NCLEX Questions for Cardiac Dysrhythmias

1. A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as:

a. Normal sinus rhythm
b. Sinus bradycardia
c. Sick sinus syndrome
d. First-degree heart block.

2. A nurse notices frequent artifact on the ECG monitor for a client whose leads are connected by cable to a console at the bedside. The nurse examines the client to determine the cause. Which of the following items is unlikely to be responsible for the artifact?

a. Frequent movement of the client
b. Tightly secured cable connections
c. Leads applied over hairy areas
d. Leads applied to the limbs

3. A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing:

a. Premature ventricular contractions
b. Ventricular tachycardia
c. Ventricular fibrillation
d. Sinus tachycardia

4. A nurse is viewing the cardiac monitor in a client’s room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following?

a. Immediately defibrillate
b. Prepare for pacemaker insertion
c. Administer amiodarone (Cordarone) intravenously
d. Administer epinephrine (Adrenaline) intravenously

5. A nurse is caring for a client with unstable ventricular tachycardia. The nurse instructs the client to do which of the following, if prescribed, during an episode of ventricular tachycardia?

a. Breathe deeply, regularly, and easily.
b. Inhale deeply and cough forcefully every 1 to 3 seconds.
c. Lie down flat in bed
d. Remove any metal jewelry

6. A client is having frequent premature ventricular contractions. A nurse would place priority on assessment of which of the following items?

a. Blood pressure and peripheral perfusion
b. Sensation of palpitations
c. Causative factors such as caffeine
d. Precipitating factors such as infection

7. A client has developed atrial fibrillation, which a ventricular rate of 150 beats per minute. A nurse assesses the client for:

a. Hypotension and dizziness
b. Nausea and vomiting
c. Hypertension and headache
d. Flat neck veins

8. A nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There are no P waves; instead there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as:

a. Sinus tachycardia
b. Atrial fibrillation
c. Ventricular tachycardia
d. Ventricular fibrillation

9. A client with rapid rate atrial fibrillation asks a nurse why the physician is going to perform carotid massage. The nurse responds that this procedure may stimulate the:

a. Vagus nerve to slow the heart rate
b. Vagus nerve to increase the heart rate; overdriving the rhythm.
c. Diaphragmic nerve to slow the heart rate
d. Diaphragmic nerve to overdrive the rhythm

10. A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client’s rhythm suddenly changes to one with no P waves or definable QRS complexes. Instead there are coarse wavy lines of varying amplitude. The nurse assesses this rhythm to be:

a. Ventricular tachycardia
b. Ventricular fibrillation
c. Atrial fibrillation
d. Asystole

11. While caring for a client who has sustained an MI, the nurse notes eight PVCs in one minute on the cardiac monitor. The client is receiving an IV infusion of D5W and oxygen at 2 L/minute. The nurse’s first course of action should be to:

a. Increase the IV infusion rate
b. Notify the physician promptly
c. Increase the oxygen concentration
d. Administer a prescribed analgesic

12. The adaptations of a client with complete heart block would most likely include:

a. Nausea and vertigo
b. Flushing and slurred speech
c. Cephalalgia and blurred vision
d. Syncope and low ventricular rate

13. A client with a bundle branch block is on a cardiac monitor. The nurse should expect to observe:

a. Sagging ST segments
b. Absence of P wave configurations
c. Inverted T waves following each QRS complex
d. Widening of QRS complexes to 0.12 second or greater.

14. When ventricular fibrillation occurs in a CCU, the first person reaching the client should:

a. Administer oxygen
b. Defibrillate the client
c. Initiate CPR
d. Administer sodium bicarbonate intravenously

15. What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Check all that apply.

a. The RR intervals are relatively consistent
b. One P wave precedes each QRS complex
c. Four to eight complexes occur in a 6 second strip
d. The ST segment is higher than the PR interval
e. The QRS complex ranges from 0.12 to 0.20 second

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