BSN 445: WEEK 5: CARDIOVASCULAR DISORDERS: TEST
QUESTIONS WITH ACCURATE SOLUTIONS
1) In which chamber would the nurse expect to find a permanent, leadless
pacemaker on a chest x-ray?
− Right atrium
− Right ventricle
− Left atrium
− Left ventricle -- Correct Answer ✔✔ Right ventricle
Leadless pacemakers consist of a self-contained unit that is placed in the right
ventricle via the femoral vein.
2) Which patient would benefit from cardiac resynchronization therapy (CRT)?
− A patient with sick sinus syndrome and syncope
− A patient with an ejection fraction of 30% and dyspnea on exertion
− A patient with a right bundle branch block from an overdose of
beta-blockers
− A patient with atrial fibrillation and palpitations -- Correct Answer
✔✔ A patient with an ejection fraction of 30% and dyspnea on
exertion
CRT is used to optimize cardiac output in patients with moderate to advanced
heart failure. This patient would benefit from CRT because of the ejection
fraction below 50% and manifestations of heart failure.
,3) Which postoperative complication will the nurse assess for after permanent
pacemaker placement?
− Pneumothorax
− Hypertension
− Bradycardia
− Renal failure -- Correct Answer ✔✔ Pneumothorax
Possible complications following insertion of a permanent pacemaker include
pneumothorax, hematoma, infection, lead displacement, cardiac perforation,
and tamponade.
4) Which change would the nurse expect to see after implementing temporary
pacing in a patient with supraventricular tachycardia?
− Ventricular rate change from 210 to 85
− Blood pressure change from 130/86 to 120/82
− Ejection fraction change from 60% to 40%
− Respiratory rate change from 15 to 22 -- Correct Answer ✔✔
Ventricular rate change from 210 to 85
Temporary pacing is used in patients with tachydysrhythmias to decrease the
ventricular rate and prevent breakthrough ectopy. This would be an expected
change following initiation of temporary pacing for tachydysrhythmias.
5) Which patient statement shows understanding of the benefit of temporary pacing
after cardiac surgery?
− "This pacemaker will prevent my heart from beating too fast after
surgery."
− "This pacemaker will prevent me from having cardiac arrest in the
first week after surgery."
− "This pacemaker will help my heart pump blood better while I heal
from surgery."
− "This pacemaker will help my heart when it beats too slow from the
surgery." -- Correct Answer ✔✔ "This pacemaker will help my
heart pump blood better while I heal from surgery."
, After cardiac surgery, temporary pacing may be used to improve a transiently
depressed, rate-dependent cardiac output.
6) Which statement explains the therapeutic benefit of radiofrequency current
catheter ablation?
− Ablation is used to record cardiac electrical activity using pacing
electrodes inside of the heart.
− Ablation is a treatment for patients with supraventricular
tachycardias or atrioventricular node reentry.
− Ablations record atrial activity through an esophageal pill electrode
and standard electrocardiogram machine.
− Ablations permanently implant an electrical device to identify
episodes of atrial fibrillation. -- Correct Answer ✔✔
atrioventricular node reentry.
Ablation prevents accessory pathways and atrioventricular node reentry from
occurring. It is used as a treatment method for tachydysrhythmias.
7) Which statement accurately describes temporary pacing? Select all that apply.
One, some, or all responses may be correct.
− Transcutaneous pacing provides rapid, noninvasive relief from
symptomatic bradycardia.
− Epicardial pacing is part of the advanced cardiac life support
algorithm for bradycardia unresponsive to atropine.
− Transvenous pacing can be inserted with direct visualization by
fluoroscopy or with the use of a standard electrocardiogram (ECG).
− Transcutaneous pacing is the preferred method of pacing after
cardiac surgery.
− Transvenous pacing requires pacing electrodes to be inserted
through a vein into the left side of the heart. -- Correct Answer
✔✔ Transcutaneous pacing provides rapid, noninvasive relief from
symptomatic bradycardia.
Transcutaneous pacing is a quick method to provide electrical stimulus to the
heart for bradycardia. This form of pacing uses two large skin electrodes and
is used for rapid, short-term therapy until the situation resolves or another
route of pacing is established.
, Transvenous pacing can be inserted with direct visualization by fluoroscopy or
with the use of a standard electrocardiogram (ECG).
The transvenous pacing electrode is advanced through a vein into the right
atrium or ventricle. This process can occur with direct visualization by
fluoroscopy or with the use of a standard ECG.
8) Which element of the pacing system would the nurse assess if the positive and
negative terminals are not connecting to the pulse generator?
− Pulse generator
− Electrode
− Pacing lead
− Bridging cable -- Correct Answer ✔✔ Bridging cable
The bridging cable connects the positive and negative terminals to the pulse
generator. Based on the presentation, this should be the first element of the
system assessed by the nurse.
9) Which action would the nurse take after noting that there is not a P wave behind
every atrial pacing artifact?
− Increase the output (milliamperes).
− Ask the patient to turn onto the right side.
− Adjust the sensitivity settings to 15 millivolts.
− Increase the rate setting on the generator. -- Correct Answer ✔✔
Increase the output (milliamperes).
When the pacing stimulus fires but fails to initiate a myocardial depolarization,
a pacing artifact will be present but will not be followed by the expected P
wave or QRS complex; this is loss of capture. In many cases, increasing the
output (mA) elicits capture.
10) Which action would be appropriate for the nurse to take after noting rate drift
on the electrocardiogram monitor on a patient with a temporary pacemaker?
− Replace the lead wires and electrodes.
− Increase the output (milliamperes).
− Check and replace the batteries.
QUESTIONS WITH ACCURATE SOLUTIONS
1) In which chamber would the nurse expect to find a permanent, leadless
pacemaker on a chest x-ray?
− Right atrium
− Right ventricle
− Left atrium
− Left ventricle -- Correct Answer ✔✔ Right ventricle
Leadless pacemakers consist of a self-contained unit that is placed in the right
ventricle via the femoral vein.
2) Which patient would benefit from cardiac resynchronization therapy (CRT)?
− A patient with sick sinus syndrome and syncope
− A patient with an ejection fraction of 30% and dyspnea on exertion
− A patient with a right bundle branch block from an overdose of
beta-blockers
− A patient with atrial fibrillation and palpitations -- Correct Answer
✔✔ A patient with an ejection fraction of 30% and dyspnea on
exertion
CRT is used to optimize cardiac output in patients with moderate to advanced
heart failure. This patient would benefit from CRT because of the ejection
fraction below 50% and manifestations of heart failure.
,3) Which postoperative complication will the nurse assess for after permanent
pacemaker placement?
− Pneumothorax
− Hypertension
− Bradycardia
− Renal failure -- Correct Answer ✔✔ Pneumothorax
Possible complications following insertion of a permanent pacemaker include
pneumothorax, hematoma, infection, lead displacement, cardiac perforation,
and tamponade.
4) Which change would the nurse expect to see after implementing temporary
pacing in a patient with supraventricular tachycardia?
− Ventricular rate change from 210 to 85
− Blood pressure change from 130/86 to 120/82
− Ejection fraction change from 60% to 40%
− Respiratory rate change from 15 to 22 -- Correct Answer ✔✔
Ventricular rate change from 210 to 85
Temporary pacing is used in patients with tachydysrhythmias to decrease the
ventricular rate and prevent breakthrough ectopy. This would be an expected
change following initiation of temporary pacing for tachydysrhythmias.
5) Which patient statement shows understanding of the benefit of temporary pacing
after cardiac surgery?
− "This pacemaker will prevent my heart from beating too fast after
surgery."
− "This pacemaker will prevent me from having cardiac arrest in the
first week after surgery."
− "This pacemaker will help my heart pump blood better while I heal
from surgery."
− "This pacemaker will help my heart when it beats too slow from the
surgery." -- Correct Answer ✔✔ "This pacemaker will help my
heart pump blood better while I heal from surgery."
, After cardiac surgery, temporary pacing may be used to improve a transiently
depressed, rate-dependent cardiac output.
6) Which statement explains the therapeutic benefit of radiofrequency current
catheter ablation?
− Ablation is used to record cardiac electrical activity using pacing
electrodes inside of the heart.
− Ablation is a treatment for patients with supraventricular
tachycardias or atrioventricular node reentry.
− Ablations record atrial activity through an esophageal pill electrode
and standard electrocardiogram machine.
− Ablations permanently implant an electrical device to identify
episodes of atrial fibrillation. -- Correct Answer ✔✔
atrioventricular node reentry.
Ablation prevents accessory pathways and atrioventricular node reentry from
occurring. It is used as a treatment method for tachydysrhythmias.
7) Which statement accurately describes temporary pacing? Select all that apply.
One, some, or all responses may be correct.
− Transcutaneous pacing provides rapid, noninvasive relief from
symptomatic bradycardia.
− Epicardial pacing is part of the advanced cardiac life support
algorithm for bradycardia unresponsive to atropine.
− Transvenous pacing can be inserted with direct visualization by
fluoroscopy or with the use of a standard electrocardiogram (ECG).
− Transcutaneous pacing is the preferred method of pacing after
cardiac surgery.
− Transvenous pacing requires pacing electrodes to be inserted
through a vein into the left side of the heart. -- Correct Answer
✔✔ Transcutaneous pacing provides rapid, noninvasive relief from
symptomatic bradycardia.
Transcutaneous pacing is a quick method to provide electrical stimulus to the
heart for bradycardia. This form of pacing uses two large skin electrodes and
is used for rapid, short-term therapy until the situation resolves or another
route of pacing is established.
, Transvenous pacing can be inserted with direct visualization by fluoroscopy or
with the use of a standard electrocardiogram (ECG).
The transvenous pacing electrode is advanced through a vein into the right
atrium or ventricle. This process can occur with direct visualization by
fluoroscopy or with the use of a standard ECG.
8) Which element of the pacing system would the nurse assess if the positive and
negative terminals are not connecting to the pulse generator?
− Pulse generator
− Electrode
− Pacing lead
− Bridging cable -- Correct Answer ✔✔ Bridging cable
The bridging cable connects the positive and negative terminals to the pulse
generator. Based on the presentation, this should be the first element of the
system assessed by the nurse.
9) Which action would the nurse take after noting that there is not a P wave behind
every atrial pacing artifact?
− Increase the output (milliamperes).
− Ask the patient to turn onto the right side.
− Adjust the sensitivity settings to 15 millivolts.
− Increase the rate setting on the generator. -- Correct Answer ✔✔
Increase the output (milliamperes).
When the pacing stimulus fires but fails to initiate a myocardial depolarization,
a pacing artifact will be present but will not be followed by the expected P
wave or QRS complex; this is loss of capture. In many cases, increasing the
output (mA) elicits capture.
10) Which action would be appropriate for the nurse to take after noting rate drift
on the electrocardiogram monitor on a patient with a temporary pacemaker?
− Replace the lead wires and electrodes.
− Increase the output (milliamperes).
− Check and replace the batteries.
