RELIAS DYSRHYTHMIA BASIC B COMPLETE EXAM PACK Q & A (NSR, SB, AR, VR, EKG) 2024, Exams of Nursing

Download RELIAS DYSRHYTHMIA BASIC B COMPLETE EXAM PACK Q & A (NSR, SB, AR, VR, EKG) 2024 and more Exams Nursing in PDF only on Docsity! RELIAS DYSRHYTHMIA BASIC A COMPLETE EXAM PACK Q & A NSR, SB, AR, VR, EKG 2024 1. A patient is admitted with chest pain and dyspnea. The nurse obtains a 12-lead ECG and observes a regular rhythm with a rate of 110 beats per minute, upright P waves before each QRS complex, a PR interval of 0.16 seconds, and a QRS duration of 0.08 seconds. How should the nurse interpret this rhythm? - A) Normal sinus rhythm - B) Sinus arrhythmia - C) Sinus bradycardia - D) *Sinus tachycardia* - Rationale: Sinus tachycardia is a normal sinus rhythm with a rate of 100 to 150 beats per minute. The other options are incorrect because they do not match the rate or the characteristics of the rhythm. 2. A patient is diagnosed with atrial fibrillation and is started on anticoagulation therapy. The nurse explains to the patient that this therapy is important to prevent which complication of atrial fibrillation? - A) *Stroke* - B) Heart failure - C) Myocardial infarction - D) Ventricular fibrillation - Rationale: Stroke is a common complication of atrial fibrillation because the irregular and often rapid atrial activity can lead to the formation of blood clots in the atria, which can then embolize to the brain or other organs. The other options are not directly related to atrial fibrillation. 3. A patient is monitored in the telemetry unit for recurrent palpitations. The nurse observes a regular rhythm with a rate of 160 beats per minute, no discernible P waves, a narrow QRS complex, and a normal T wave. How should the nurse document this rhythm? - A) Atrial flutter - B) *Supraventricular tachycardia* - C) Junctional tachycardia - D) Ventricular tachycardia - Rationale: Supraventricular tachycardia (SVT) is an abnormal rhythm that originates above the ventricles, usually in the atria or the AV node. It is characterized by a rapid rate (150 to 350 beats per minute), no visible P waves, a narrow QRS complex (<0.12 seconds), and a normal T wave. The other options are incorrect because they have different rates or QRS characteristics. 4. A patient has a permanent pacemaker inserted for symptomatic bradycardia. The nurse reviews the pacemaker settings and notes that the mode is DDD. What does this mode mean? - A) The pacemaker paces and senses both the atria and the ventricles, and inhibits or triggers pacing as needed. - B) The pacemaker paces both the atria and the ventricles, but only senses the ventricles, and inhibits pacing when intrinsic activity is detected. - C) The pacemaker paces both the atria and the ventricles, but only senses the atria, and triggers ventricular pacing after an atrial event. - D) *The pacemaker paces and senses both the atria and the ventricles, and inhibits pacing when intrinsic activity is detected in either chamber.* - Rationale: DDD is a dual-chamber pacemaker mode that paces and senses both the atria and the ventricles, and inhibits pacing when intrinsic activity is detected in either chamber. This mode preserves the normal AV synchrony and allows for rate responsiveness. The other options describe different modes of pacemaker operation. 5. A patient is experiencing frequent premature ventricular contractions (PVCs). The nurse recognizes that these PVCs are potentially dangerous if they exhibit which characteristic? - A) They occur in pairs or triplets. - B) They have different shapes and sizes. - C) *They fall on the T wave of the preceding beat.* - D) They have a wide and bizarre QRS complex. - Rationale: PVCs that fall on the T wave of the preceding beat are called 1. Which of the following cardiac rhythms is characterized by a consistent, even, and regular P-P interval, QRS complex, and R-R interval on the EKG strip? a) Normal Sinus Rhythm b) Sinus Bradycardia c) Atrial Flutter d) Ventricular Tachycardia Answer: a) Normal Sinus Rhythm Rationale: Normal Sinus Rhythm is the regular, organized wave pattern that originates from the SA node, ensuring normal atrial and ventricular functioning. 2. A nursing student observes a heart rate of 50 beats per minute on a patient's EKG strip. Which cardiac rhythm is this indicative of? a) Normal Sinus Rhythm b) Sinus Bradycardia c) Atrial Fibrillation d) Ventricular Fibrillation Answer: b) Sinus Bradycardia Rationale: Sinus Bradycardia is characterized by a heart rate below 60 beats per minute, originating from the SA node. It can be a normal variant or a manifestation of certain conditions like hypothyroidism or inferior wall myocardial infarction. 3. Which of the following atrial rhythms can be identified by the presence of "sawtooth" waves in the P-wave region of the EKG strip? a) Normal Sinus Rhythm b) Sinus Bradycardia c) Atrial Fibrillation d) Ventricular Tachycardia Answer: c) Atrial Fibrillation Rationale: Atrial Fibrillation is characterized by chaotic, rapid, and irregular atrial depolarizations, resulting in a disorganized baseline and absence of distinct P waves. The "sawtooth" waves are known as F waves. 4. In which cardiac rhythm is ventricular depolarization initiated by an ectopic focus, bypassing the normal conduction pathway? a) Normal Sinus Rhythm b) Sinus Bradycardia c) Atrial Flutter d) Premature Ventricular Contraction (PVC) Answer: d) Premature Ventricular Contraction (PVC) Rationale: A PVC is characterized by an early ventricular depolarization originating from an ectopic focus within the ventricles. It appears as a wide QRS complex occurring before the expected R-R interval. 5. A nursing student observes a wide, bizarre, and ventricular rhythm with a rate of 150 beats per minute on the EKG strip. Which cardiac rhythm is this indicative of? a) Normal Sinus Rhythm b) Sinus Bradycardia c) Atrial Flutter d) Ventricular Tachycardia Answer: d) Ventricular Tachycardia Rationale: Ventricular Tachycardia is characterized by a regular, wide QRS complex and a heart rate greater than 100 beats per minute. It originates from the ventricles and can be life-threatening. 6. Which of the following is an important step in EKG strip interpretation to determine the heart rate? a) Measuring the distance between the P waves b) Calculating the QT interval duration c) Counting the number of QRS complexes in a 6-second strip and multiplying by 10 d) Assessing the PR interval consistency Answer: c) Counting the number of QRS complexes in a 6-second strip and multiplying by 10 Rationale: To determine the heart rate from an EKG strip, we count the number of QRS complexes in a 6-second strip (30 large squares) and multiply by 10. This method provides a rough estimation of the heart rate. 7. Which EKG characteristic is crucial in the differentiation between sinus bradycardia and atrial fibrillation? a) PR interval measurement b) QRS duration analysis c) Presence of P waves d) Heart rate calculation Answer: c) Presence of P waves Rationale: Sinus bradycardia exhibits normal P waves that are present before each QRS complex, while atrial fibrillation depicts a lack of discernible P waves, indicating chaotic atrial electrical activity. 8. Which of the following is considered the "pacemaker" of the heart in normal sinus rhythm? a) Atrioventricular (AV) node b) Bundle of His c) Purkinje fibers d) Sinoatrial (SA) node Answer: d) Sinoatrial (SA) node Rationale: The SA node, located near the superior vena cava, is responsible for initiating the electrical impulses in the heart, resulting in normal sinus rhythm. 9. A nursing student observes a rapid, irregular rhythm on the EKG strip with absent P waves and "irregularly irregular" R-R intervals. Which of the following conditions is likely present? a) Normal Sinus Rhythm b) Sinus Tachycardia c) Atrial Fibrillation d) Ventricular Fibrillation Answer: c) Atrial Fibrillation Rationale: Atrial Fibrillation is characterized by chaotic, rapid atrial depolarizations, resulting in absent P waves and "irregularly irregular" R-R intervals. 10. On an EKG strip, a student notices inverted P waves occurring before each QRS complex. What would be the appropriate interpretation? a) Normal Sinus Rhythm Question 1: A patient presents with the following EKG reading: P wave, PR interval, QRS complex, and T wave are all within normal parameters. Which dysrhythmia is most likely to be indicated by this EKG strip? A) Normal Sinus Rhythm B) Sinus Bradycardia C) Atrial Fibrillation D) Ventricular Tachycardia Answer: A) Normal Sinus Rhythm Rationale: In a normal sinus rhythm, the EKG reading displays a P wave, PR interval, QRS complex, and T wave within normal parameters. Question 2: A patient's EKG strip shows a heart rate of 50 bpm, with a regular rhythm and normal P waves. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Bradycardia C) Atrial Flutter D) Ventricular Tachycardia Answer: B) Sinus Bradycardia Rationale: A heart rate of 50 bpm, with a regular rhythm and normal P waves, indicates sinus bradycardia. Question 3: A patient's EKG strip shows an irregular rhythm with no identifiable P waves and a rapid ventricular rate. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Tachycardia C) Atrial Fibrillation D) Ventricular Fibrillation Answer: C) Atrial Fibrillation Rationale: An irregular rhythm with no identifiable P waves and a rapid ventricular rate indicates atrial fibrillation. Question 4: A patient's EKG strip shows an irregular rhythm, with sawtooth-like atrial waves and a ventricular rate of 150 bpm. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Tachycardia C) Atrial Flutter D) Ventricular Tachycardia Answer: C) Atrial Flutter Rationale: The irregular rhythm with sawtooth-like atrial waves and a ventricular rate of 150 bpm indicates atrial flutter. Question 5: A patient's EKG strip shows a regular rhythm, wide QRS complexes, and a heart rate of 180 bpm. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Tachycardia C) Atrial Fibrillation D) Ventricular Tachycardia Answer: D) Ventricular Tachycardia Rationale: A regular rhythm, wide QRS complexes, and a heart rate of 180 bpm indicate ventricular tachycardia. Question 6: A patient's EKG strip shows a regular rhythm, narrow QRS complexes, and a heart rate of 140 bpm. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Tachycardia C) Atrial Tachycardia D) Ventricular Fibrillation Answer: C) Atrial Tachycardia Rationale: A regular rhythm, narrow QRS complexes, and a heart rate of 140 bpm indicate atrial tachycardia. Question 7: A patient's EKG strip shows a regular rhythm, normal P waves, and a heart rate of 100 bpm. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Tachycardia C) Atrial Fibrillation D) Ventricular Fibrillation Answer: A) Normal Sinus Rhythm Rationale: A regular rhythm, normal P waves, and a heart rate of 100 bpm indicate normal sinus rhythm. Question 8: A patient's EKG strip shows a regular rhythm, normal P waves, and a heart rate of 110 bpm. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Bradycardia C) Atrial Flutter D) Ventricular Tachycardia Answer: A) Normal Sinus Rhythm Rationale: A regular rhythm, normal P waves, and a heart rate of 110 bpm indicate normal sinus rhythm. Question 9: A patient's EKG strip shows a regular rhythm, normal P waves, and a heart rate of 75 bpm. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Bradycardia C) Atrial Fibrillation D) Ventricular Fibrillation Answer: A) Normal Sinus Rhythm Rationale: A regular rhythm, normal P waves, and a heart rate of 75 bpm indicate normal sinus rhythm. Question 10: A patient's EKG strip shows a regular rhythm, no P waves, and a heart rate of 120 bpm. What dysrhythmia is most likely to be indicated by this EKG reading? A) Normal Sinus Rhythm B) Sinus Tachycardia C) Atrial Fibrillation D) Ventricular Tachycardia Answer: B) Sinus Tachycardia Sinus Arrhythmia Appearance is ALMOST NORMAL: Respiratory – Circulatory interaction Rate INCREASES with INSPIRATION (IN=IN) Sinus Bradycardia <60 normal sinus rhythm Sinus Tachycardia >100 (100-150) normal sinus rhythm Premature Atrial Contraction (PAC) Heart Rate: Depends on underlying rhythm Regularity: Interrupts the regularity of underlying rhythm P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes QRS: <.12 seconds Sinus Arrest/Pause – SA node doesn’t fire – notice absence of P-wave for a complete cycle (a missed cycle) length of pause ≠ multiple of normal rate (block) Atrial Fibrillation (A-Fib) an irregular and often very fast heart rate originating from abnormal conduction in the atria Atrial Flutter irregular beating of the atria; often described as “a-flutter with 2 to 1 block or 3 to 1 block” Junctional Rhythm 40-60 Regular! -impulse from AV node w/ retro/antegrade transmission – P wave often inverted/buried/follow QRS – slow rate – narrow QRS (not wide like ventricular) Junctional Tachycardia >60 bpm (ms. K; 150-250) – KEY: will be regular (consistent) – AV junction produces a rapid sequence of QRS-T cycles – p-wave often inverted/buried/follow QRS Premature Junctional Contraction Inverted p wave or hidden p wave PRI<0.12 or none Normal QRS QRS: Wide QRS – “Twisting of the Points” Conduction: Ventricular only Rhythm: Slightly irregular Ventricular fibrillation (V-fib) abnormal heart rhythm which results in quivering of ventricles Idioventricular Rhythm <40 *looks like vtach but slow* – no P waves (from vent foci) – Wide QRS (serious, death like rhythm) – called “dying heart” rhythm…occasional ventric beat b4 death (asystole) Accelerated Idioventricular Rhythm Rate: 50 – 100 usually (usually slow) P wave: Obscured by ventricular waves (occur during ventricular contraction) – SA node slower than faster ventricular pacing than should be QRS: Wide QRS Conduction: Ventricular only Rhythm: Regular- benign rhythm that is sometimes seen during acute MI or early after reperfusion. – Rarely sustained, does not progress to vfib, rarely requires treatment asystole absence of contractions of the heart Failure to capture (pacemaker) failure to sense (pacemaker) Atrial paced rhythm spike before P wave Ventricular paced rhythm ventricular contractions which occur in cases of complete heart block. Normal sinus rhythm Regular Rate: 60-100 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec Sinus Bradycardia Regular Rate: <60 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec Sinus Tachycardia Regular Rate: 100-150 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec QRS: <0.12 sec Accelerated Junctional Rhythm Regular Rate: 60-100 P Wave: NONE or INVERTED PR Interval: None or <0.12 QRS: <0.12 sec Junctional Tachycardia Regular Rate: >100 P Wave: NONE or INVERTED PR Interval: None or <0.12 QRS: <0.12 sec Premature Ventricular Contraction IRREGULAR Rate: refer to underlying rhythm P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE , >0.12 sec Ventricular Tachycardia Regular Rate: >100 P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE, >0.12 sec Ventricular Fibrillation Chaotic Coarse: big waves Fine: small waves Rate: unmeasurable P Wave: NONE PR Interval: N/A QRS: N/A Idioventricular Regular Rate: 20-50 P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec Accelerated Idoventricular Rhythm Regular Rate: 50-100 P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec 1st Degree AV Block Regular Rate: 60-100 P Wave: Present, upright PR interval: >0.20 sec CONSISTENTLY LONG QRS: <0.12 secHusband stays late till 9 consistently 2nd Degree AV Block Type I Mobitz, Wenckebach IRREGULAR Rate: 60-100