatest risk for CAD.
Answer A – African-American is the only risk; central obesity is a risk factor – waist
circumference of more than 35 inches for a female.
Answer C – Being male and having an elevated serum cholesterol put him at risk but less risk
than B
Answer D – Age, gender,t family member . Less risk than Choice B
Resource: Hinkle & Cheever, 14th edition, Chapter 27, p. 752-753, (Chart 27-1)
,Adamswk 1 quizz review. Graded A
The RN is admitting a client with a new onset of atrial fibrillation and no previous cardiac
history. Which medical order would cue the RN to call the primary care provider?
Correct Answer: Place the client as NPO for six hours.
Rationale: This client has no history of cardiac disease so ablation is not indicated unless the
dysrhythmia is recurrent.; thus does not need to be NPO.
Answers A, B and C should not be questioned.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 723-725
Which evidence-based practice interventions would the RN implement to help prevent alarm
fatigue? Select all that apply.
Correct Answer:
• Individualize ECG alarm parameters for each patient.
• Change electrodes every 24 hours.
• Select the two leads that provide the best ECG tracing.
• Inspect the electrical equipment in use around the patient regularly.
Rationale: Clinical alarm systems are designed to alert clinicians to potential patient issues. Staf
may become desensitized to alarms which may compromise patient safety. Suggested actions
include:
Answer A – Customize the alarm parameters for the
individual. Answer B – Electrodes should be changed every 24
hours.
Answer D – Two leads should be used to decrease the amount of artifact.
Answer E – Improperly functioning electrical equipment may cause false alarms from artifact
Answer C – Alarms should be paused during patient care.
Resource: Hinkle & Cheever, 14th edition, Chapter 25, pp. 698-699
Which outcome would the RN identify for the client with a new cardiac dysrhythmia and a
nursing diagnosis of Anxiety?
Correct Answer: Express a positive attitude about living with the dysrhythmia.
Rationale:
Answer A is an outcome for the client experiencing anxiety.
Answers B and D are outcomes for the client who requires teaching at the time of discharge.
Answer C is an outcome for decreased cardiac output.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, p. 736
,Adamswk 1 quizz review. Graded A
The client, who is one day postoperative following a major abdominal procedure, has a rhythm
on the telemetry that is regular, with a P wave in front of each QRS complex and the rate is
112 beats per minute. The blood pressure is 130/80. Which interventions will the RN
implement? Select all that apply.
Correct Answer:
• Calculate 24-hour intake and output.
• Assess the client for pain.
• Assess the client’s temperature.
Rationale: Pain, fever and hypovolemia can be causes of sinus tachycardia.
Answer D – The client is not hypotensive.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pp. 719-720
Which statement made by the client with a new implantable cardiac device demonstrates to the
RN that client teaching has been efective?
Correct Answer: “I can resume driving when my doctor tells me.”
Rationale:
Answer c – Discussion of safety of activities such as driving need to be done with the primary
provider.
Answer a – There is no need to avoid using a microwave.
Answer b – Exercise of the arm on the side of the implantable device needs to be limited until
the incision heals and the arm cannot be lifted over the head for 2 weeks.
Answer d – The incision should be uncovered.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, p. 747
Which nursing intervention is a priority for the client immediately after the placement of a
permanent pacemaker?
Correct Answer: Initiate continuous ECG monitoring.
Rationale:
Answer A – The RN should initiate continuous ECG monitoring to ensure function of the
pacemaker.
Answer B – An analgesic may be needed but it is not the priority.
Answer C – A chest x-ray is necessary but it is not an immediate
priority.
Answer D – The arm should be immobilized to prevent lead dislodgment but it is not an
immediate priority
Resource: Hinkle & Cheever, 14th edition, Chapter 26, p. 746
, Adamswk 1 quizz review. Graded A
A client comes to the emergency room reporting retrosternal chest pain and shortness of breath.
His blood pressure is 110/70; pulse rate 100 and irregular; respirations 28. After attaching a cardiac
monitor, which order should the RN implement first?
Correct Answer: Administer oxygen per nasal prongs.
Rationale: The client with a suspected MI should receive supplemental oxygen via nasal cannula
immediately.
Resource: Hinkle & Cheever, 14th edition, Chapter 25, pg.681
The RN explains to a client why the primary care provider has prescribed nitroglycerin. Which statement
by the client demonstrates that the teaching was successful?
Correct Answer: “The medication will reduce my heart’s workload.”
Rationale: Nitroglycerin is a vasodilator that improves blood flow to the heart muscle and relieves pain.
Resource: Hinkle & Cheever, 14th edition, Chapter 25, pg. 681
A client reports having light headedness and palpitations. The RN administers oxygen and obtains a 12
lead EKG. Which EKG findings confirms a suspicion of a possible atrial fibrillation?
Correct Answer: absent p-waves
Rationale: Atrial fibrillation has the following characteristics: heart rate 120-200, irregular rhythm, QRS is
usually normal, absent P-wave.
Resource: Hinkle & Cheever, 14th edition, Chapter 26, pg. 722
The RN is teaching the LPN how to properly assess for orthostatic hypotension. Place the steps
in the correct sequence:
3. Reposition the client to a sitting position.
1. Position the client supine for 10 minutes.
2. Take the initial blood pressure and heart rate.
5. Assist the client to a standing position.
4. Take second set of vital signs.
Correct Answer: 1, 2, 3, 4, 5
Rationale: Start with the patient in a lying position for 10 minutes, then take initial b/p and pulse. Have
patient sit up with leg dependent, wait 2 minutes then retake B/P and pulse. If patient is
asymptomatic, have the patient stand and take B/P and pulse yet again.
