Dysrhythmia NCLEX Questions and Answers with Rationales (Latest Update 2025), Exams of Nursing

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Answers with Rationales (Latest Update

2025)

You are the nurse working on the telemetry unit and you have finally gotten to sit down to work on some charting. Suddenly the heart monitors at the station start beeping. Patient in room 18 is showing this rhythm on the monitor. The medical team advances together into the room and finds them unconscious. What is priority action by the nurse? A) Prepare to administer adenosine to the patient B) Begin chest compressions C) Prepare for defibrillation D) Check for a pulse - Correct Answer ✅Answer: D. A pulse would be assessed for first. Then the patient will be defibrillized and chest compressions will begin immediately. The nurse sees the following rhythm on the monitor. Which of the following lab values does the nurse identify as being most likely to have caused this dysrhythmia? a) K 3. b) Ca 10.

Answers with Rationales (Latest Update

2025)

c) Hgb 9 d) Magnesium 2.1 - Correct Answer ✅Answer: C. Anemia can contribute to sinus tachycardia. The patient who has recently been experiencing runs of ventricular tachycardia suddenly loses consciousness. The patient is defibrillated, and the rate returns as the following. What should the nurse do first? A) Begin compressions B) Shock the client again immediately C) Prepare for intubation D) Administer adenosine - Correct Answer ✅Answer: A. Following defibrillation, CPR is immediately initiated if a perfusable rhythm is not initiated. The client may need to be shocked again, but chest compressions must begin first.

Answers with Rationales (Latest Update

2025)

A patient with cardiomyopathy has been given an ICD. Which of the following medications would the nurse expect to see in the MAR for this patient? A) Warfarin B) Cardizem C) Nitroglycerin D) Digoxin - Correct Answer ✅Answer: B. Antiarrhythmic medications are prescribed with the use of an ICD in order to prevent the tachycardic (or other deadly arrhythmia) from occurring in the first place. This makes sure that the ICD is used only when absolutely necessary. The patient with a history of hypertension and diabetes has the following rhythm strip. The patient's vitals are as follows: BP 145/89, HR 90, SpO2 95%, RR 19. Which of the following does the nurse expect to do at this time? a) Prepare the client for cardioversion STAT b) Begin administering anticoagulants c) Grab the crash cart for administration of adenosine

Answers with Rationales (Latest Update

2025)

d) Teach the client about possibility of pacemaker installation - Correct Answer ✅Answer: B. Atrial flutter places the client at high risk for development of clot formation in the atria. Because the client is stable at this time, cardioversion or adenosine would not be performed at this time. Before cardioversion can occur in a patient, anticoagulant therapy should be begun at least 48 hours beforehand if possible. The nurse is preparing to administer adenosine to the patient with the following rhythm which is symptomatic. What should the nurse plan on having in the patient room? a) Physician b) Crash cart c) IV pump d) EKG monitor e) Lidocaine - Correct Answer ✅Answer: A, B, and D. Adenosine is administered as a very quick IV push. The physician must be present in the room and the crash cart

Answers with Rationales (Latest Update

2025)

must be on hand. An ekg monitor should be in the room to monitor the effectiveness of the medication. The nurse has just administered adenosine via IV push and sees the following rhythm on the monitor. What is the nurse's priority intervention? a) Apply conductive gel and defibrillate the patient b) Document the findings and continue to monitor c) Administer another mg of the medication d) Begin chest compressions - Correct Answer ✅Answer: B. This finding would be expected upon administration of adenosine. The rhythm should then begin again in some other rhythm, hopefully normal sinus rhythm. It would be important to document the exact time of this change and continue to monitor the change back to NSR. If this change does not occur, or if another rhythm is produced, appropriate action would then be taken based on the result.

Answers with Rationales (Latest Update

2025)

You, the nurse, note the following rhythm on the EKG monitor for a patient named billy. What is the first thing the nurse should do? a) Check for a pulse b) Tell Billy to try to poop c) Prepare to defibrillate billy d) Prepare to administer Amiodorone - Correct Answer ✅Answer: B. With SVT (Supraventricular tachycardia), the first thing to do would be to instruct the pt. to perform the Valsalva maneuver by bearing down. A group of nursing students are discussing atrial flutter. These students recognize that which of the following are seen with atrial flutter? Select all that apply:

1. Ventricular rate of 220-300 bpm.
2. Regular rhythm
3. Saw-tooth pattern
4. Measurable PR interval
5. Long QRS interval - Correct Answer ✅Answer(s): 2, 3

Answers with Rationales (Latest Update

2025)

The ATRIAL rate is 220-300 bpm. Ventricular is about 75-

150. The rhythm is regular, with the P wave appearing as little flutter or a "saw tooth pattern". The PR interval is not measurable r/t this saw-tooth P wave. The QRS is normal. A nursing student is aware that which of the following is the treatment for unstable atrial flutter?

1. Adenosine (Adenocard) 6 mg rapid IVP.
2. Cardioversion with adjacent Heparin therapy
3. Defibrillation STAT followed by CPR.
4. Altemose 3 mg IVP over 1-2 seconds. - Correct Answer ✅Answer: 2) Cardioversion is used if the patient is unstable. Anticoagulants are used if the arrhythmia has stuck around for 48 hr +. Adenosine may be used with a narrow QRS and regular RR interval. I made up Altemose.

Answers with Rationales (Latest Update

2025)

A nurse working on a CVT unit receives report from day shift. After receiving report, which patient should the nurse see first?

1. A 23-year-old professional tennis player with a HR of 47 bpm.
2. A 69-year-old male with atrial fibrillation who has new onset confusion.
3. A 72-year-old female with atrial flutter who reports feeling unusually tired today and yesterday.
4. A 33-year-old female with sinus tachycardia who is asking for her at-home Metoprolol. - Correct Answer ✅Answer: 2) Patients with a-fib are at risk for pulmonary and systemic emboli, and new onset of confusion may indicate a stroke in this patient. Patients with atrial flutter may feel more tired some days than others.

Answers with Rationales (Latest Update

2025)

A nurse on a CVT unit views the monitor and sees the patient in room 452 has just begun having occasional PVCs. Which action should the nurse take first?

1. Check on the patient
2. Check last magnesium and potassium levels
3. Document the occurrence and watch for further PVCs
4. Contact the physician - Correct Answer ✅Answer: 1) Although electrolytes are likely the culprit, the nurse first needs to first assess the patient. Then, the nurse should look in the patient's chart and evaluate or request an order for electrolyte levels. This may eventually need to be documented, but the nurse can be held liable for neglect if he/she does not assess the patient first. The physician may or may not need to be contacted. Which of the following does the nursing student realize is the treatment for a stable patient presenting with QRS intervals above 0.12 seconds with a regular rhythm and a rate of 100-250 bpm?

Answers with Rationales (Latest Update

2025)

1. Atropine
2. Defibrillation
3. Amiodarone
4. Adenosine - Correct Answer ✅Answer: 3) This is describing ventricular tachycardia (QRS is a giveaway), and the treatment for a stable patient is Amiodarone or cardioversion. If the patient were unstable, we'd go ahead and defibrillate. The nurse in the intensive care unit (ICU) hears an alarm sound in the patient's room. Arriving in the room, the patient is unresponsive, without a pulse, and a flat line on the monitor. What is the first action by the nurse? a) Administer atropine 0.5 mg b) Administer epinephrine c) Defibrillate with 360 joules

Answers with Rationales (Latest Update

2025)

d) Begin cardiopulmonary resuscitation (CPR) - Correct Answer ✅Answer: d) We cannot defibrillate asystole. A A group of nursing students are studying AV blocks and ask their instructor, "what causes a first-degree block?" The nursing instructor responds that which of the following can cause a first-degree block: Select all that apply

1. Diarrhea
2. Chronic constipation
3. Diltiazem
4. Digoxin
5. Metoprolol - Correct Answer ✅Answer(s): 2, 3, 4, 5 Diarrhea will not stimulate a vagal response, but vomiting can. Chronic constipation will cause a consistent vagal response. Digoxin, beta blockers, and calcium channel

Answers with Rationales (Latest Update

2025)

blockers can all contribute to first degree blocks. Relate this to bradycardia. A 26-year-old client with atrial fibrillation that has not responded to medication therapy has arrived at the hospital for an elective cardioversion. Which of the following patient statements most concerns the nurse?

1. "I can't wait to stop taking this Coumadin. I've been on this crap for weeks now."
2. "I'm starving. I haven't eaten anything in 3 hours."
3. "I feel really short of breath, can I lie down?"
4. "I haven't taken my Digoxin since 9 o'clock last night. Is that okay?" - Correct Answer ✅Answer: 3 Patients with atrial fibrillation are at incredibly high risk for clots, even with anticoagulation therapy. Shortness of breath could indicate a PE, and this should be immediately investigated by the nurse. The patient should be NPO for at least 4 hr. prior to the procedure related to anesthesia use, but this is not as urgent of a

Answers with Rationales (Latest Update

2025)

concern. The patient should also withhold Digoxin therapy for 48 hours to ensure that, once cardioverted, NSR returns. Which of the following signs and symptoms indicate pacemaker failure? a) excessive thirst b) prolonged hiccups c) flushing of the skin d) increased urine output - Correct Answer ✅Answer: B

• prolonged hiccups indicate pacemaker failure. Other signs and symptoms of pacemaker failure are dysrhythmias, dizziness, faintness, chest pain, shortness of breath, increase or decrease in apical rate. The nurse is providing discharge teaching to the client who has just received a pacemaker. Which of the following should the nurse include in the plan of care? SATA:

Answers with Rationales (Latest Update

2025)

A) Use your cell phone on the opposite side of your pacemaker B) You should avoid using a microwave from now on C) For the next week, it would be best to limit activity on the side with your new pacemaker D) You will need to inform airport security about your pacemaker before you fly anywhere E) It would be a good idea to check your pulse daily - Correct Answer ✅Answer: A, C, D, and E. A cellphone should not be used near the pacemaker and it's best to keep the phone about half a foot away from the pacemaker. It is not necessary for the client to avoid using a microwave or other electrical devices. However, magnets should be kept away from the device. In order to prevent disruption of the leads after implantation (the most common complication), patients are often taught to limit activity on the affected side for awhile after implantation. Pulses are a good indicator of whether the pacemaker is supplying the body with enough cardiac output.

Answers with Rationales (Latest Update

2025)

A - Correct Answer ✅A client's electrocardiogram strip shows atrial and ventricular rates of 80 complexes per minute. The PR interval is 0.14 second, and the QRS complex measures 0.08 second. The nurse interprets this rhythm is: A) Normal sinus rhythm B) Sinus bradycardia C) Sinus tachycardia D) Sinus dysrhythmia D Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly to cerebral and myocardial ischemia. Client's frequently experience a feeling of impending death. Ventricular tachycardia is treated with

Answers with Rationales (Latest Update

2025)

antidysrhythmic medications or magnesium sulfate, cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can deteriorate into ventricular defibrillation at any time. - Correct Answer ✅A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most concerned with this dysrhythmia because: A) It is uncomfortable for the client, giving a sense of impending doom. B) It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia. C) It is almost impossible to convert to a normal sinus rhythm. D) It can develop into ventricular fibrillation at any time. BCD Amiodarone causes prolongation of the QT interval, which can precipitate dysrhythmia. Antidysrhythmic medications cause changes in cardiac rhythm and rate;

Answers with Rationales (Latest Update

2025)

therefore monitoring of heart rate and rhythm is needed.Electrolyte depletion, specifically potassium and magnesium, may predispose to further dysrhythmia. Although it is always important to monitor vital signs and urine output, these assessments are not specific to amiodarone. - Correct Answer ✅The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply. a. Respiratory rate b. QT interval c. Heart rate and rhythm d. Magnesium level e. Urine output B The effects of metoprolol are to decrease heart rate, blood pressure, and myocardial oxygen demand. ST

Answers with Rationales (Latest Update

2025)

segment elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in troponin is consistent with a diagnosis of MI but does not address needed monitoring for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS but does not address needed monitoring related to metoprolol. - Correct Answer ✅The nurse is caring for a client with acute coronary syndrome (ACS) and atrial fibrillation who has a new prescription for metoprolol (Lopressor). Which monitoring is essential when administering the medication? a. ST segment b. Heart rate c. Troponin d. Myoglobin A Clients with atrial fibrillation are prone to blood pooling in the atrium, clotting, then embolizing. Heparin is used to

Answers with Rationales (Latest Update

2025)

prevent thrombus development in the atrium and the consequence of embolization (i.e., stroke). - Correct Answer ✅The nurse is caring for a client with atrial fibrillation. In addition to an antidysrhythmic, what medication does the nurse plan to administer? a. Heparin b. Atropine c. Dobutamine d. Magnesium sulfate D The client is displaying sinus rhythm with first-degree atrioventicular heart block; this is usually asymptomatic and does not require treatment. Atropine is used in emergency treatment of symptomatic bradycardia. This client has normal vital signs. Digoxin is used in the treatment of atrial fibrillation, which is, by definition, an irregular rhythm. Clonidine is used in the treatment of hypertension; a side effect is bradycardia. - Correct

Answers with Rationales (Latest Update

2025)

Answer ✅The nurse is caring for a client on a telemetry unit with a regular heart rhythm and rate of 60; a P wave precedes each QRS complex, and the PR interval is 0. second. Additional vital signs are as follows: blood pressure 118/68, respiratory rate 16, and temperature 98.8° F. The following medications are available on the medication record. What action should the nurse take? a. Administer atropine. b. Administer digoxin. c. Administer clonidine. d. Continue to monitor. A This client has a stable, asymptomatic dysrhythmia, which usually requires no treatment; this client can be managed by a nurse with less cardiac dysrhythmia training. - Correct Answer ✅You are the charge nurse on the telemetry unit and are responsible for making client

Answers with Rationales (Latest Update

2025)

assignments. Which client would be appropriate to assign to the float RN from the medical-surgical unit? a. The 64-year-old admitted for weakness who has a first- degree heart block with a heart rate of 58 beats/min b. The 71-year-old admitted for heart failure who is short of breath and has a heart rate of 120 to 130 beats/min c. The 88-year-old admitted with an elevated troponin level who is hypotensive with a heart rate of 96 beats/min d. The 92-year-old admitted with chest pain who has premature ventricular complexes and a heart rate of 102 beats/min C - Correct Answer ✅A client with atrial fibrillation with rapid ventricular response has received medication to slow the ventricular rate. The pulse is now 88. For which additional therapy does the nurse plan? a. Synchronized cardioversion

Answers with Rationales (Latest Update

2025)

b. Electrophysiology studies (EPS) c. Anticoagulation d. Radiofrequency ablation therapy B The nurse needs to assess the client to determine stability before proceeding with further interventions. If the client has a pulse and is relatively stable, elective cardioversion or antidysrhythmic medications may be prescribed. - Correct Answer ✅The nurse is caring for a client with unstable angina whose cardiac monitor shows ventricular tachycardia. Which action is appropriate to implement first? a. Defibrillate the client at 200 J. b. Check the client for a pulse. c. Cardiovert the client at 50 J. d. Give the client IV lidocaine.

Answers with Rationales (Latest Update

2025)

A

Defibrillating is of priority before any other resuscitative measures according to Advanced Cardiac Life Support protocols. - Correct Answer ✅A client admitted after using crack cocaine develops ventricular fibrillation. After determining unresponsiveness, which action should the nurse take next? a. Defibrillate at 200 J. b. Establish IV access. c. Place an oral airway and ventilate. d. Start cardiopulmonary resuscitation (CPR). D Clients at risk for bradydysrhythmias should avoid bearing down or straining during a bowel movement; the Valsalva maneuver can cause bradycardia. Taking a stool softener helps to prevent this. - Correct Answer ✅In

Answers with Rationales (Latest Update

2025)

teaching clients at risk for bradydysrhythmias, what information does the nurse include? a. "Avoid potassium-containing foods." b. "Stop smoking and avoid caffeine." c. "Take nitroglycerin for a slow heartbeat." d. "Use a stool softener." C A P wave is generated by the SA node and represents atrial depolarization. - Correct Answer ✅The nurse is determining whether the client's rhythm strip demonstrates proper firing of the sinoatrial (SA) node. Which waveform indicates proper function of the SA node? a. The QRS complex is present. b. The PR interval is 0.24 second.

Answers with Rationales (Latest Update

2025)

c. A P wave precedes every QRS complex. d. The ST segment is elevated. ABE The Valsalva maneuver stimulates the vagus nerve, causing bradycardia. Inferior wall MI is a cause of bradycardia and heart blocks. Calcium channel blockers such as diltiazem may cause bradycardia. - Correct Answer ✅The nurse is caring for a client who has developed a bradycardia. Which possible causes should the nurse investigate? Select all that apply a. Bearing down for a bowel movement b. Possible inferior wall myocardial infarction (MI) c. Client stating that he just had a cup of coffee d. Client becoming emotional when visitors arrived e. Diltiazem (Cardizem) administered an hour ago