Question 1

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with bigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Accepted Answer

A single ectopic focus produces PVC waveforms that look alike,called unifocal PVCs.Waveforms of PVCs arising from multiple foci are not identical and are called multifocal PVCs.PVCs may occur in a predictable pattern,such as every other beat (bigeminal),every third beat (trigeminal),or every fourth beat (quadrigeminal).PVCs can also occur sequentially.Two PVCs in a row are called a pair (or couplets),and three or more in a row are called nonsustained ventricular tachycardia.

Question 2

The patient has a permanent pacemaker inserted.The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute.The nurse realizes that
A) the pacemaker will pace only if the patient's intrinsic heart rate is less than 60 beats per minute.
B) the demand mode often competes with the patient's own rhythm.
C) the demand mode places the patient at risk for the R-on-T phenomenon.
D) the fixed-rate mode is safer and is the mode of choice.

Accepted Answer

Pacemakers can be operated in a demand mode or a fixed-rate (asynchronous)mode.The demand mode paces the heart when no intrinsic or native beat is sensed.For example,if the rate control is set at 60 beats per minute,the pacemaker will only pace if the patient's heart rate drops to less than 60.The fixed-rate mode paces the heart at a set rate,independent of any activity the patient's heart generates.The fixed-rate mode may compete with the patient's own rhythm and deliver an impulse on the T wave (R-on-T phenomenon),with the potential for producing ventricular tachycardia or fibrillation.The demand mode is safer and is the mode of choice.

Question 3

The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I.The patient is on digitalis medication at home.The nurse should expect that
A) the patient has had an anterior wall myocardial infarction.
B) the physician will order the digitalis to be continued in the hospital.
C) a digitalis level would be ordered upon admission.
D) the patient will require a transcutaneous pacemaker.

Accepted Answer

Digitalis toxicity is a major cause of this rhythm,and further digitalis doses should not be given until a digitalis level is obtained.Other causes of Mobitz I include AV nodal blocking drugs,acute inferior wall myocardial infarction or right ventricular infarction,ischemic heart disease,and excess vagal response.This type of block is usually well tolerated,and no treatment is indicated unless the dropped beats occur frequently.

Question 4

Interpret the following rhythm:

A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) Sinus arrhythmia

Accepted Answer

Normal sinus rhythm (NSR)reflects normal conduction of the sinus impulse through the atria and ventricles.Atrial and ventricular rates are the same and range from 60 to 100 beats per minute.Rhythm is regular or essentially regular.PR interval is 0.12 to 0.20 seconds.QRS interval is 0.06 to 0.10 seconds.P and QRS waves are consistent in shape.Sinus tachycardia results when the SA node fires faster than 100 beats per minute.Bradycardia is defined as a heart rate less than 60 beats per minute.Sinus arrhythmia is a cyclical change in heart rate that is associated with respiration.The heart rate increases slightly during inspiration and slows slightly during exhalation because of changes in vagal tone.

Question 5

The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min.The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes.The nurse recognizes this as:
A) normal pacemaker function.
B) failure to capture.
C) failure to pace.
D) failure to sense.

Accepted Answer

Failure to pace or fire occurs when the pacemaker fails to initiate an electrical stimulus when it should fire.The problem is noted by absence of pacer spikes on the rhythm strip.Causes of failure to pace include battery or pulse generator failure,fracture or displacement of a pacemaker wire,or loose connections.This is not normal pacemaker function.When the pacemaker generates an electrical impulse (pacer spike)and no depolarization is noted,it is described as a failure to capture.On the ECG,a pacer spike is noted,but it is not followed by a P wave (atrial pacemaker)or a QRS complex (ventricular pacemaker).When the pacemaker does not sense the patient's own cardiac rhythm and initiates an electrical impulse,it is called failure to sense.Failure to sense manifests as pacer spikes that fall too closely to the patient's own rhythm,earlier than the programmed rate.

Question 6

Interpret the following rhythm:

A) Atrial flutter with variable conduction
B) Ventricular fibrillation
C) Atrial fibrillation
D) Atrial flutter with RVR (rapid ventricular response)

Accepted Answer

Atrial flutter arises from a single irritable focus in the atria.The atrial focus fires at an extremely rapid,regular rate,between 240 and 320 beats per minute.The P waves are called flutter waves and may have a sawtooth appearance.The ventricular response may be regular or irregular based on how many flutter waves are conducted through the AV node.Atrial flutter with RVR occurs when atrial impulses cause a ventricular response greater than 100 beats per minute.Atrial fibrillation arises from multiple ectopic foci in the atria,causing chaotic quivering of the atria and ineffectual atrial contraction.

Question 7

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with bigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Accepted Answer

A single ectopic focus produces PVC waveforms that look alike,called unifocal PVCs.Waveforms of PVCs arising from multiple foci are not identical and are called multifocal PVCs.PVCs may occur in a predictable pattern,such as every other beat (bigeminal),every third beat (trigeminal),or every fourth beat (quadrigeminal).PVCs can also occur sequentially.Two PVCs in a row are called a pair (couplet),and three or more in a row are called nonsustained ventricular tachycardia.

Question 8

Interpret the following rhythm:

A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) Sinus arrhythmia

Accepted Answer

Normal sinus rhythm (NSR)reflects normal conduction of the sinus impulse through the atria and ventricles.Atrial and ventricular rates are the same and range from 60 to 100 beats per minute.Rhythm is regular or essentially regular.PR interval is 0.12 to 0.20 seconds.QRS interval is 0.06 to 0.10 seconds.P and QRS waves are consistent in shape.Sinus tachycardia results when the SA node fires faster than 100 beats per minute.Bradycardia is defined as a heart rate less than 60 beats per minute.Sinus arrhythmia is a cyclical change in heart rate that is associated with respiration.The heart rate slightly increases during inspiration and slightly slows during exhalation because of changes in vagal tone.

Question 9

The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex.The nurse should
A) defibrillate the patient immediately.
B) initiate basic life support.
C) initiate advanced life support.
D) assess the patient and the electrical leads.

Accepted Answer

Ventricular fibrillation (VF)is a chaotic rhythm characterized by a quivering of the ventricles,which results in total loss of cardiac output and pulse.VF is a life-threatening emergency,and the more immediate the treatment is,the better the survival will be.VF produces a wavy baseline without a PQRST complex.Because a loose lead or electrical interference can produce a waveform similar to VF,it is always important to immediately assess the patient for pulse and consciousness.

Question 10

Interpret the following rhythm:

A) Atrial fibrillation
B) Atrial flutter
C) Atrial flutter with RVR
D) Junctional escape rhythm

Accepted Answer

Atrial fibrillation arises from multiple ectopic foci in the atria,causing chaotic quivering of the atria and ineffectual atrial contraction.The AV node is bombarded with hundreds of atrial impulses and conducts these impulses in an unpredictable manner to the ventricles.The atrial rate may be as high 700 and no discernible P waves can be identified,resulting in a wavy baseline and an extremely irregular ventricular response.Atrial flutter arises from a single irritable focus in the atria.The atrial focus fires at an extremely rapid,regular rate,between 240 and 320 beats per minute.The P waves are called flutter waves and may have a sawtooth appearance.The ventricular response may be regular or irregular based on how many flutter waves are conducted through the AV node.Atrial flutter with RVR occurs when atrial impulses cause a ventricular response greater than 100 beats per minute.A junctional escape rhythm is a ventricular rate between 40 and 60 beats per minute with a regular rhythm.P waves may be absent,inverted,or follow the QRS complex.If a P wave is present before the QRS complex,the PR interval is shortened to less than 0.12 milliseconds.QRS complex is normal.

Question 11

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with trigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Accepted Answer

A single ectopic focus produces PVC waveforms that look alike,called unifocal PVCs.Waveforms of PVCs arising from multiple foci are not identical and are called multifocal PVCs.PVCs may occur in a predictable pattern,such as every other beat (bigeminal),every third beat (trigeminal),or every fourth beat (quadrigeminal).PVCs also can occur sequentially.Two PVCs in a row are called a pair,and three or more in a row are called nonsustained ventricular tachycardia.

Question 12

The rhythm on the cardiac monitor is showing numerous pacemaker spikes,but no P waves or QRS complexes following the spikes.The nurse recognizes this as:
A) normal pacemaker function.
B) failure to capture.
C) failure to pace.
D) failure to sense.

Accepted Answer

When the pacemaker generates an electrical impulse (pacer spike)and no depolarization is noted,it is described as a failure to capture.On the ECG,a pacer spike is noted,but it is not followed by a P wave (atrial pacemaker)or a QRS complex (ventricular pacemaker).This is not normal pacemaker function.Failure to pace or fire occurs when the pacemaker fails to initiate an electrical stimulus when it should fire.The problem is noted by absence of pacer spikes on the rhythm strip.When the pacemaker does not sense the patient's own cardiac rhythm and initiates an electrical impulse,it is called failure to sense.Failure to sense manifests as pacer spikes that fall too closely to the patient's own rhythm,earlier than the programmed rate.

Question 13

The nurse notices that the patient has a first-degree AV block.Everything else about the rhythm is normal.The nurse should
A) prepare to place the patient on a transcutaneous pacemaker.
B) give the patient atropine to shorten the PR interval.
C) monitor the rhythm and patient's condition.
D) give the patient an antiarrhythmic medication.

Accepted Answer

First-degree AV block is a common dysrhythmia in the elderly and in patients with cardiac disease.As the normal conduction pathway ages or becomes diseased,impulse conduction becomes slower than normal.It is well tolerated.No treatment is required.Continue to monitor the patient and the rhythm.

Question 14

The nurse understands that in a third-degree AV block
A) every P wave is conducted to the ventricles.
B) some P waves are conducted to the ventricles.
C) none of the P waves are conducted to the ventricles.
D) the PR interval is prolonged.

Accepted Answer

Third-degree block is often called complete heart block because no atrial impulses are conducted through the AV node to the ventricles.Normally every P wave is conducted to the ventricles.If some of the P waves are conducted but others are not,further assessment is needed to determine the type of block present.A prolonged PR interval is a first-degree AV block,and is well tolerated and requires no treatment.

Question 15

The patient is scheduled to have a permanent pacemaker implanted.The patient asks the nurse,"How long will the battery in this thing last?" The nurse should solve,
A) "Life expectancy is about 1 year.Then it will need to be replaced."
B) "Pacemaker batteries can last up to 25 years with constant use."
C) "Battery life varies depending on usage, but it can last up to 10 years."
D) "Pacemakers are used to treat temporary problems, so the batteries don't last long."

Accepted Answer

Implanted permanent pacemakers are used to treat chronic conditions.These devices have a battery life of up to 10 years,which varies based on the manufacturer's recommendations and the usage of the device.

Question 16

Interpret the following rhythm:

A) Sinus rhythm with PACs
B) Normal sinus rhythm
C) Sinus tachycardia
D) Sinus bradycardia

Accepted Answer

The underlying rhythm is identified first.Following this step,the dysrhythmia that is occurring to disrupt the underlying rhythm is then determined.A premature atrial contraction (PAC)is a single ectopic beat arising from atrial tissue,not the sinus node.The PAC occurs earlier than the next normal beat and interrupts the regularity of the underlying rhythm.The P wave of the PAC has a different shape than the sinus P wave because it arises from a different area in the atria; it may follow or be in the T wave of the preceding normal beat.If the early P wave is in the T wave,this T wave will look different from the T wave of a normal beat.Normal sinus rhythm (NSR)reflects normal conduction of the sinus impulse through the atria and ventricles.Atrial and ventricular rates are the same and range from 60 to 100 beats per minute.Rhythm is regular or essentially regular.PR interval is 0.12 to 0.20 seconds.QRS interval is 0.06 to 0.10 seconds.P and QRS waves are consistent in shape.Sinus tachycardia results when the SA node fires faster than 100 beats per minute.Bradycardia is defined as a heart rate less than 60 beats per minute.

Question 17

Interpret the following rhythm:

A) Normal sinus rhythm
B) Sinus bradycardia
C) Sinus tachycardia
D) Sinus arrhythmia

Accepted Answer

Normal sinus rhythm (NSR)reflects normal conduction of the sinus impulse through the atria and ventricles.Atrial and ventricular rates are the same and range from 60 to 100 beats per minute.Rhythm is regular or essentially regular.PR interval is 0.12 to 0.20 seconds.QRS interval is 0.06 to 0.10 seconds.P and QRS waves are consistent in shape.Sinus tachycardia results when the SA node fires faster than 100 beats per minute.Bradycardia is defined as a heart rate less than 60 beats per minute.Sinus arrhythmia is a cyclical change in heart rate that is associated with respiration.The heart rate slightly increases during inspiration and slightly slows during exhalation because of changes in vagal tone.

Question 18

The patient is in chronic junctional escape rhythm with no atrial activity noted.Studies have demonstrated normal AV node function.This patient may be a candidate for which type of pacing?
A) Atrial pacing
B) Ventricular pacing
C) Dual-chamber pacing
D) Transcutaneous pacing

Accepted Answer

Pacemakers may be used to stimulate the atrium,ventricle,or both chambers (dual-chamber pacemakers).Atrial pacing is used to mimic normal conduction and to produce atrial contraction,thus providing atrial kick.This is the case in the scenario provided.Ventricular pacing stimulates ventricular depolarization and is commonly used in emergency situations or when pacing is required infrequently.Dual-chamber pacing allows for stimulation of both atria and ventricles as needed to synchronize the chambers and mimic the normal cardiac cycle.However,with this patient,ventricular and AV function are normal.

Question 19

Interpret the following rhythm:

A) Junctional rhythm
B) An accelerated junctional rhythm
C) A junctional tachycardia
D) Atrial fibrillation

Accepted Answer

The normal intrinsic rate for the AV node and junctional tissue is 40 to 60 beats per minute,but rates can accelerate.An accelerated junctional rhythm has a rate between 60 and 100 beats per minute,and the rate for junctional tachycardia is greater than 100 beats per minute.If a P wave precedes QRS,it is inverted or upside down; the P wave may not be visible,or it may follow the QRS.If a P wave is present before the QRS,the PR interval is shortened to less than 0.12 milliseconds.Atrial fibrillation arises from multiple ectopic foci in the atria,causing chaotic quivering of the atria and ineffectual atrial contraction.The AV node is bombarded with hundreds of atrial impulses and conducts these impulses in an unpredictable manner to the ventricles.

Question 20

Interpret the following rhythm:

A) Sinus rhythm with multifocal premature ventricular contractions
B) Sinus rhythm with unifocal premature ventricular contractions
C) Sinus rhythm with bigeminal premature ventricular contractions
D) Sinus rhythm with paired premature ventricular contractions (couplets)

Accepted Answer

A single ectopic focus produces PVC waveforms that look alike,called unifocal PVCs.Waveforms of PVCs arising from multiple foci are not identical and are called multifocal PVCs.PVCs may occur in a predictable pattern,such as every other beat (bigeminal),every third beat (trigeminal),or every fourth beat (quadrigeminal).PVCs can also occur sequentially.Two PVCs in a row are called a pair (couplet),and three or more in a row are called nonsustained ventricular tachycardia.

Quiz 7: Dysrhythmia Interpretation and Management

Interpret the following rhythm:

The patient has a permanent pacemaker inserted.The provider has set the pacemaker to the demand mode at a rate of 60 beats per minute.The nurse realizes that

The patient is asymptomatic but is diagnosed with second-degree heart block Mobitz I.The patient is on digitalis medication at home.The nurse should expect that

Interpret the following rhythm:

The patient has a permanent pacemaker in place with a demand rate set at 60 beats/min.The cardiac monitor is showing a heart rate of 44 beats/min with no pacemaker spikes.The nurse recognizes this as:

Interpret the following rhythm:

Interpret the following rhythm:

Interpret the following rhythm:

The nurse is talking with the patient when the monitor alarms and shows a wavy baseline without a PQRST complex.The nurse should

Interpret the following rhythm:

Interpret the following rhythm:

The rhythm on the cardiac monitor is showing numerous pacemaker spikes,but no P waves or QRS complexes following the spikes.The nurse recognizes this as:

The nurse notices that the patient has a first-degree AV block.Everything else about the rhythm is normal.The nurse should

The nurse understands that in a third-degree AV block

The patient is scheduled to have a permanent pacemaker implanted.The patient asks the nurse,"How long will the battery in this thing last?" The nurse should solve,

Interpret the following rhythm:

Interpret the following rhythm:

The patient is in chronic junctional escape rhythm with no atrial activity noted.Studies have demonstrated normal AV node function.This patient may be a candidate for which type of pacing?

Interpret the following rhythm:

Interpret the following rhythm: