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RELIAS DYSRHYTHMIA BASIC TEST 2026
PRACTICE QUESTION SET TWO
◉ The nurse knows that what PR interval presents a first-degree heart block? A. 0.16 seconds B. 0.14 seconds C. 0.24 seconds D. 0.18 seconds Answer: C. 0.24 seconds In adults, the normal range for the PR is 0.12 to 0.20 seconds. A PR internal of 0.24 seconds would indicate a first-degree heart block. ◉ 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
A. Call a code and obtain the crash cart. B. Call for assistance and begin CPR. C. Administer a pericardial thump. D.Assess the client and monitor leads. Answer: D.Assess the client and monitor leads. The nurse should assess the client and monitor leads first. It is important that the nurse "treat the client, not the monitor." Ventricular asystole may often appear on the monitor when leads are displaced. The other interventions are not necessary. ◉ A patient with hypertension has a newly diagnosed atrial fibrillation. What medication does the nurse anticipate administering to prevent the complication of atrial thrombi? A. Atropine 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
metal casing and programming magnet could trigger the metal detector. ◉ A nurse is performing discharge teaching with a client who has an implantable cardioverter defibrillator (ICD) placed. Which client statement indicates effective teaching? A. "I'll keep a log of each time my ICD discharges." B. "I need to stay at least 10 inches away from the microwave." C. "I can't wait to get back to my football league." D. "I have an appointment for magnetic resonance imaging of my knee scheduled for next week." Answer: A. "I'll keep a log of each time my ICD discharges." The client stating that he should keep a log of all ICD discharges indicates effective teaching. This log helps the client and physician identify activities that may cause the arrhythmias that make the ICD discharge. He should also record the events right before the discharge. Clients with ICDs should avoid contact sports such as football. They must also avoid magnetic fields, which could permanently damage the ICD. Household appliances don't interfere with the ICD.
◉ Which term is used to describe a tachycardia characterized by abrupt onset, abrupt cessation, and a QRS of normal duration? A. Atrial fibrillation B. Paroxysmal atrial tachycardia C. Sinus tachycardia D. Atrial flutter Answer: B. Paroxysmal atrial tachycardia Paroxysmal atrial tachycardia (PAT) is often caused by a conduction problem in the AV node and is now called AV nodal reentry tachycardia. Sinus tachycardia occurs when the sinus node regularly creates an impulse at a faster-than-normal rate. Atrial flutter occurs in the atrium and creates an atrial rate between 250 to 400 times per minute. Atrial fibrillation causes a rapid, disorganized, and uncoordinated twitching of atrial musculature. ◉ The client returns to the clinic for a follow-up appointment following a permanent pacemaker insertion and reports tenderness and throbbing around the incision. The nurse observes mild swelling, erythema, and warmth at the pacemaker insertion site. What does the nurse suspect?
B. "We have to allow your heart to rest for a few weeks before it is stressed by the cardioversion." C. "The doctor wants to see if your heart will switch back to its normal rhythm by itself." D. "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Answer: D. "Your atrial chambers may contain blood clots now, so you must take an anticoagulant for a few weeks before the cardioversion." Because of the high risk of embolization of atrial thrombi, cardioversion of atrial fibrillation that has lasted longer than 48 hours should be avoided unless the client has received warfarin for at least 3 to 4 weeks prior to cardioversion. The doctor will not wait for a change in rhythm. Resting the heart will not change the rhythm. There is no delay but safer for the clots to be dissolved with the anticoagulant. ◉ An operating room nurse is caring for a client who is having a pacemaker implanted. Thehealth care provider has requested a demand mode pacemaker for this client. What is this type of pacemaker? A. A temporary pacemaker
B. Asynchronous C. Self-activated D. A fixed-rate pacemaker Answer: C. Self-activated Demand (synchronous) mode pacemakers self-activate when the client's pulse falls below a certain level. A fixed-rate pacemaker is asynchronous and permanent. Temporary pacemakers are used until a permanent pacemaker can be implanted. ◉ A client is diagnosed with a dysrhythmia at a rate slower than 60 beats/minute. What type of dysrhythmia does the client have? A. atrial bradycardia B. heart block C. sinus bradycardia D. none Answer: C. sinus bradycardia
A. Atrial flutter B. Asystole C. Premature ventricular contraction D. Ventricular fibrillation Answer: A. Atrial flutter Atrial flutter is a disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate. The atrioventricular (AV) node conducts only some impulses to the ventricle, resulting in a ventricular rate slower than the atrial rate, thus forming a sawtooth pattern on the heart monitor. Asystole is the absence of cardiac function and can indicate death. Premature ventricular contraction indicates an early electric impulse and does not necessarily produce an exceedingly rapid heart rate. Ventricular fibrillation is the inefficient quivering of the ventricles and indicative of a dying heart. ◉ The nurse reads an athletic client's electrocardigram. What finding will be consistent with a sinus bradycardia? A. QR interval of 0.25 seconds.
B. Heart rate of 42 beats per minute (bpm). C. P-to-QR ratio of 1:2. D. PR interval of 0.24 seconds. Answer: B. Heart rate of 42 beats per minute (bpm). The heart rate of 42 bpm is slow but normal when it occurs in athletes with a sinus bradycardia. The PR interval is prolonged at 0.24 seconds, indicating a heart block. The QR interval is prolonged and indicates ventricular delay.The ratio of P to QR should be 1:1 in sinus bradycardia. ◉ After evaluating a client for hypertension, a health care provider orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have in treating hypertension? A. Decreased peripheral vascular resistance B. Increased cardiac output and increased systolic and diastolic blood pressure C. Decreased blood pressure with reflex tachycardia
The nurse should instruct the client to restrict food and oral intake before the cardioversion procedure. Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion. The presence of digitalis and diuretics in myocardial cells decreases the ability to restore normal conduction and increases the chances of a fatal dysrhythmia developing after cardioversion. When the client is in cardiopulmonary arrest, the nurse should facilitate CPR until the client is prepared for defibrillation and not for cardioversion. Monitoring blood pressure every 4 hours is not required to prepare a client with cardiac dysrhythmia. ◉ A nurse is caring for a client who has been admitted to have a cardioverter defibrillator implanted. The nurse knows that implanted cardioverter defibrillators are used in which clients? A. Clients with recurrent life-threatening bradycardias B. Clients with sinus tachycardia C. Clients with ventricular bradycardia D. Clients with recurrent life-threatening tachydysrhythmias Answer: D. Clients with recurrent life-threatening tachydysrhythmias
The automatic implanted cardioverter defibrillator (AICD) is an internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias. Therefore, options A, B, and C are incorrect. ◉ The nurse recognizes that Premature ventricular contractions (PVCs) are considered precursors of ventricular tachycardia (VT) when they: A. occur at a rate of more than six per minute B. occur during the QRS complex C. have the same shape D. are paired with a normal beat Answer: A. occur at a rate of more than six per minute When PVCs occur at a rate of more than six per minute, they indicate increasing ventricular irritability and are considered forerunners of VT. PVCs are dangerous when they occur on the T wave. PVCs are dangerous when they are multifocal (have different shapes). A PVC that is paired with a normal beat is termed bigeminy.
C. Altered patterns frequently affect the heart's ability to pump blood effectively. D. Altered patterns frequently cause a variety of home safety issues. Answer: C. Altered patterns frequently affect the heart's ability to pump blood effectively. The best representation of a nursing concern related to a cardiac arrhythmia is the inability of the heart to fill the chambers and eject blow flow efficiently. Lack of an efficient method to circulate blood and bodily fluids produces a variety of complications such as tissue ischemia, pulmonary edema, hypotension, decreased urine output, and impaired level of consciousness. The other options can occur with dysrhythmias, but the cause stemming from the altered pattern is the best answer. ◉ A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic? A. Vibration under the skin B. Quality of the pulse
C. "Spike" on the rhythm strip D. Scar on the chest Answer: C. "Spike" on the rhythm strip Confirmation that the client has a permanent pacemaker is the characteristic "spike" identified by a thin, straight stroke on the rhythm strip. The scar on the chest is suggestive of pacer implantation but not definitive. There should be no change in pulse quality, and no vibration under the skin. ◉ A nurse evaluates a client with a temporary pacemaker. The client's ECG tracing shows each P wave followed by the pacing spike. What is the nurse's best response? A. Document the findings and continue to monitor the client B. Check the security of all connections and increase the milliamperage C. Obtain a 12-lead ECG and a portable chest x-ray D. Reposition the extremity and turn the client to left side Answer: A. Document the findings and continue to monitor the client
