EKG QUESTIONS

1.The client is admitted in stable condition from the emergency department. Based on the ECG strip,
(atrial flutter) the nurse anticipates which of the following types of medications will be ordered?

Select all that apply.

1.Cardiac glycoside

2.An anticoagulant

3.Calcium channel blocker

4.Beta blocker

5.Diuretic

6.Vasodilator

2. The nurse is caring for a client who had a permanent pacemaker inserted because of a complete heart
block. The nurse determines that which client outcome indicates a successful procedure?

1. Client ambulating in the hall within 4 hours of the procedure without dyspnea or chest pain

2. Client’s ECG monitor demonstrates normal sinus rhythm

3. Heart rate of 80 beats per minute, BP 112/74 mmHg

4. Client’s ECG monitor shows paced beats at the rate of 72 per minute

3. The nurse is admitting a client from the post-anesthesia care unit who just received a permanent
atrioventricular pacemaker for a complete heart block. Which action should the nurse implement first?

1.

Assess incision for bleeding or hematoma formation

2.

Auscultate bilateral anterior and posterior lung sounds

3.

Initiate continuous cardiac monitoring

4.Reestablish IV fluids and postoperative antibiotics

4. What clinical indicator is the nurse most likely to identify when completing a history and physical
assessment of a client with complete heart block?

1. Syncope

2. Headache

3. Tachycardia

4. Hemiparesis

5. Which client should the nurse assess first?

1. Client with atrial fibrillation with a new prescription for warfarin

2. Client with chronic obstructive pulmonary disease with an oxygen saturation of 91%

3. Client with postoperative pain rated 8 out of 10

4. Client with third-degree heart block with a pulse of 42/min,

6. The nurse is assessing a client who has had a myocardial infarction (MI). The nurse notes the cardiac
rhythm shown on the electrocardiogram strip below. The nurse identifies this rhythm as which of the
following?

1. Atrial fibrillation.

2. Ventricular tachycardia.

3. Premature ventricular contractions (PVCs).

4. Third-degree heart block.

7. A client is admitted to the emergency department after a fall with dizziness and light-headedness.
Blood pressure is 88/62 mm Hg, and the cardiac monitor displays the rhythm in the exhibit. The nurse
recognizes it as which rhythm? Click on the exhibit button for additional information.

1.Complete heart block

2.1st-degree heart block

3.Sinus bradycardia

4.Sinus rhythm

Submit

8. A client comes to the clinic with complaints of heart palpitations, shortness of breath, fatigue, and
syncope. An ECG indicates atrial fibrillation. When the nurse performs an assessment, which finding is
MOST concerning?
1.Heart rate of 150

2.Unplanned weight loss

3.Difficulty speaking

4. History of type 2 diabetes

9. The nurse is discharging to home a client with a new diagnosis of atrial fibrillation. The nurse should
explain that onset of which symptom is most important to report to the healthcare provider?

1. Irregular pulse

2. Fever

3. Fatigue

4. Hemoptysis

10. A client with chronic heart failure presents to the ED with a new onset of atrial fibrillation. Which of
the following medications would the nurse question?

a. Lasix (furosemide)

b. Toprol XL (metoprolol succinate)

c. Cardizem (diltiazem)

d. Corlanor (ivabradine)

11. The nurse reinforces teaching a client on prescribed dabigatran for chronic atrial fibrillation. Which
statement by the client indicates a need for further teaching?

1. "I will call my health care provider if I notice red urine or blood in my stool."

2. "I will not stop taking dabigatran even if I get a stomachache."

3. "I will place capsules in my pill box so I will not forget to take a dose."

4. "I will swallow the capsule whole with a full glass of water."

12. Members of a resuscitation team have arrived at a client’s bedside with a defibrillator. A nurse and a
nursing assistant are performing cardiopulmonary resuscitation (CPR). What should be the nurse’s next
action?
1. Stop CPR to apply the conduction pads and analyze the rhythm.

2. Complete a full minute of CPR, then apply the conduction pads and analyze the rhythm.

3. Continue with CPR while the resuscitation team is applying the conduction pads and analyzing the
rhythm.

4. Continue with rescue breathing while the resuscitation team is applying the conduction pads.

13. The nurse working in the intensive care unit hears an alarm coming from a client's room. On
entering the room, the nurse sees the rhythm displayed in the exhibit on the monitor. The nurse
recognizes it as which rhythm? Click on the exhibit button for additional information.

1. Asystole

2. Atrial fibrillation

3. Ventricular fibrillation (VF)

4. Ventricular tachycardia

14. The nurse is assigned the care of a client who experienced a myocardial infarction and is being
monitored by cardiac telemetry. The nurse notes the sudden onset of this cardiac rhythm on the
monitor. The nurse should immediately take which action? Refer to Figure.

1. Take the client's blood pressure.

2. Initiate cardiopulmonary resuscitation (CPR).

3. Place a nitroglycerin tablet under the client's tongue.

4. Continue to monitor the client for 1 minute and then contact the health care provider (HCP).

15. The nurse observes a normal sinus rhythm on the 5-lead telemetry monitor after a client has been in
atrial fibrillation with a rapid ventricular response. Which of the following should the nurse do first?

1. Notify the healthcare provider

2. Obtain a 12 lead EKG

3. Monitor the client

4. Check the pulse

16. A client is showing sinus tachycardia on the telemetry monitor. Which medication would the 7nurse
expect to give?

1. Atropine.

2. Lidocaine.

3. Diltiazem.

4. Epinephrine.

17. Two hours after admission, a client reports palpitations, chest discomfort, and light-headedness. The
nurse connects the client to a cardiac monitor and notes a weak, thread pulse, and a BP of 90/50. Which
action should the nurse take? Select all that apply.

Exhibit
 1. Administer Lidocaine 50 mg intravenous push (IVP).

2. Initiate oxygen at 2 liters per nasal cannula.

3. Apply oxygen saturation monitor to client.

4. Prepare for immediate synchronized cardioversion.

5. Perform carotid massage.

6. Begin cardiopulmonary resuscitation.

18. A client is admitted to the emergency department with digoxin toxicity. Nursing assessment reveals
cool skin, a slow, weak pulse, and a BP of 86/44. What initial action should the nurse take based on the
assessment and cardiac rhythm strip?

Exhibit

1. Administer sodium nitroprusside 0.3 mcg/kg/min IV.

2. Set up for transcutaneous pacing.

3. Have client perform vagal maneuver.

4. Draw blood for potassium level.

19. The nurse is reviewing medication instructions with a client who is taking digoxin. The nurse should
reinforce to the client to report which of the following side effects?

Polyuria, thirst, dry skin

Hunger, dizziness, diaphoresis

Nausea, vomiting, fatigue

Rash, dyspnea, edema

20. An 18-month-old with a congenital heart defect is to receive digoxin twice a day. The nurse should
instruct the parents about which of the following?

1. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm.

2. Signs of toxicity include loss of appetite, vomiting, increased pulse, and visual disturbances.

3. Digoxin is absorbed better if taken with meals.

4. If the child vomits within 15 minutes of administration, the dosage should be repeated

21. The nurse is assessing a client who has had a myocardial infarction. The nurse notes the cardiac
rhythm shown on the electrocardiogram strip below. The nurse identifi es this rhythm as which of the

following?

1. Atrial fi brillation.

2. Ventricular tachycardia.

3. Premature ventricular contractions.

4. Sinus tachycardia
22. A client is wearing a continuous cardiac monitor, which begins to sound its alarm. The nurse sees no
electrocardiographic complexes on the screen. Which is the priority nursing action?

1. Call a code.

2. Call the health care provider.

3. Check the client's status and lead placement.

4. Press the recorder button on the electrocardiogram console

23. A client has frequent bursts of ventricular tachycardia on the cardiac monitor. What should the
nurse be most concerned about with this dysrhythmia?

1. It can develop into ventricular fibrillation at any time.

2. It is almost impossible to convert to a normal rhythm.

3. It is uncomfortable for the client, giving a sense of impending doom.

4. It produces a high cardiac output that quickly leads to cerebral and myocardial ischemia

24. A client in ventricular fibrillation is about to be defibrillated. To convert this rhythm effectively, the
monophasic defibrillator machine should be set at which energy level (in joules, J) for the first delivery?

1. 50 J

2. 120 J

3. 200 J

4. 360 J

25.The nurse notes the client’s electrocardiogram (ECG) tracing shows a prolonged PR interval, a wide
QRS complex, and tall peaked T waves. Which action does the nurse take next?

1. Palpate the peripheral pulses.

2. Check the serum potassium.

3. Raise the head of the bed.

4. Obtain serum troponin level.

26. A client's electrocardiogram strip shows atrial and ventricular rates of 110 beats/minute. The PR
interval is 0.14 seconds, the QRS complex measures 0.08 seconds, and the PP and RR intervals are
regular. How should the nurse correctly interpret this rhythm?
1. Sinus tachycardia

2. Sinus bradycardia

3. Sinus dysrhythmia

4. Normal sinus rhythm

27. **A client is complaining of chest pain. Nursing assessment reveals a BP of 78/40, shortness of
breath, and third-degree AV block on the heart monitor. What medication would the nurse prepare for
initial administration?

A. Atropine

B. Verapamil (Calan)

C. Lidocaine (Xylocaine)

D. Procainamide (Pronesty

28. A client is attached to a cardiac monitor, and the nurse notes the presence of this cardiac rhythm on
the monitor. The nurse quickly assesses the client, knowing that this rhythm is indicative of which
rhythm? Refer to Figure.

1. Atrial fibrillation

2. Ventricular fibrillation (VF)

3. Ventricular tachycardia (VT)

4. Premature ventricular complexes

29. The nurse is caring for a client who suddenly starts complaining of palpitations, restlessness, and
anxiety. The nurse obtains a stat electrocardiogram (ECG) which shows this rhythm. Refer to figure. The
nurse should perform which actions, in anticipation of appropriate medication therapy with
amiodarone? (Figure from Ignatavicius, Workman, 2016).

1. Obtain an infusion pump and prepare to administer 150 mg over 1 hour followed by a maintenance
dose.

2. Obtain an infusion pump and prepare to administer 150 mg over 10 minutes followed by a
maintenance dose.

3. Obtain a syringe and administer 150 mg over 1 minute via intravenous push followed by a
maintenance dose.

4. Obtain a syringe and administer 360 mg over 2 minutes via intravenous push followed by a
maintenance dose

30. The nurse is assigned the care of a client with a diagnosis of heart failure who is receiving
intravenous doses of furosemide. The client is attached to cardiac telemetry, and the nurse is
monitoring the client's cardiac status. The nurse notes that the client's cardiac rhythm has changed to
this pattern. The nurse determines that the most likely cause of this cardiac rhythm in the client is which
problem? Refer to Figure.
1. Pacemaker dysfunction

2. The presence of hypokalemia

3. The effectiveness of the furosemide

4. An impending myocardial infarction (MI)

31. A permanent demand pacemaker, set at a rate of 72 bpm, is implanted in a client for persistent
third-degree heart block. The nurse is most concerned if which finding is observed?

1. Pulse rate 88 bpm and irregular.

2. Apical pulse rate regular at 68 bpm.

3. Blood pressure 110/88 mm Hg, pulse at 78 bpm.

4. Skin warm and dry to touch. .

32. A client with a permanent pacemaker with continuous telemetry calls the nurse and reports feeling
lightheaded and dizzy. The client's blood pressure is 75/55 mm Hg. What is the nurse's priority action?
Click the exhibit button for additional information.

1.
Administer atropine 0.5 mg IV

2.

Administer dopamine 5 mcg/kg/min IV

3.

Initiate transcutaneous pacing

4.

Notify the health care provider

33. The nurse receives a report that a client with a pacemaker has experienced loss of capture. What
assessment data would the nurse anticipate?

1. The heart rate is 42 beats/min, and no pacemaker spikes are seen on the rhythm strip.

2. The patient demonstrates hiccups.

3. Pacemaker spikes are noted, but no P wave or QRS complex follows.

4. The pacemaker spike falls on the T wave.

34. The nurse is caring for a client who just had a permanent ventricular pacemaker inserted.  The nurse
observes the cardiac monitor and sees a pacing spike followed by a QRS complex for each heartbeat. 
How should the nurse assess for mechanical capture of the pacemaker?

  1. Auscultate the client's apical pulse rate

  2. Measure the client's blood pressure

  3. Obtain a 12-lead ECG

  4. Palpate the client's radial pulse rate

35. The nurse is caring for a client with an implantable cardioverter defibrillator (ICD). The client goes
into ventricular tachycardia and is pulseless. The ICD has fired twice. What action should the nurse
take?

1. Administer epinephrine 1 mg IV push

2. Deactivate the ICD with a magnet

3. Initiate chest compressions

4. Take no action and let the ICD work

36. The nurse is monitoring a client’s EKG strip and notes coupled premature ventricular contractions
greater than 10 per minute. The nurse should expect to administer which of the following?

1. Atropine sulfate (Atropine) IV.

2. Isoproterenol (Isuprel) IV.

3. Verapamil (Calan) IV.

4. Lidocaine hydrochloride (Xylocaine) IV.

37. The clinic nurse instructs a client about an ambulatory electrocardiogram (ECG). Which client
statements indicate to the nurse a need for additional education? (Select all that apply.)

1.

“I will have to use a safety razor while the monitor is in place.”

2.

“I will keep a log of all of my activities during monitoring.”

3.

“I will wrap the device with plastic wrap before taking a shower.”

4.
“I will contact the health care provider if I experience lightheadedness.”

5.

“I will decrease my fiber during the monitoring.”

38. The nurse notes the client’s electrocardiogram (ECG) rhythm is torsades de pointes. Which
assessment does the nurse complete after a normal sinus rhythm is restored?

1. Monitor for ST segment depression.

2. Monitor for QT interval prolongation.

3. Monitor for PR interval prolongation.

4. Monitor for narrow QRS complexes.

39. A client's electrocardiogram shows that the ventricular rhythm is irregular and there are no
discernible P waves. The nurse recognizes that this pattern is associated with which condition?

1. Atrial flutter

2. Atrial fibrillation

3. Third-degree atrioventricular (AV) block

4. First-degree AV block

40. A new graduate nurse is working with a registered nurse (RN) to care for a patient who has asked to
see their ECG strip. The patient is confused about how the pattern is interpreted and asks for some
clarification. Which of the following statements made by the new graduate nurse requires intervention
from the registered nurse?

Select all that apply:

1. The ECG is a graphical representation of the heart’s electrical impulses

2. Voltage is measured on the horizontal axis

3. Time is measured on the vertical axis

4. Waveforms represent the depolarization and repolarization of the heart

5. 5 lead ECGs are the standard

41. A client complains of feeling “lightheaded” after radiofrequency catheter ablation. His cardiac
monitor reveals dissociation of P waves and QRS complexes as shown below. Which of the following is
the most appropriate first nursing intervention?

A. Call the rapid response team for cardioversion.

B. Notify the healthcare provider and prepare to administer atropine.

C. Notify the cardiologist and prepare for transcutaneous or transvenous pacing.

D. Document the rhythm and assessment in the client’s chart and monitor for further changes.

Check Answer

Challenge a Friend

Question Feedback

42. A client is found to be in stable supraventricular ventricular tachycardia (SVT). The nurse implements
which of the following interventions? Select all that apply.

Calls a code

Calls for a 12-lead EKG

Instructs the client to perform a vagal maneuver

Assists the client to sit up on the side of the bed

Gives the client 6 mg of adenosine

43. A client recently had a pacemaker implanted and the nurse assistant notifies the nurse that the
client called out complaining of dizziness. Which of the following is the first step that the nurse should
take?

Call for pacemaker interrogation

Call the healthcare provider

Listen to the client's heart and check pulses

Perform an EKG

44. The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what
medication does the nurse anticipate administering?

Magnesium sulfate

Atropine

Dobutamine

Heparin
45. A client admitted with a diagnosis of acute coronary syndrome calls for a nurse after experiencing
sharp chest pains that radiate to the left shoulder. The nurse notes, prior to entering the client’s room,
that the client’s rhythm is sinus tachycardia with a 10-beat run of premature ventricular contractions
(PVCs). Admitting orders included all of the following interventions for treating chest pain. Which should
the nurse implement first?

1. Obtain a stat 12-lead electrocardiogram (ECG).

2. Administer oxygen by nasal cannula.

3. Administer sublingual nitroglycerin.

4. Administer morphine sulfate intravenously.