Cardiac Rhythm Interpretation | Exercises Medicine

Saunders NCLEX Cardiac Questions

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are

regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart

rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics? -

verified answer Normal sinus rhythm

Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute.

The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second,

respectively.

A client is having frequent premature ventricular contractions. The nurse should place priority on

assessment of which item? - verified answer Blood pressure and oxygen saturation

Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is

to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead

to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature

ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number

of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine,

nicotine, or alcohol.

The nurse is evaluating a client's response to cardioversion. Which observation would be of highest

priority to the nurse? - verified answer Status of airway

Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then

oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia

detection.

A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR

interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are

regular. How should the nurse correctly interpret this rhythm? - verified answer Sinus tachycardia

Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and

normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus

tachycardia, the atrial and ventricular rates are greater than 100 beats/minute.

The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The

nurse notes that the client has developed atrial fibrillation and has a ventricular rate of 150

beats/min. The nurse should next assess the client for which finding? - verified answer hypotension

The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at

risk for low cardiac output owing to loss of atrial kick. The nurse assesses the client for palpitations,

chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness

of breath, and distended neck veins.

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Saunders NCLEX Cardiac Questions

The nurse is reviewing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats/minute. Which would be a correct interpretation based on these characteristics? - verified answer Normal sinus rhythm Normal sinus rhythm is defined as a regular rhythm, with an overall rate of 60 to 100 beats/minute. The PR and QRS measurements are normal, measuring 0.12 to 0.20 second and 0.04 to 0.10 second, respectively. A client is having frequent premature ventricular contractions. The nurse should place priority on assessment of which item? - verified answer Blood pressure and oxygen saturation Premature ventricular contractions can cause hemodynamic compromise. Therefore, the priority is to monitor the blood pressure and oxygen saturation. The shortened ventricular filling time can lead to decreased cardiac output. The client may be asymptomatic or may feel palpitations. Premature ventricular contractions can be caused by cardiac disorders, states of hypoxemia, or by any number of physiological stressors, such as infection, illness, surgery, or trauma, and by intake of caffeine, nicotine, or alcohol. The nurse is evaluating a client's response to cardioversion. Which observation would be of highest priority to the nurse? - verified answer Status of airway Nursing responsibilities after cardioversion include maintenance first of a patent airway, and then oxygen administration, assessment of vital signs and level of consciousness, and dysrhythmia detection. A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR interval is 0.14 second, the QRS complex measures 0.08 second, and the PP and RR intervals are regular. How should the nurse correctly interpret this rhythm? - verified answer Sinus tachycardia Sinus tachycardia has the characteristics of normal sinus rhythm, including a regular PP interval and normal-width PR and QRS intervals; however, the rate is the differentiating factor. In sinus tachycardia, the atrial and ventricular rates are greater than 100 beats/minute. The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a ventricular rate of 150 beats/min. The nurse should next assess the client for which finding? - verified answer hypotension The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output owing to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.

The nurse is performing an assessment on a client with a diagnosis of left-sided heart failure. Which assessment component would elicit specific information regarding the client's left-sided heart function? - verified answer Listening to lung sounds The client with heart failure may present with different symptoms, depending on whether the right or the left side of the heart is failing. Peripheral and sacral edema, jugular vein distention, and organomegaly all are manifestations of problems with right-sided heart function. Lung sounds constitute an accurate indicator of left-sided heart function. The nurse is reviewing the electrocardiogram (ECG) rhythm strip obtained on a client with a diagnosis of myocardial infarction. The nurse notes that the PR interval is 0.20 second. The nurse should make which interpretation about this finding? - verified answer A normal finding The PR interval represents the time it takes for the cardiac impulse to spread from the atria to the ventricles. The normal range for the PR interval is 0.12 to 0.20 second. Options 2, 3, and 4 are incorrect. The home care nurse has taught a client with a problem of inadequate cardiac output about helpful lifestyle adaptations to promote health. Which statement by the client best demonstrates an understanding of the information provided? - verified answer "I will eat enough daily fiber to prevent straining at stool." Standard home care instructions for a client with this problem include, among others, lifestyle changes such as decreased alcohol intake, avoiding activities that increase the demands on the heart, instituting a bowel regimen to prevent straining and constipation, and maintaining fluid and electrolyte balance. Consuming 3000 to 3500 mL of fluid and exercising vigorously will increase the cardiac workload. A client with a first-degree heart block has an electrocardiogram (ECG) taken during an episode of chest pain. The nurse knows that which ECG finding would be an indication of first-degree heart block? - verified answer Prolonged PR interval A prolonged PR interval indicates first-degree heart block. The development of Q waves indicates myocardial necrosis. Tall, peaked T waves may indicate hyperkalemia. A widened QRS complex indicates a delay in intraventricular conduction, such as bundle branch block. An ECG taken during a pain episode is intended to capture ischemic changes, which also include ST-segment elevation or depression. A hospitalized client is experiencing a decrease in blood pressure. The nurse plans care for the client, knowing that this change will have which primary effect on his or her heart? - verified answer Decreased myocardial blood flow The primary effect of a decrease in blood pressure is reduced blood flow to the myocardium. This in turn decreases oxygenation of the cardiac tissue. Cardiac tissue is likely to become more excitable or

A client's electrocardiogram (ECG) strip shows atrial and ventricular rates of 70 complexes/min. The PR interval is 0.16 second, the QRS complex measures 0.06 second, and the PP interval is slightly irregular. How should the nurse interpret this rhythm? - verified answer Sinus dysrhythmia Sinus dysrhythmia has all of the characteristics of normal sinus rhythm except for the presence of an irregular PP interval. This irregular rhythm occurs because of phasic changes in the rate of firing of the sinoatrial node, which may occur with vagal tone and with respiration. Cardiac output is not affected. The nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. No P waves or QRS complexes are seen; instead, the monitor screen shows an irregular wavy line. The nurse interprets that the client is experiencing which rhythm? - verified answer Ventricular fibrillation Ventricular fibrillation is characterized by the absence of P waves and QRS complexes. The rhythm is instantly recognizable by the presence of coarse or fine fibrillatory waves on the cardiac monitoring screen. Sinus tachycardia has a recognizable P wave and QRS. Ventricular tachycardia is a regular pattern of wide QRS complexes. PVCs appear as irregular beats within a rhythm. Each of the incorrect options has a recognizable complex that appears on the monitoring screen. A client with myocardial infarction is experiencing new, multiform premature ventricular contractions (PVCs). Knowing that the client is allergic to lidocaine hydrochloride, the nurse plans to have which medication available for immediate use? - verified answer ProcainamideProcainamide is an antidysrhythmic that may be used to treat ventricular dysrhythmias in clients who are allergic to lidocaine. Digoxin is a cardiac glycoside; verapamil is a calcium-channel blocking agent; metoprolol is a β-adrenergic blocking agent. A client has received antidysrhythmic therapy for the treatment of premature ventricular contractions (PVCs). The nurse evaluates this therapy as most effective if the client's PVCs continued to exhibit which finding? - verified answer Decrease to a frequency of less than 6 per minute PVCs are considered dangerous when they are frequent (more than 6 per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave. In each of these instances, the client's cardiac rhythm is likely to degenerate into ventricular tachycardia or ventricular fibrillation, both of which are potentially deadly dysrhythmias. The nurse notes that a client's cardiac rhythm shows absent P waves and no PR interval. How should the nurse interpret this rhythm? - verified answer Atrial fibrillation In atrial fibrillation, the P waves may be absent. There is no PR interval, and the QRS duration usually is normal and constant. Bradycardia is a slowed heart rate, and tachycardia is a fast heart rate. In NSR a P wave precedes each QRS complex, the rhythm is essentially regular, the PR interval is 0.12 to 0.20 seconds in duration, and the QRS interval is 0.06 to 0.10 seconds in duration.

A client has developed uncontrolled atrial fibrillation with a ventricular rate of 150 beats/min. What manifestation should the nurse observe for when performing the client's focused assessment? - verified answer Hypotension and dizziness The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is at risk for low cardiac output due to loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins. Cardiac monitoring leads are placed on a client who is at risk for premature ventricular contractions (PVCs). Which heart rhythm will the nurse most anticipate in this client if PVCs are occurring? - verified answer Premature beats followed by a compensatory pause PVCs are abnormal ectopic beats originating in the ventricles. They are characterized by an absence of P waves, presence of wide and bizarre QRS complexes, and a compensatory pause that follows the ectopy. A nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which conditions reported by the client could play a role in exacerbating the heart failure? - verified answer Emotional stress Atrial fibrillation Nutritional anemia Recent upper respiratory infection Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget's disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, and hypervolemia. A nurse is caring for a client with unstable ventricular tachycardia. The nurse should instruct the client to take which action, if prescribed, during an episode of ventricular tachycardia? - verified answer Inhale deeply and cough forcefully every 1 to 3 seconds. Restorative coughing techniques are sometimes used in the client with unstable ventricular tachycardia. The nurse tells the client to use cough cardiopulmonary resuscitation (CPR), if prescribed, by inhaling deeply and coughing forcefully every 1 to 3 seconds. Cough CPR may terminate the dysrhythmia or sustain the cerebral and coronary circulation for a short time until other measures can be implemented. The other options will not assist in terminating the dysrhythmia. A client with angina has a 12-lead electrocardiogram taken during an episode of chest pain. The nurse should examine the tracing for which electrocardiographic (ECG) change caused by myocardial ischemia? - verified answer ST segment elevation or depression

A nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which result would be consistent with the observation? - verified answer Serum potassium level of 2.8 mEq/L The nurse should check the client's serum laboratory study results for hypokalemia. The client may experience PVCs in the presence of hypokalemia, because this electrolyte imbalance increases the electrical instability of the heart. The values noted in the remaining options are normal.

Cardiac Rhythm Interpretation, Exercises of Medicine

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Saunders NCLEX Cardiac Questions