‼️FINAL Dysrhythmias‼️

Question 1

Which ECG finding is most consistent with atrial fibrillation?

Answer 1

A: Irregularly irregular rhythm with no distinct P

R: Atrial fibrillation is characterized by a disorganized atrial rhythm resulting in an irregularly irregular ventricular response and the absence of identifiable P waves.

Question 2

Which medication is most appropriate for controlling the ventricular rate in a patient with atrial fibrillation?

Answer 2

A: Metoprolol

R: Metoprolol is a beta-blocker that reduces heart rate and is commonly used for rate control in atrial fibrillation.

Question 3

What is the priority intervention for a patient in ventricular fibrillation?

Answer 3

A: Start CPR and defibrillate

R: Ventricular fibrillation is a pulseless rhythm requiring immediate defibrillation and CPR to restore .

Question 4

Question: What is the primary reason patients with atrial fibrillation are placed on anticoagulants?
A. To manage hypertension
B. To reduce heart rate
C. To prevent stroke
D. To prevent myocardial infarction

Answer 4

Answer: C: To prevent stroke
Rationale: Atrial fibrillation increases the risk of thrombus formation in the atria, which can embolize and cause a stroke.

Question 5

Question: Which medication is commonly used to convert atrial fibrillation to sinus rhythm?
A. Atropine
B. Amiodarone
C. Lisinopril
D. Digoxin

Answer 5

Answer: B: Amiodarone
Rationale: Amiodarone is an antidysrhythmic commonly used to restore and maintain sinus rhythm in patients with atrial fibrillation.

Question 6

Question: What is the therapeutic INR range for a patient with atrial fibrillation on warfarin?
A. 1.0–1.5
B. 2.0–3.0
C. 3.5–4.5
D. 0.8–1.2

Answer 6

Answer: B: 2.0–3.0
Rationale: The therapeutic INR for stroke prevention in atrial fibrillation is typically between 2.0 and 3.0.

Question 7

Question: Which characteristic is most indicative of ventricular fibrillation on an ECG?
A. Regular wide QRS complexes
B. No identifiable P waves or QRS complexes
C. Sawtooth atrial waves
D. Premature beats with compensatory pause

Answer 7

Answer: B: No identifiable P waves or QRS complexes
Rationale: VF is identified by chaotic electrical activity without organized P waves or QRS complexes.

Question 8

Question: What is the immediate nursing action for a patient in ventricular tachycardia with no pulse?
A. Administer adenosine
B. Start CPR and prepare to defibrillate
C. Give IV metoprolol
D. Administer a bolus of fluids

Answer 8

Answer: B: Start CPR and prepare to defibrillate
Rationale: Pulseless VT is treated the same as VF—with immediate CPR and defibrillation.

Question 9

Question: What is the difference between defibrillation and synchronized cardioversion?
A. Cardioversion is for pulseless rhythms
B. Cardioversion is always done in emergencies
C. Defibrillation is unsynchronized and used in VF/VT
D. Defibrillation is used for atrial fibrillation

Answer 9

Answer: C: Defibrillation is unsynchronized and used in VF/VT
Rationale: Defibrillation is delivered immediately without synchronization, typically for VF or pulseless VT.

Question 10

Question: Which lead is best used for rhythm monitoring in telemetry?
A. aVR
B. V1
C. Lead II
D. Lead III

Answer 10

Answer: C: Lead II
Rationale: Lead II provides a clear view of P waves and is ideal for rhythm analysis.

Question 11

Question: Which patient report is most concerning in a patient with a pacemaker?
A. Fatigue after activity
B. Tingling at incision site
C. Dizziness and irregular heartbeat
D. Muscle soreness in the arm

Answer 11

Answer: C: Dizziness and irregular heartbeat
Rationale: This could indicate pacemaker failure to capture or sense and requires immediate evaluation.

Question 12

Question: What ECG pattern is typically seen in atrial fibrillation?
A. Regular P-P intervals
B. Chaotic atrial activity with irregularly irregular rhythm
C. PR interval shortening
D. ST segment depression

Answer 12

Answer: B: Chaotic atrial activity with irregularly irregular rhythm
Rationale: A hallmark of Afib is chaotic atrial impulses leading to an irregularly irregular ventricular response.

Question 13

Question: What is the recommended initial intervention for a stable patient with VT and a pulse?
A. Defibrillation
B. Synchronized cardioversion
C. Start CPR
D. IV atropine

Answer 13

Answer: B: Synchronized cardioversion
Rationale: For stable VT with a pulse, synchronized cardioversion is the treatment of choice.

Question 14

Question: Which property of cardiac cells allows them to initiate an impulse without external stimulus?
A. Excitability
B. Conductivity
C. Automaticity
D. Contractility

Answer 14

Answer: C: Automaticity
Rationale: Automaticity is the ability of pacemaker cells to initiate an impulse spontaneously.

Question 15

Question: What is the most common symptom in patients experiencing ventricular tachycardia?
A. Nausea
B. Bradycardia
C. Palpitations and chest discomfort
D. Muscle cramps

Answer 15

Answer: C: Palpitations and chest discomfort
Rationale: VT often causes decreased cardiac output, leading to palpitations, hypotension, and chest symptoms.

Question 16

Question: Which of the following is a key risk associated with atrial fibrillation?
A. Bradycardia
B. Heart valve rupture
C. Embolic stroke
D. Pericardial effusion

Answer 16

Answer: C: Embolic stroke
Rationale: Due to ineffective atrial contraction, clots may form and embolize to the brain.

Question 17

Question: Which nursing assessment is priority in a patient with new-onset dysrhythmia?
A. Urine output
B. Pupil size
C. Level of consciousness and vital signs
D. Bowel sounds

Answer 17

Answer: C: Level of consciousness and vital signs
Rationale: These reflect perfusion status and are essential to determine urgency of intervention.

Question 18

Question: What finding would suggest failure to capture in a pacemaker?
A. No spikes visible
B. Spikes with no associated QRS complex
C. Bradycardia with wide QRS
D. Ventricular fibrillation

Answer 18

Answer: B: Spikes with no associated QRS complex
Rationale: This indicates the pacemaker fired, but the heart did not respond.

Question 19

Question: What is the primary goal of cardioversion in atrial fibrillation?
A. Prevent chest pain
B. Restore normal sinus rhythm
C. Lower blood pressure
D. Prevent pacemaker malfunction

Answer 19

Answer: B: Restore normal sinus rhythm
Rationale: Cardioversion can reset the electrical rhythm to normal in hemodynamically stable patients.

Question 19

Question: What is the initial drug of choice for treating PSVT?
A. Epinephrine
B. Amiodarone
C. Adenosine
D. Metoprolol

Answer 19

Answer: C: Adenosine
Rationale: Adenosine rapidly slows conduction through the AV node and can restore normal rhythm.

Question 20

Question: What is the effect of vagus nerve stimulation on the heart?
A. Increases HR and contractility
B. Slows SA and AV node conduction
C. Stimulates Purkinje fibers
D. Causes atrial fibrillation

Answer 20

Answer: B: Slows SA and AV node conduction
Rationale: Vagal stimulation decreases heart rate by slowing impulse formation and conduction.

Question 21

Question: Which symptom is most concerning in a patient with ventricular fibrillation?
A. Palpitations
B. Chest pain
C. Loss of consciousness
D. Bradycardia

Answer 21

Answer: C: Loss of consciousness
Rationale: VF causes immediate loss of perfusion, leading to unconsciousness and death if untreated.

Question 22

Question: What is the purpose of an ICD?
A. Monitor INR levels
B. Pace the heart permanently
C. Detect and terminate VT/VF
D. Replace pacemaker leads

Answer 22

Answer: C: Detect and terminate VT/VF
Rationale: ICDs deliver shocks to stop life-threatening arrhythmias such as VT and VF.

Question 23

Question: What effect does sympathetic stimulation have on the heart?
A. Decreases conduction velocity
B. Slows SA node firing
C. Increases HR and contractility
D. Reduces preload

Answer 23

Answer: C: Increases HR and contractility
Rationale: Sympathetic stimulation activates beta-adrenergic receptors, increasing HR and force of contraction.

Question 24

Question: A patient with atrial fibrillation reports fatigue and dyspnea. What is the likely cause? A. Medication side effects B. Low blood glucose C. Decreased cardiac output D. High cholesterol

Answer 24

Answer: C: Decreased cardiac output Rationale: Loss of atrial contraction (kick) leads to reduced ventricular filling and output.

Question 25

Question: Which intervention is required before elective cardioversion in a patient with Afib >48 hours? A. Beta-blocker infusion B. Transesophageal echocardiogram C. Defibrillation D. Administer calcium gluconate

Answer 25

Answer: B: Transesophageal echocardiogram Rationale: TEE is used to rule out atrial thrombus before cardioversion to avoid embolic events.

Question 26

Question: What is the first step in interpreting a rhythm strip? A. Analyze the ST segment B. Count the number of P waves C. Assess the regularity of the R-R interval D. Measure QRS voltage

Answer 26

Answer: C: Assess the regularity of the R-R interval Rationale: Regularity helps determine the type of rhythm and guides further interpretation steps.

Question 27

Question: What is an important teaching point for patients on apixaban? A. Avoid all dairy products B. Report any signs of bleeding C. Stop the drug if dizzy D. Take it on an empty stomach only

Answer 27

Answer: B: Report any signs of bleeding Rationale: Apixaban increases bleeding risk; patients should be instructed to report bleeding immediately.

Question 28

Question: What is the function of the bundle of His in the conduction system? A. Initiates impulses spontaneously B. Delays atrial signal C. Transmits impulse to the ventricles D. Stimulates the atria to contract

Answer 28

Answer: C: Transmits impulse to the ventricles Rationale: The bundle of His conducts the impulse from the AV node to the bundle branches and ventricles.

Question 29

Question: Which drug would the nurse expect to give to decrease ventricular response in Afib? A. Amiodarone B. Diltiazem C. Atropine D. Epinephrine

Answer 29

Answer: B: Diltiazem Rationale: Diltiazem is a calcium channel blocker used to slow ventricular rate in patients with Afib.