Chapter 22: Management of Patients with Arrhythmias and Conduction Problems
1. The nurse is caring for a client who has had an ECG. The nurse notices that leads I, II,
and III differ from one another on the cardiac rhythm strip. How should the nurse best
respond?
A. Recognize that the view of the electrical current changes in relation to the lead
placement.
B. Recognize that the electrophysiological conduction of the heart differs with lead
placement.
C. Inform the technician that the ECG equipment has malfunctioned.
D. Inform the health care provider that the client is experiencing a new onset of
dysrhythmia.
2. The nurse is analyzing a rhythm strip. What component of the ECG corresponds to the
resting state of the client's heart?
A. P wave
B. T wave
C. U wave
D. QRS complex
3. The nursing educator is presenting a case study of an adult client who has abnormal
ventricular depolarization. This pathologic change would be most evident in what
component of the ECG?
A. P wave
B. T wave
C. QRS complex
D. U wave
4. An adult client with third-degree AV block is admitted to the cardiac care unit and
placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most
likely show?
A. PP interval and RR interval are irregular.
B. PP interval is equal to RR interval.
C. Fewer QRS complexes than P waves
D. PR interval is constant.
5. A 62-year-old client with atrial fibrillation and a CHA2DS2-VASC score of 3 is being
discharged home today. Based on this score, which additional medications or
medications would be prescribed for this client?
A. No antithrombotic therapy, oral anticoagulant or aspirin
B. Low molecular weight heparin or intravenous heparin
C. Warfarin, direct thrombin inhibitor, or factor Xa inhibitor
D. Antiarrhythmic agents and aspirin
6. A client has returned to the cardiac care unit after having a permanent pacemaker
implantation. For which potential complication should the nurse most closely assess this
client?
A. Chest pain
B. Bleeding at the implantation site
C. Malignant hyperthermia
D. Bradycardia
7. A client the nurse is caring for has a permanent pacemaker implanted, with the
identification code beginning with VVI. What does this indicate?
A. Ventricular paced, ventricular sensed, inhibited
B. Variable paced, ventricular sensed, inhibited
C. Ventricular sensed, ventricular situated, implanted
D. Variable sensed, variable paced, inhibited
8. The nurse is caring for an adult client who has gone into ventricular fibrillation. When
assisting with defibrillating the client, what must the nurse do?
A. Maintain firm contact between paddles and the client's skin.
B. Apply a layer of water as a conducting agent.
C. Call "all clear" once before discharging the defibrillator.
D. Ensure the defibrillator is in the sync mode.
9. A client who is a candidate for an implantable cardioverter defibrillator (ICD) asks the
nurse about the purpose of this device. What would be the nurse's best response?
A. "To detect and treat dysrhythmias such as ventricular fibrillation and ventricular
tachycardia."
B. "To detect and treat bradycardia, which is an excessively slow heart rate."
C. "To detect and treat atrial fibrillation, in which your heart beats too quickly and
inefficiently."
D. "To shock your heart if you have a heart attack at home."
10. The nurse is caring for a client who has just had an implantable cardioverter
defibrillator (ICD) placed. What is the priority area for the nurse's assessment?
A. Assessing the client's mobility
B. Facilitating transthoracic echocardiography
C. Vigilant monitoring of the client's ECG
D. Close monitoring of the client's peripheral perfusion
11. A nurse is caring for a client who is exhibiting ventricular tachycardia (VT). Because
the client is pulseless, the nurse should prepare for what intervention?
A. Defibrillation
B. ECG monitoring
C. Implantation of a cardioverter defibrillator
D. Angioplasty
12. A client converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a
ventricular response at 166 bpm. Blood pressure is 162/74 mm Hg. Respiratory rate is 20
breaths per minute with normal chest expansion and clear lungs bilaterally. IV heparin
and diltiazem are given. The nurse caring for the client understands that the treatment
has what main goal?
A. Decrease SA node conduction.
B. Control ventricular heart rate.
C. Improve oxygenation.
D. Maintain anticoagulation.
13. The nurse and the other members of the team are caring for a client who converted
to ventricular fibrillation (VF). The client was defibrillated unsuccessfully and the client
remains in VF. The nurse should anticipate the administration of what medication?
A. Epinephrine 1 mg IV push
B. Lidocaine 100 mg IV push
C. Amiodarone 300 mg IV push
D. Sodium bicarbonate 1 amp IV push
14. The nurse is planning discharge teaching for a client with a newly inserted permanent
pacemaker. What is the priority teaching point for this client?
A. Start lifting the arm above the shoulder right away to prevent chest wall
adhesion.
B. Avoid cooking with a microwave oven.
C. Avoid exposure to strong electromagnetic fields
D. Avoid walking through store and library antitheft devices.
15. A client is brought to the ED and determined to be experiencing symptomatic sinus
bradycardia. The nurse caring for this client is aware the medication of choice for
treatment of this dysrhythmia is the administration of atropine. What guidelines will the
nurse follow when administering atropine?
A. Administer atropine 0.5 mg as an IV bolus every 3 to 5 minutes to a maximum
of 3.0 mg.
B. Administer atropine as a continuous infusion until symptoms resolve.
C. Administer atropine as a continuous infusion to a maximum of 30 mg in 24
hours.
D. Administer atropine 1.0 mg sublingually.
16. An ECG has been ordered for a newly admitted client. What should the nurse do prior
to electrode placement?
A. Clean the skin with povidone-iodine solution.
B. Ensure that the area for electrode placement is dry.
C. Apply tincture of benzoin to the electrode sites and wait for it to become "tacky."
D. Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
17. The nurse is caring for a client who has just undergone catheter ablation therapy. The
nurse in the step-down unit should prioritize what assessment?
A. Cardiac monitoring
B. Monitoring the implanted device signal
C. Pain assessment
D. Monitoring the client's level of consciousness (LOC)
18. The ED nurse is caring for a client who has gone into cardiac arrest. During external
defibrillation, what action should the nurse perform?
A. Place gel pads over the apex and posterior chest for better conduction.
B. Ensure no one is touching the client at the time shock is delivered.
C. Continue to ventilate the client via endotracheal tube during the procedure.
D. Allow at least 3 minutes between shocks.
19. A group of nurses is participating in orientation to a telemetry unit. The nurse who is
providing the education should tell the class that ST segments:
A. are the part of an ECG that reflects systole.
B. are the part of an ECG used to calculate ventricular rate and rhythm.
C. are the part of an ECG that reflects the time from ventricular depolarization
through repolarization.
D. represent early ventricular repolarization.
20. The nurse is providing care to a client who has just undergone an electrophysiologic
(EP) study. The client reports being nervous about "things going wrong" during the
procedure. What is the nurse's best response?
A. "This is basically a risk-free procedure."
B. "Thousands of clients undergo EP every year."
C. "Remember that this is a step that will bring you closer to enjoying good health."
D. "The whole team will be monitoring you very closely for the entire procedure."
21. The nurse is caring for a client with complex cardiac history. How should the nurse
best explain the process of depolarization to a colleague?
A. Mechanical contraction of the heart muscles
B. Electrical stimulation of the heart muscles
C. Electrical relaxation of the heart muscles.
D. Mechanical relaxation of the heart muscles
22. A cardiac care nurse is caring for a client who is experiencing positive chronotropy.
What effect should the nurse prepare for?
A. Exacerbation of an existing dysrhythmia
B. Initiation of a new dysrhythmia
C. Resolution of ventricular tachycardia
D. Increased heart rate
23. The nurse is caring for a client with refractory atrial fibrillation who underwent the
maze procedure several months ago. The nurse reviews the result of the client's most
recent cardiac imaging, which notes the presence of scarring on the atria. How should the
nurse best interpret this finding?
A. Recognize that the procedure was unsuccessful.
B. Recognize this as a therapeutic goal of the procedure.
C. Liaise with the care team in preparation for repeating the maze procedure.
D. Prepare the client for pacemaker implantation.
24. A client is scheduled for catheter ablation therapy. When describing this procedure to
the client's family, the nurse should address which aspect of the treatment?
A. Resetting of the heart's contractility
B. Destruction of specific cardiac cells
C. Correction of structural cardiac abnormalities
D. Clearance of partially occluded coronary arteries
25. A client has undergone diagnostic testing and received a diagnosis of sinus
bradycardia attributable to sinus node dysfunction. When planning this client's care,
which nursing diagnosis is most appropriate?
A. Risk for acute pain
B. Risk for unilateral neglect
C. Risk for activity intolerance
D. Risk for fluid volume excess
26. The nurse is caring for a client on telemetry. The client's ECG shows atrial fibrillation,
wide QRS and a fast, irregular ventricular rhythm. What does this ECG show?
A. Sinus bradycardia
B. Myocardial infarction
C. Lupus-like syndrome
D. Wolff–Parkinson–White (WPW) syndrome
27. A client is undergoing preoperative teaching before his cardiac surgery and the nurse
is aware that a temporary pacemaker will be placed later that day. What is the nurse's
responsibility in the care of the client's pacemaker?
A. Monitoring for pacemaker malfunction or battery failure
B. Determining when it is appropriate to remove the pacemaker
C. Making necessary changes to the pacemaker settings
D. Selecting alternatives to future pacemaker use
28. The nurse caring for a client whose sudden onset of sinus bradycardia is not
responding adequately to atropine. What might be the treatment of choice for this client?
A. Implanted pacemaker
B. Transcutaneous pacemaker
C. ICD
D. Asynchronous defibrillator
29. The nurse is caring for a client who has had a dysrhythmic event. The nurse is aware
of the need to assess for signs of diminished cardiac output (CO). What change in status
may signal to the nurse a decrease in cardiac output?
A. Increased blood pressure
B. Bounding peripheral pulses
C. Changes in level of consciousness
D. Skin flushing
30. The nurse is caring for a client who has had a biventricular pacemaker implanted.
When planning the client's care, the nurse should recognize what goal of this
intervention?
A. Resynchronization
B. Defibrillation
C. Angioplasty
D. Ablation
31. When planning the care of a client with an implanted pacemaker, what assessment
should the nurse prioritize?
A. Core body temperature
B. Heart rate and rhythm
C. Blood pressure
D. Oxygen saturation level
32. The nurse is assessing a client who had a pacemaker implanted 4 weeks ago. During
the client's most recent follow-up appointment, the nurse identifies data that suggest the
client may be socially isolated and depressed. What nursing diagnosis is suggested by
these data?
A. Decisional conflict related to pacemaker implantation
B. Deficient knowledge related to pacemaker implantation
C. Spiritual distress related to pacemaker implantation
D. Ineffective coping related to pacemaker implantation
33. The nurse is caring for a client who is in the recovery room following the implantation
of an ICD. The client has developed ventricular tachycardia (VT). What should the nurse
assess and document?
A. ECG to compare time of onset of VT and onset of device's shock
B. ECG so health care provider can see what type of dysrhythmia the client has
C. Client's level of consciousness (LOC) at the time of the dysrhythmia
D. Client's activity at time of dysrhythmia
34. The staff educator is teaching a CPR class. Which of the following aspects of
defibrillation should the educator stress to the class?
A. Apply the paddles directly to the client's skin.
B. Use a conducting medium between the paddles and the skin.
C. Always use a petroleum-based gel between the paddles and the skin.
D. Any available liquid can be used between the paddles and the skin.
35. During a CPR class, a participant asks about the difference between cardioversion and
defibrillation. What would be the instructor's best response?
A. "Cardioversion is done on a beating heart; defibrillation is not."
B. "The difference is the timing of the delivery of the electric current."
C. "Defibrillation is synchronized with the electrical activity of the heart, but
cardioversion is not."
D. "Cardioversion is always attempted before defibrillation because it has fewer
risks."
36. A client with an ICD calls the cardiologist's office and talks to the nurse. The client is
concerned about being defibrillated too often. The nurse tells the client to come to the
office to be evaluated because the nurse knows that the most frequent complication of
ICD therapy is what issue?
A. Infection
B. Failure to capture
C. Premature battery depletion
D. Oversensing of dysrhythmias