(Osborn Chapter) 38 Learning Outcomes (Number and Title)

[Osborn chapter] 38
Learning Outcomes [Number and Title ]

Learning Outcome 1
Describe the configuration of the normal electrocardiogram
(ECG).
Learning Outcome 2
Identify and calculate heart rate, rhythm, PR interval, QRS
complex, and QT interval for normal and abnormal cardiac
rhythms.
Learning Outcome 3
Discuss the etiology and significant ECG features of the
following dysrhythmia classifications: sinus, atrial, junctional,
block, ventricular, and asystole.
Learning Outcome 4
Interpret the significance of each of the dysrhythmias and
formulate nursing responsibilities for each dysrhythmia.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. Which of the following accurately describes the Q wave?

1.
2.
3.
4.
First negative deflection after the P wave

Rounded and upright and precedes the QRS complex
Negative deflection following the R wave
Rounded and upright and follows the QRS complex
Correct Answer: First negative deflection after the P wave

Rationale: The Q wave is the first negative deflection following the P wave. The negative
deflection following the R wave is the S wave. P waves are rounded and generally
upright and precede the QRS, while T waves are generally rounded and upright and
follow the QRS complex.
Cognitive Level: Application
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 1
2. The normal PR interval represents the amount of time it takes for the impulse to travel
from the:
1. SA node to the ventricles.
2. AV node to the ventricles.
3. Bundle of His to the ventricles.
4. Purkinje fibers to the ventricles.
Correct Answer: SA node to the ventricles.
Rationale: The PR interval, sometimes referred to as the PRI or PR segment, represents
the time it takes for the impulse to travel from the SA node down the intra-atrial pathways
to the ventricles. The normal PR interval is 0.12 to 0.20 seconds. In other words, it
represents the beginning of the atrial contraction to the beginning of the ventricular
contraction.
LO: 1
3. Which interval represents atrial contraction?

1. PR interval
2. QRS complex
3. QT interval
4. R to R interval
Correct Answer: PR interval
Rationale: The PR interval represents atrial contraction. The QRS complex represents ventricular
contraction. The QT interval measures depolarization and repolarization of the ventricles. The R
to R interval measures pulse regularity.
LO: 1
4. The nurse is told in report that the clients PR interval is within normal limits. Which
of the following would the nurse anticipate as a result of receiving this information? The
clients PR interval would:
1.
2.
3.
4.
Be between 0.12 and 0.20 seconds.

Extend between 8.5 to 11 small boxes on the ECG paper.
Correct Answer: Be between 0.12 and 0.20 seconds.

Rationale: If a PR interval is within normal limits, it will be between 0.12 and
0.20 seconds, which is equal to 3 to 5 small boxes. The normal QRS width is
between 0.06 and 0.12 seconds, which is equal to 1.5 to 3 small boxes. The
normal QT interval is between 0.34 to 0.43 seconds, which is equal to 8.5 to 11
small boxes.
Nursing Process: Planning
LO: 2
5. The nurse obtains an ECG monitor strip and makes the following analysis: no apparent
P waves, ventricular rate 152 beats per minute and regular, and narrow QRS complex
(0.08). The nurse interrupts this rhythm as:
1.
2.
3.
4.
Supraventricular tachycardia.
Sinus tachycardia.
Atrial fibrillation.
Ventricular fibrillation.
Correct Answer: Supraventricular tachycardia.

Rationale: Supraventricular tachycardia (SVT) is a tachycardia that is generated somewhere
above the ventricles. This general term encompasses all fast (tachy) rhythms with normal QRS
complexes and heart rates greater than 100 beats per minute. There are no apparent P waves; thus
it cannot be called sinus tachycardia. Atrial fibrillation does not have P waves present, but it is
always irregular. Ventricular fibrillation would have no P waves, but the QRS complexes would
be > 0.12 second.
Cognitive Level: Synthesis
Nursing Process: Evaluating
LO: 2
6. The nurse admits a client into the emergency department who complains of lightheadedness and nausea. During the assessment, the nurse determines that the radial pulse
is 42 and regular, QRS complex is within normal limits, and there is no measurable PR
interval because there is not a consistent relationship between the P waves and the QRS
complexes. The nurse would interpret this dysrhythmia as:
1. Third-degree AV heart block.
2. Sinus bradycardia.
3. Sinus arrest.
4. Supraventricular tachycardia.
Correct Answer: Third-degree AV heart block.
Rationale: Third-degree AV block, or complete block, is the independent excitation and
contraction of the atria and ventricles due to the inability of any atrial impulses to reach the
ventricles. In other words, the top and bottom of the heart are not communicating; they are
beating independently. This is why there are no consistent PR intervals. Sinus bradycardia occurs
when the SA node is firing at a rate of less than 60 beats per minute. There is a consistent PR
interval with sinus bradycardia. Sinus arrest is a momentary cessation of sinus impulse formation
(SA node failure), causing the absence of the PQRST complex. The remainder of the beats have
normal PR intervals. Supraventricular tachycardia has a rate of greater than 100 beats per minute.
Cognitive Level: Analysis
LO: 2
7. Which of the following are characteristics of atrial fibrillation?

Select all that apply.
1. The ventricular rhythm is irregular.
2. The QT interval cannot be measured because the T waves are buried in the f
waves.
3. P waves are replaced by f waves, which are due to atrial quivering.
4. The PR intervals are measurable.
5. The atrial rate can be calculated by counting the P waves in 6 seconds and
multiplying by 10.
Correct Answers:
1. The ventricular rhythm is irregular.
2. The QT interval cannot be measured because the T waves are buried in the
f waves.
3. P waves are replaced by f waves, which are due to atrial quivering.
Rationale: The ventricular rhythm is irregular. The ventricular rhythm is irregular in
atrial fibrillation. The QT interval cannot be measured because the T waves are
buried in the f waves. Because T waves are buried within the f waves, the QT
interval cannot be measured. P waves are replaced by f waves, which are due to
atrial quivering. Waves that are seen between R-to-R intervals are called f waves and
are due to atrial quivering. The PR intervals are measurable. Because there are no P
waves, the PR interval cannot be measured. The atrial rate can be calculated by
counting the P waves in 6 seconds and multiplying by 10. In atrial fibrillation there are
no P waves, therefore the atrial rate cannot be counted.
LO: 3
8. While admitting a client to the emergency room, the nurse observes the cardiac
monitor and identifies the following rhythm: one inverted P wave for every QRS complex
and a regular heart rate of 46 beats per minute. The nurse interprets this rhythm as:
1. Junctional escape rhythm.
2. Normal sinus rhythm.
3. Mobitz II heart block.
4. Complete heart block.
Correct Answer: Junctional escape rhythm.
Rationale: Junctional escape rhythm results from either an irritable focus in the junctional tissue
that discharges before the SA node has had a chance to or because the SA node has failed to fire,
thereby making junctional node the secondary pacemaker. The impulse is initiated in the AV
junctional tissue and must travel in a backward (retrograde) direction to activate the atria.
Therefore, the P wave is inverted or negatively deflected, due to this retrograde conduction, and
may occur before, after, or buried in the QRS complex. The intrinsic rate of the AV junction is 40
to 60 beats per minute. This is not normal sinus rhythm because it is not initiated by the SA node.
Both Mobitz II and complete heart block are rhythms that occur below the AV junction and have
normal P waves.
LO: 3
9. Which of the following ECG findings is present in a client who has both a first-degree
heart block and a bundle branch block?
1.
2.
3.
4.
A PR interval of 0.24 second and a QRS complex width of 0.16 second

An ST segment elevation and an inverted T wave
A QT interval of > 0.44 second and a PR interval of 0.16 second
An ST segment elevation and a QT interval of < 0.44 second
Correct Answer: A PR interval of 0.24 second and a QRS complex width of 0.16 second.
Rationale: A PR interval of > 0.20 second indicates first-degree block, and a QRS complex with
of > 0.12 seconds is bundle branch block. ST segment elevation and inverted T waves are both
indicative of myocardial ischemia/injury. A QT interval of > 0.44 is abnormal but is not related to
first-degree block or bundle branch block.
LO: 3
10. The nurse observes sinus bradycardia on a clients monitor. Which of the following
data sets would indicate the client is in need of treatment for this rhythm?
1. Client is lightheaded and complaining of chest discomfort.
2. Client is alert, oriented X3, and blood pressure is 120/60, with no other
complaints.
3. Clients heart rate is 50 and blood pressure is 110/62, with no other
complaints.
4. Clients respiratory rate is 16, blood pressure is 114/70, and client is painfree.
Correct Answer: Client is lightheaded and complaining of chest discomfort.
Rationale: Sinus bradycardia requires treatment when the client is exhibiting a decrease
in cardiac output manifesting itself in complaints of angina, syncope, dizziness, shortness
of breath, weakness, and possible changes in mental status. As a result of decreased
cardiac output, the client may manifest hypotension. The other answer choices do not
present a need for treatment.
LO: 4
11. The nurse admits a client into the emergency department who complains of light-headedness
and nausea. During the assessment, the nurse determines that the radial pulse is 42 and regular,
the cardiac monitor shows there are P waves present, the QRS complex is within normal limits,
but there is no measurable PR interval because there is not a consistent relationship between the
P waves and the QRS complexes. The nurse would interpret this dysrhythmia as:
1. Complete heart block.
2. Sinus bradycardia.
3. Atrial fibrillation.
4. Supraventricular tachycardia.
Correct Answer: Complete heart block.
Rationale: Third-degree AV block, or complete block, is the independent excitation and
contraction of the atria and ventricles due to the inability of any atrial impulses to reach the
ventricles. In other words, the top and bottom of the heart are not communicating; they are
beating independently. This results in no consistent meaningful PR interval. Sinus bradycardia
and supraventricular tachycardia have consistent normal PR intervals. Atrial fibrillation does not
have P waves, and therefore there is no PR interval.
LO: 4
12. The clinical significance for a client who is having premature ventricular contractions
(PVC) is that they:
Select all that apply.
1.
2.
3.
4.
5.
Indicate myocardial ischemia and injury.

Could become the dominant pacemaker.
Are a life-threatening cardiac rhythm.
Are not significant; PVCs are not dangerous.
Show that the rhythm is regular.
Correct Answer:
1. Indicate myocardial ischemia and injury.
2. Could become the dominant pacemaker.
3. Are a life-threatening cardiac rhythm.
Rationale: Indicate myocardial ischemia and injury. When the cardiac muscle does not receive
adequate blood supply, the muscle becomes ischemic and irritable, resulting in PVCs. Could
become the dominant pacemaker. With a PVC that becomes the dominant pacemaker, the
rhythm is ventricular tachycardia, which is life threatening and must be terminated. Are a lifethreatening cardiac rhythm. Ventricular dysrhythmias are considered to be very serious lifethreatening dysrhythmias, mainly because they drop cardiac output. Are not significant; PVCs
are not dangerous. Ventricular dysrhythmias are considered to be very serious, life-threatening
dysrhythmias, mainly because they drop cardiac output. Show that the rhythm is regular.
When PVCs occur, the rhythm is irregular, not regular.
Nursing Process: Evaluation
LO: 4

(Osborn Chapter) 38 Learning Outcomes (Number and Title)

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[Osborn chapter] 38

Learning Outcomes [Number and Title ]

1. Which of the following accurately describes the Q wave?

First negative deflection after the P wave

Correct Answer: First negative deflection after the P wave

3. Which interval represents atrial contraction?

Be between 0.12 and 0.20 seconds.

Correct Answer: Be between 0.12 and 0.20 seconds.

Correct Answer: Supraventricular tachycardia.

7. Which of the following are characteristics of atrial fibrillation?

A PR interval of 0.24 second and a QRS complex width of 0.16 second

Indicate myocardial ischemia and injury.

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