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RELIAS DYSRHYTHMIA BASIC TEST 2026
PRACTICE QUESTION SET ONE
◉ A nurse is teaching the client about the causes of fast heart rates. What client statement indicates the client requires more teaching? A. "I will cut back on my smoking and drinking alcohol." B. "If I take my metoprolol daily, I will be able to control my heart rate." C. "I will drink coffee with only two of my meals." D. "I will take my levothyroxine daily." Answer: C. "I will drink coffee with only two of my meals." Stimulation of the sympathetic nervous system with caffeinated beverages, smoking, and drinking alcohol increases heart rate.The client is still drinking caffeine with two meals, increasing the risk for a fast heart rate. Taking medications such as metoprolol and levothyroxine will help the client maintain a normal heart rate by decreasing stimulation of the sympathetic nervous system.
◉ The nurse is proving discharge instructions for a client with a new arrhythmia. Which statement should the nurse include? A. It is not necessary to learn how to take your own pulse. B. If you miss a dose of your antiarrhythmia medication, double up on the next dose. C. Your family and friends may want to take a CPR class. D. Do not be concerned if you experience symptoms of lightheadedness and dizziness. Answer: C. Your family and friends may want to take a CPR class. Having friends and family learn to perform CPR will help the client manage the arrhythmia. Monitoring pulse rate at home also helps the client manage the condition. Antiarrhythmic medication should be taken on time. Lightheadedness and dizziness should be reported to the provider. ◉ A client reports light-headedness, chest pain, and shortness of breath. They physician orders tests to ascertain what is causing the client's problems. Which test is used to identify cardiac rhythms?
Atropine blocks acetylcholine at parasympathetic neuroeffector sites and blocks vagal stimulation. The client will be treated with an anticholinergic that blocks the effects of the vagal nerve. Atenolol and nadolol are beta blockers that are used for chest pain, myocardial infarction, and hypertension. Diltazem is a calcium channel blocker used to treat angina or slow the heart rate. ◉ To evaluate a client's atrial depolarization, the nurse observes which part of the electrocardiogram waveform? A. T wave B. QRS complex C. P wave D. PR interval Answer: C. P wave The P wave depicts atrial depolarization, or spread of the electrical impulse from the sinoatrial node through the atria. The PR interval represents spread of the impulse through the interatrial and internodal fibers, atrioventricular node, bundle of His, and Purkinje fibers. The QRS complex represents ventricular depolarization. The
T wave depicts the relative refractory period, representing ventricular repolarization. ◉ The nursing student asks the nurse to describe the difference between sinus rhythm and sinus bradycardia on the electrocardiogram strip. What is the nurse's best reply? A. "The P-R interval will be prolonged in sinus bradycardia." B. "The only difference is the heart rate." C. "The QRS complex will be smaller in sinus bradycardia." D. "The P waves will be shaped differently." Answer: B. "The only difference is the heart rate." All characteristics of sinus bradycardia are the same as those of normal sinus rhythm except for the rate, which will be below 60 in sinus bradycardia. The P waves will be shaped differently in other dysrhythmias. The QRS is the same voltage for sinus rhythms. The P- R interval is prolonged in aterioventricular blocks.
◉ The nurse assesses a client with a heart rate of 120 beats per minute. What are the known causes of sinus tachycardia? A. vagal stimulation B. digoxin C. hypovolemia D. hypothyroidism Answer: C. hypovolemia The causes of sinus tachycardia include physiologic or psychological stress (acute blood loss, anemia, shock, hypovolemia, fever, and exercise). Vagal stimulation, hypothyroidism, and digoxin will cause a sinus bradycardia. ◉ The staff educator is teaching a class in dysrhythmias. What statement is correct for defibrillation? A. It is a scheduled procedure 1 to 10 days in advance. B. The client is sedated before the procedure.
C. It is used to eliminate ventricular dysrhythmias. D. It uses less electrical energy than cardioversion. Answer: C. It is used to eliminate ventricular dysrhythmias. The only treatment for a life-threatening ventricular dysrhythmia is immediate defibrillation, which has the exact same effect as cardioversion, except that defibrillation is used when there is no functional ventricular contraction. It is an emergency procedure performed during resuscitation. The client is not sedated but is unresponsive. Defibrillation uses more electrical energy (200 to 360 joules) than cardioversion. ◉ A nurse enters a client's room and finds the client pulseless and unresponsive. What would be the treatment of choice for this client? A. Chemical cardioversion B. Electric cardioversion C. IV lidocaine D. Immediate CPR Answer: D. Immediate CPR
A. Early ventricular repolarization B. Ventricular depolarization C. Ventricular repolarization D. Atrial depolarization Answer: D. Atrial depolarization The P wave represents atrial depolarization. The QRS complex represents ventricular depolarization. The T wave represents ventricular repolarization. The ST segment represents early ventricular repolarization, and lasts from the end of the QRS complex to the beginning of the T wave. ◉ The client has just been diagnosed with a dysrhythmia. The client asks the nurse to explain normal sinus rhythm. What would the nurse explain is the characteristic of normal sinus rhythm? A. Impulse travels to the atrioventricular (AV) node in 0.15 to 0. second. B. The sinoatrial (SA) node initiates the impulse.
C. The ventricles depolarize in 0.5 second or less. D. Heart rate between 60 and 150 beats/minute. Answer: B. The sinoatrial (SA) node initiates the impulse. The characteristics of normal sinus rhythm are heart rate between 60 and 100 beats/minute, the SA node initiates the impulse, the impulse travels to the AV node in 0.12 to 0.2 second, the ventricles depolarize in 0.12 seconds or less, and each impulse occurs regularly ◉ The nurse is assessing vital signs in a patient with a permanent pacemaker. What should the nurse document about the pacemaker? A. Date and time of insertion B. Model number C. Location of the generator D. Pacer rate Answer: D. Pacer rate After a permanent pacemaker is inserted, the patient's heart rate and rhythm are monitored by ECG.
◉ A home care nurse is visiting a left-handed client who has an implantable cardioverter-defibrillator (ICD) implanted in the left chest. The client is planning to go rifle hunting. How should the nurse respond? A. "You'll need to take an extra dose of your antiarrhythmic before you shoot." B. "Being that close to a rifle might make your ICD fire." C. "Enjoy your hunting trip." D. "You can't shoot a rifle left-handed because the rifle's recoil will traumatize the ICD site." Answer: D. "You can't shoot a rifle left- handed because the rifle's recoil will traumatize the ICD site." The recoil from the rifle can damage the ICD, so the client should be warned against shooting a rifle with the left hand. Close proximity to a rifle won't cause the ICD to fire inadvertently. The client shouldn't take an extra dose of an antiarrhythmic. ◉ The nurse is caring for a client who had a permanent pacemaker surgically placed and is now ready for discharge. What statement made by the client indicates the need for more education?
A. "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting." B. "I will avoid any large magnets that may affect my pacemaker." C. "I will call the doctor if my incision becomes swollen and red." D. "We will be getting rid of our microwave oven so it will not affect my pacemaker." Answer: D. "We will be getting rid of our microwave oven so it will not affect my pacemaker." Permanent pacemaker generators have filters that protect them from electrical interference from most household devices, motors, and appliances, so the client can keep the microwave oven. Clients are taught to check pulses daily, avoid large magnets, and report any incisional redness or swelling. ◉ The client has been prescribed procainamide for a dysrhythmia. Which medication side effect will the nurse teach the client to watch for? A. hypertension
◉ The licensed practical nurse is co-assigned with a registered nurse in the care of a client admitted to the cardiac unit with chest pain. The licensed practical nurse is assessing the accuracy of the cardiac monitor, which notes a heart rate of 34 beats/minute. The client appears anxious and states not feeling well. The licensed practical nurse confirms the monitor reading. When consulting with the registered nurse, which of the following is anticipated? A. The registered nurse administering atropine sulfate intravenously B. The registered nurse stating to administer all medications except those which are cardiotonics C. The registered nurse stating to hold all medication until the pulse rate returns to 60 beats/minute D. The registered nurse stating to administer digoxin Answer: A. The registered nurse administering atropine sulfate intravenously The licensed practical nurse and registered nurse both identify that client's bradycardia. Atropine sulfate, a cholinergic blocking agent, is given intravenously (IV) to increase a dangerously slow heart rate. Lanoxin is not administered when the pulse rate falls under 60 beats/minute. It is dangerous to wait until the pulse rate increases
without nursing intervention or administering additional medications until the imminent concern is addressed. ◉ The nurse analyzes a 6-second electrocardiogram (ECG) tracing. The P waves and QRS complexes are regular. The PR interval is 0. seconds long, and the QRS complexes are 0.08 seconds long. The heart rate is calculated at 70 bpm. The nurse correctly identifies this rhythm as A. junctional tachycardia. B. first-degree atrioventricular block. C. sinus tachycardia. D. normal sinus rhythm. Answer: D. normal sinus rhythm. The electrocardiogram (ECG) tracing shows normal sinus rhythm (NSR). NSR has the following characteristics: ventricular and atrial rate: 60 to 100 beats per minute (bpm) in the adult; ventricular and atrial rhythm: regular; and QRS shape and duration: usually normal, but may be regularly abnormal; P wave: normal and consistent shape, always in front of the QRS; PR interval: consistent interval between 0.12 and 0.20 seconds and P:QRS ratio: 1:1.
B. Warfarin C. Amiodarone D. Adenosine Answer: B. Warfarin Because atrial function may be impaired for several weeks after cardioversion, warfarin is indicated for at least 4 weeks after the procedure. Patients may be given amiodarone, flecainide, ibutilide, propafenone, or sotalol prior to cardioversion to enhance the success of cardioversion and prevent relapse of the atrial fibrillation ◉ A client experiences a faster-than-normal heart rate when drinking more than two cups of coffee in the morning. What does the nurse identify on the electrocardigram as an indicator of sinus tachycardia? A. Q wave of 0.04 seconds B. PR interval of 0.1 seconds C. heart rate of 118 bpm
D. QRS duration of 0.16 seconds Answer: C. heart rate of 118 bpm The sinus node creates an impulse at a faster-than-normal rate. The PR interval of 0.1 seconds, QRS duration of 0.16 seconds and Q wave of 0.04 seconds are consistent with a normal sinus rhythm. Sinus tachycardia occurs when the heart rate is over 100 bpm ◉ The nurse is providing discharge instructions to a client after a permanent pacemaker insertion. Which safety precaution will the nurse communicate to the client? A. Avoid going through airport metal detectors. B. Avoid undergoing magnetic resonance imaging (MRI). C. Never engage in activities that require vigorous arm and shoulder movement. D. Stay at least 5 feet away from microwave ovens. Answer: B. Avoid undergoing magnetic resonance imaging (MRI). A client with a pacemaker should avoid undergoing an MRI because the magnet could disrupt pacemaker function and cause injury to the client. Disruption is less likely to occur with newer microwave
