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C35 - ch 35 test bank
Med Surg (Fortis College)
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Chapter 35: Dysrhythmias
Lewis: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. To determine whether there is a delay in impulse conduction through the ventricles, the nurse
will measure the duration of the patient’s
a. P wave.
b. Q wave.
c. PR interval.
d. QRS complex.
ANS: D
The QRS complex represents ventricular depolarization. The P wave represents the
depolarization of the atria. The PR interval represents depolarization of the atria,
atrioventricular node, bundle of His, bundle branches, and the Purkinje fibers. The Q wave is
the first negative deflection following the P wave and should be narrow and short.
DIF: Cognitive Level: Understand (comprehension)
REF: 759
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
2. The nurse needs to quickly estimate the heart rate for a patient with a regular heart rhythm.
Which method will be best to use?
a. Count the number of large squares in the R-R interval and divide by 300.
b. Print a 1-minute electrocardiogram (ECG) strip and count the number of QRS
complexes.
c. Use the 3-second markers to count the number of QRS complexes in 6 seconds
and multiply by 10.
d. Calculate the number of small squares between one QRS complex and the next
and divide into 1500.
ANS: C
This is the quickest way to determine the ventricular rate for a patient with a regular rhythm.
All the other methods are accurate, but take longer.
DIF: Cognitive Level: Analyze (analysis)
REF: 759
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
3. A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to
have a heart rate of _____ beats/min.
a. 15 to 20
b. 20 to 40
c. 40 to 60
d. 60 to 100
ANS: C
If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically
discharge at the normal rate of 40 to 60 beats/minute. The slower rates are typical of the
bundle of His and Purkinje system and may be seen with failure of both the SA and AV node
to discharge. The normal SA node rate is 60 to 100 beats/min.
DIF: Cognitive Level: Understand (comprehension)
REF: 760
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
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4. The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes
the following analysis: no visible P waves, PR interval not measurable, ventricular rate of 162,
R-R interval regular, and QRS complex wide and distorted, and QRS duration of 0.18 second.
The nurse interprets the patient’s cardiac rhythm as
a. atrial flutter.
c. ventricular fibrillation.
b. sinus tachycardia.
d. ventricular tachycardia.
ANS: D
The absence of P waves, wide QRS, rate greater than 150 beats/min, and the regularity of the
rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS
configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has
P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.
DIF: Cognitive Level: Apply (application)
REF:
764
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
5. The nurse notes that a patient’s heart monitor shows that every other beat is earlier than
expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape.
How will the nurse document the rhythm?
a. Ventricular couplets
b. Ventricular bigeminy
c. Ventricular R-on-T phenomenon
d. Multifocal premature ventricular contractions
ANS: B
Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and
bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets. There is
no indication that the premature ventricular contractions are multifocal or that the R-on-T
phenomenon is occurring.
DIF: Cognitive Level: Apply (application)
REF:
768
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
6. A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the
PR interval is 0.24 seconds. The most appropriate intervention by the nurse would be to
notify the health care provider immediately.
document the finding and monitor the patient.
give atropine per agency dysrhythmia protocol.
prepare the patient for temporary pacemaker insertion.
a.
b.
c.
d.
ANS: B
First-degree atrioventricular block is asymptomatic and requires ongoing monitoring because
it may progress to more serious forms of heart block. The rate is normal, so there is no
indication that atropine is needed. Immediate notification of the health care provider about an
asymptomatic rhythm is not necessary.
DIF: Cognitive Level: Apply (application)
REF:
767
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
7. A patient who was admitted with a myocardial infarction experiences a 45-second episode of
ventricular tachycardia, then converts to sinus rhythm with a heart rate of 98 beats/min. Which
action should the nurse take next?
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a.
b.
c.
d.
Immediately notify the health care provider.
Document the rhythm and continue to monitor the patient.
Prepare to give IV amiodarone per agency dysrhythmia protocol.
Perform synchronized cardioversion per agency dysrhythmia protocol.
ANS: C
The burst of sustained ventricular tachycardia indicates that the patient has significant
ventricular irritability, and antidysrhythmic medication administration is needed to prevent
further episodes. The nurse should notify the health care provider after the medication is
started. Cardioversion is not indicated given that the patient has returned to a sinus rhythm.
Documentation and continued monitoring are not adequate responses to this situation.
DIF: Cognitive Level: Analyze (analysis)
REF: 766
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
8. After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree
atrioventricular (AV) block, which finding indicates that the drug has been effective?
Increase in the patient’s heart rate
Increase in strength of peripheral pulses
Decrease in premature atrial contractions
Decrease in premature ventricular contractions
a.
b.
c.
d.
ANS: A
Atropine will increase the heart rate and conduction through the AV node. Because the drug
increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is
not used to evaluate the drug effectiveness. The patient does not have premature atrial or
ventricular contractions.
DIF: Cognitive Level: Apply (application)
REF:
763
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
9. A patient with dilated cardiomyopathy has new onset atrial fibrillation that has been
unresponsive to drug therapy for several days. Teaching for this patient would include
information about
a. anticoagulant therapy.
c. emergency cardioversion.
b. permanent pacemakers.
d. IV adenosine (Adenocard).
ANS: A
Atrial fibrillation therapy that has persisted for more than 48 hours requires anticoagulant
treatment for 3 weeks before attempting cardioversion. This is done to prevent embolization
of clots from the atria. Cardioversion may be done after several weeks of anticoagulation
therapy. Adenosine is not used to treat atrial fibrillation. Pacemakers are routinely used for
patients with bradydysrhythmias. Information does not indicate that the patient has a slow
heart rate.
DIF: Cognitive Level: Apply (application)
REF:
766
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
10. Which information will the nurse include when teaching a patient who is scheduled for a
radiofrequency catheter ablation for treatment of atrial flutter?
a. The procedure prevents or minimizes the risk for sudden cardiac death.
b. The procedure uses cold therapy to stop the formation of the flutter waves.
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c. The procedure uses electrical energy to destroy areas of the conduction system.
d. The procedure stimulates the growth of new conduction pathways between the
atria.
ANS: C
Radiofrequency catheter ablation therapy uses electrical energy to “burn” or ablate areas of
the conduction system as definitive treatment of atrial flutter (i.e., restore normal sinus
rhythm) and tachydysrhythmias. All other statements regarding the procedure are incorrect.
DIF: Cognitive Level: Apply (application)
REF:
765
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
11. The nurse knows that discharge teaching about the management of a new permanent
pacemaker has been most effective when the patient states
a. “It will be several weeks before I can return to my usual activities.”
b. “I will avoid cooking with a microwave oven or being near one in use.”
c. “I will notify the airlines when I make a reservation that I have a pacemaker.”
d. “I won’t lift the arm on the pacemaker side until I see the health care provider.”
ANS: D
The patient is instructed to avoid lifting the arm on the pacemaker side above the shoulder to
avoid displacing the pacemaker leads. The patient should notify airport security about the
presence of a pacemaker before going through the metal detector, but there is no need to
notify the airlines when making a reservation. Microwave oven use does not affect the
pacemaker. The insertion procedure involves minor surgery that will have a short recovery
period.
DIF: Cognitive Level: Apply (application)
REF:
775
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
12. Which intervention by a new nurse who is caring for a patient who has just had an implantable
cardioverter-defibrillator (ICD) inserted indicates a need for more teaching about the care of
patients with ICDs?
a. The nurse administers amiodarone (Cordarone) to the patient.
b. The nurse helps the patient fill out the application for obtaining a Medic Alert
device.
c. The nurse encourages the patient to do active range of motion exercises for all
extremities.
d. The nurse teaches the patient that sexual activity can be resumed when the incision
is healed.
ANS: C
The patient should avoid moving the arm on the ICD insertion site until healing has occurred
to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate
for this patient.
DIF: Cognitive Level: Apply (application)
REF:
772
TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe and Effective Care Environment
13. Which action should the nurse perform when preparing a patient with supraventricular
tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg?
a. Turn the synchronizer switch to the “off” position.
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b. Give a sedative before cardioversion is implemented.
c. Set the defibrillator/cardioverter energy to 360 joules.
d. Provide assisted ventilations with a bag-valve-mask device.
ANS: B
When a patient has a nonemergency cardioversion, sedation is used just before the procedure.
The synchronizer switch is turned “on” for cardioversion. The initial level of joules for
cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this patient.
DIF: Cognitive Level: Apply (application)
REF:
772
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
14. A 20-yr-old patient has a mandatory electrocardiogram (ECG) before participating on a
college soccer team and is found to have sinus bradycardia, rate 52. Blood pressure (BP) is
114/54 mm Hg, and the student denies any health problems. What action by the nurse is most
appropriate?
a. Allow the student to participate on the soccer team.
b. Refer the student to a cardiologist for further testing.
c. Tell the student to stop playing immediately if any dyspnea occurs.
d. Obtain more detailed information about the student’s family health history.
ANS: A
In an aerobically trained individual, sinus bradycardia is normal. The student’s normal BP and
negative health history indicate that there is no need for a cardiology referral or for more
detailed information about the family’s health history. Dyspnea during an aerobic activity such
as soccer is normal.
DIF: Cognitive Level: Apply (application)
REF:
763
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
15. When analyzing the rhythm of a patient’s electrocardiogram (ECG), the nurse will need to
investigate further upon finding a(n)
a. isoelectric ST segment.
b. PR interval of 0.18 second.
c. QT interval of 0.38 second.
d. QRS interval of 0.14 second.
ANS: D
Because the normal QRS interval is less than 0.12 seconds, the patient’s QRS interval of 0.14
seconds indicates that the conduction through the ventricular conduction system is prolonged.
The PR interval and QT interval are within normal range and ST segment should be isoelectric
(flat).
DIF: Cognitive Level: Apply (application)
REF:
761
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
16. A patient has ST segment changes that suggest an acute inferior wall myocardial infarction.
Which lead would be best for monitoring the patient?
c. V2
d. V6
a. I
b. II
ANS: B
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Leads II, III, and AVF reflect the inferior area of the heart and the ST segment changes. Lead
II will best capture any electrocardiographic changes that indicate further damage to the
myocardium. The other leads do not reflect the inferior part of the myocardial wall and will
not provide data about further ischemic changes in that area.
DIF: Cognitive Level: Analyze (analysis)
REF: 758
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
17. Which laboratory result for a patient with multifocal premature ventricular contractions
(PVCs) is most important for the nurse to communicate to the health care provider?
c. Serum sodium of 134 mEq/L
d. Serum potassium of 2.9 mEq/L
a. Blood glucose of 243 mg/dL
b. Serum chloride of 92 mEq/L
ANS: D
Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular
tachycardia, and ventricular fibrillation. The health care provider will need to prescribe a
potassium infusion to correct this abnormality. Although the other laboratory values are also
abnormal, they are not likely to be the etiology of the patient’s PVCs and do not require
immediate correction.
DIF: Cognitive Level: Analyze (analysis)
REF: 768
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
18. A patient’s heart monitor shows a pattern of undulations of varying contours and amplitude
with no measurable ECG pattern. The patient is unconscious, apneic, and pulseless. Which
action should the nurse take first?
a. Give epinephrine (Adrenalin) IV.
b. Perform immediate defibrillation.
c. Prepare for endotracheal intubation.
d. Ventilate with a bag-valve-mask device.
ANS: B
The patient’s rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the
initial action should be to defibrillate. If a defibrillator is not immediately available or is
unsuccessful in converting the patient to a better rhythm, begin chest compressions. The other
actions may also be appropriate but not first.
DIF: Cognitive Level: Analyze (analysis)
REF: 771
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
19. A patient’s heart monitor shows sinus rhythm, rate 64. The PR interval is 0.18 seconds at 1:00
AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse
take next?
a. Place the transcutaneous pacemaker pads on the patient.
b. Give atropine sulfate 1 mg IV per agency dysrhythmia protocol.
c. Call the health care provider before giving scheduled metoprolol (Lopressor).
d. Document the patient’s rhythm and assess the patient’s response to the rhythm.
ANS: C
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The patient has progressive first-degree atrioventricular (AV) block, and the b-blocker should
be held until discussing the drug with the health care provider. Documentation and assessment
are appropriate but not fully adequate responses. The patient with first-degree AV block
usually is asymptomatic and a pacemaker is not indicated. Atropine is sometimes used for
symptomatic bradycardia, but there is no indication that this patient is symptomatic.
DIF: Cognitive Level: Analyze (analysis)
REF: 767
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
20. A patient develops sinus bradycardia at a rate of 32 beats/min, has a blood pressure (BP) of
80/42 mm Hg, and is complaining of feeling faint. Which action should the nurse take next?
Recheck the heart rhythm and BP in 5 minutes.
Have the patient perform the Valsalva maneuver.
Give the scheduled dose of diltiazem (Cardizem).
Apply the transcutaneous pacemaker (TCP) pads.
a.
b.
c.
d.
ANS: D
The patient is experiencing symptomatic bradycardia and treatment with TCP is appropriate.
Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel
blockers will further decrease the heart rate and the diltiazem should be held. The Valsalva
maneuver will further decrease the rate.
DIF: Cognitive Level: Apply (application)
REF:
775
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
21. A 19-yr-old student comes to the student health center at the end of the semester complaining
that, “My heart is skipping beats.” An electrocardiogram (ECG) shows occasional unifocal
premature ventricular contractions (PVCs). What action should the nurse take next?
a. Insert an IV catheter for emergency use.
b. Start supplemental O2 at 2 to 3 L/min via nasal cannula.
c. Ask the patient about current stress level and caffeine use.
d. Have the patient taken to the nearest emergency department (ED).
ANS: C
In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the
PVCs suggests stress or caffeine as possible etiologic factors. The patient is hemodynamically
stable, so there is no indication that the patient needs supplemental O2, an IV, or to be seen in
the ED.
DIF: Cognitive Level: Apply (application)
REF:
768
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
22. The nurse has received change-of-shift report about the following patients on the progressive
care unit. Which patient should the nurse see first?
a. A patient with atrial fibrillation, rate 88 and irregular, who has a dose of warfarin
(Coumadin) due
b. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is
dizzy when ambulating
c. A patient who is in a sinus rhythm, rate 98 and regular, recovering from an
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elective cardioversion 2 hours ago
d. A patient whose implantable cardioverter-defibrillator (ICD) fired twice today and
has a dose of amiodarone (Cordarone) due
ANS: D
The frequent firing of the ICD indicates that the patient’s ventricles are very irritable and the
priority is to assess the patient and give the amiodarone. The other patients can be seen after
the amiodarone is given.
DIF: Cognitive Level: Analyze (analysis)
REF: 773
OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
23. A patient who is on the telemetry unit develops atrial flutter, rate 150, with associated dyspnea
and chest pain. Which action that is included in the hospital dysrhythmia protocol should the
nurse do first?
a. Obtain a 12-lead electrocardiogram (ECG).
b. Notify the health care provider of the change in rhythm.
c. Give supplemental O2 at 2 to 3 L/min via nasal cannula.
d. Assess the patient’s vital signs including O2 saturation.
ANS: C
Because this patient has dyspnea and chest pain in association with the new rhythm, the
nurse’s initial actions should be to address the patient’s airway, breathing, and circulation
(ABC) by starting with O2 administration. The other actions are also important and should be
implemented rapidly.
DIF: Cognitive Level: Analyze (analysis)
REF: 765
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
24. A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic, and has no
palpable pulses. What action should the nurse take next?
a. Perform synchronized cardioversion.
b. Start cardiopulmonary resuscitation (CPR).
c. Give atropine per agency dysrhythmia protocol.
d. Provide supplemental O2 via non-rebreather mask.
ANS: B
The patient’s clinical manifestations indicate pulseless electrical activity, and the nurse should
immediately start CPR. The other actions would not be of benefit to this patient.
DIF: Cognitive Level: Apply (application)
REF:
763
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
25. Which action will the nurse include in the plan of care for a patient who was admitted with
syncopal episodes of unknown origin?
Explain the association between dysrhythmias and syncope.
Instruct the patient to call for assistance before getting out of bed.
Teach the patient about the need to avoid caffeine and other stimulants.
Tell the patient about the benefits of implantable cardioverter-defibrillators.
a.
b.
c.
d.
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ANS: B
A patient with fainting episodes is at risk for falls. The nurse will plan to minimize the risk by
having assistance whenever the patient is up. The other actions may be needed if
dysrhythmias are found to be the cause of the patient’s syncope but are not appropriate for
syncope of unknown origin.
DIF: Cognitive Level: Apply (application)
REF:
777
TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
26. Which nursing action can the registered nurse (RN) delegate to experienced unlicensed
assistive personnel (UAP) working as telemetry technicians on the cardiac care unit?
a. Decide whether a patient’s heart rate of 116 requires urgent treatment.
b. Observe heart rhythms for multiple patients who have telemetry monitoring.
c. Monitor a patient’s level of consciousness during synchronized cardioversion.
d. Select the best lead for monitoring a patient admitted with acute coronary
syndrome.
ANS: B
UAP serving as telemetry technicians can monitor heart rhythms for individuals or groups of
patients. Nursing actions such as assessment and choice of the most appropriate lead based on
ST segment elevation location require RN-level education and scope of practice.
DIF: Cognitive Level: Apply (application)
REF:
760
OBJ: Special Questions: Delegation
TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
27. Which action by a new registered nurse (RN) who is orienting to the telemetry unit indicates a
good understanding of the treatment of heart dysrhythmias?
a. Prepares defibrillator settings at 360 joules for a patient whose monitor shows
asystole.
b. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular
tachycardia
c. Turns the synchronizer switch to the “on” position before defibrillating a patient
with ventricular fibrillation
d. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset
type II second degree AV block
ANS: B
Adenosine must be given over 1 to 2 seconds to be effective. The other actions indicate a need
for more teaching about treatment of heart dysrhythmias. The RN should hold the diltiazem
until discussing it with the health care provider. The treatment for asystole is immediate CPR.
The synchronizer switch should be “off” when defibrillating.
DIF: Cognitive Level: Analyze (analysis)
OBJ: Special Questions: Multiple Patients
MSC: NCLEX: Safe and Effective Care Environment
REF: 765
TOP: Nursing Process: Evaluation
28. A patient reports dizziness and shortness of breath for several days. During heart monitoring
in the emergency department (ED), the nurse obtains the following electrocardiographic
(ECG) tracing. The nurse interprets this heart rhythm as
a. junctional escape rhythm.
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b. accelerated idioventricular rhythm.
c. third-degree atrioventricular (AV) block.
d. sinus rhythm with premature atrial contractions (PACs).
ANS: C
The inconsistency between the atrial and ventricular rates and the variable PR interval indicate
that the rhythm is third-degree AV block. Sinus rhythm with PACs will have a normal rate and
consistent PR intervals with occasional PACs. An accelerated idioventricular rhythm will not
have visible P waves.
DIF: Cognitive Level: Apply (application)
REF:
768
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
29. A patient who is complaining of a “racing” heart and feeling “anxious” comes to the
emergency department. The nurse places the patient on a heart monitor and obtains the
following electrocardiographic (ECG) tracing.
Which action should the nurse take next?
a. Prepare to perform electrical cardioversion.
b. Have the patient perform the Valsalva maneuver.
c. Obtain the patient’s vital signs including O2 saturation.
d. Prepare to give a b-blocker medication to slow the heart rate.
ANS: C
The patient has sinus tachycardia, which may have multiple etiologies such as pain,
dehydration, anxiety, and myocardial ischemia. Further assessment is needed before
determining the treatment. Vagal stimulation or b-blockade may be used after further
assessment of the patient. Electrical cardioversion is used for some tachydysrhythmias but
would not be used for sinus tachycardia.
DIF: Cognitive Level: Analyze (analysis)
REF: 763
OBJ: Special Questions: Prioritization
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
COMPLETION
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1. When analyzing an electrocardiographic (ECG) rhythm strip of a patient with a regular heart
rhythm, the nurse counts 30 small blocks from one R wave to the next. The nurse calculates
the patient’s heart rate as ____.
ANS:
50
There are 1500 small blocks in a minute, and the nurse will divide 1500 by 30.
DIF: Cognitive Level: Apply (application)
REF:
759
TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity
OTHER
1. When preparing to defibrillate a patient, in which order will the nurse perform the following
steps? (Put a comma and a space between each answer choice [A, B, C, D, E].)
a. Turn the defibrillator on.
b. Deliver the electrical charge.
c. Select the appropriate energy level.
d. Place the hands-free, multifunction defibrillator pads on the patient’s chest.
e. Check the location of other staff and call out “all clear.”
ANS:
A, C, D, E, B
This order will result in rapid defibrillation without endangering hospital staff.
DIF: Cognitive Level: Analyze (analysis)
REF: 771
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
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