Cardiac Medications What To Watch

Every question in this set, with the answer

Use this to review after you finish — or instead of the timed version, if you would rather just read.

1. At 1900 you are documenting the ventricular rate from a 6-second telemetry strip. You counted 7 QRS complexes. Which entry is most accurate?

   1. Ventricular rate approximately 70 beats/min.
   2. Ventricular rate approximately 42 beats/min.
   3. Ventricular rate exactly 75 beats/min based on R-to-R boxes.
   4. Heart rate cannot be estimated from a 6-second strip.

   Answer: Ventricular rate approximately 70 beats/min.

   The section states that the fastest method is to count QRS complexes in a 6-second strip and multiply by ten, so 7 complexes is approximately 70 beats/min. The other entries either use the wrong calculation, imply a precision not supported by the scenario, or incorrectly state that the rate cannot be estimated.

2. At 0215 a telemetry alarm sounds while you are covering several patients. Which actions should be reflected in safe telemetry-monitoring documentation according to the section? Select all that apply.

   1. Keep a pager or device with you to receive telemetry alerts.
   2. Document the strip later if the patient reports no symptoms.
   3. Physically assess the patient's status and apical heart rate after the alert.
   4. Remove telemetry for transportation when alarms are inconvenient.
   5. Rely only on the monitor value without an apical heart-rate assessment.

   Answer: Keep a pager or device with you to receive telemetry alerts., Physically assess the patient's status and apical heart rate after the alert.

   The telemetry safety section includes carrying a device to receive alerts and physically assessing the patient’s status and apical heart rate in response. Delaying assessment, removing monitoring for convenience, or relying only on the monitor value does not match the listed safe practices.

3. At 0900, telemetry shows sinus bradycardia with a pulse of 54 bpm. The patient reports dizziness and has a scheduled cardiac medication due. Which charted nursing response best matches the section?

   1. Cardiac medication held for pulse less than 60 bpm; provider alerted; patient kept in bed and monitored.
   2. Cardiac medication given because the PR and QRS intervals are regular; patient encouraged to ambulate.
   3. Patient instructed to drink caffeine; no provider notification needed unless chest pain occurs.
   4. Telemetry discontinued because sinus bradycardia is always normal during relaxation.

   Answer: Cardiac medication held for pulse less than 60 bpm; provider alerted; patient kept in bed and monitored.

   For symptomatic bradycardia with pulse less than 60 bpm, the section lists holding cardiac medications, alerting the provider, keeping the patient in bed if dizzy, and monitoring. The other entries ignore symptoms, add interventions not supported by the section, or treat bradycardia as automatically normal.

4. At 1530 you are completing a rhythm note for a strip interpreted as sinus tachycardia. Which elements are consistent with the textbook description and should be included if seen? Select all that apply.

   1. Rate greater than 100 bpm.
   2. Regular PR intervals.
   3. Regular QRS intervals.
   4. Rate less than 60 bpm.
   5. Early wide QRS complexes without P waves.

   Answer: Rate greater than 100 bpm., Regular PR intervals., Regular QRS intervals.

   The section defines sinus tachycardia as a rate greater than 100 bpm with regular PR and QRS intervals. A rate less than 60 bpm describes bradycardia, and an early wide QRS without a P wave is consistent with a PVC rather than sinus tachycardia.

5. At 1110 you review a strip showing one early wide-appearing QRS complex with no preceding P wave, followed by a pause. Which documentation is most accurate?

   1. Premature ventricular contraction (PVC) with a compensatory pause.
   2. Premature atrial contraction (PAC) with a non-compensatory pause.
   3. Mobitz I second-degree heart block with progressive PR lengthening.
   4. Sinus tachycardia with regular PR and QRS intervals.

   Answer: Premature ventricular contraction (PVC) with a compensatory pause.

   The described finding matches the section’s description of a PVC: an early, wide QRS without a P wave followed by a compensatory pause. A PAC has an early P and QRS, Mobitz I involves progressive PR lengthening, and sinus tachycardia has regular PR and QRS intervals.

6. At 0600 your preceptor identifies a strip as Mobitz II second-degree heart block and asks you to update the telemetry note. Which rhythm details match that diagnosis in this section? Select all that apply.

   1. The PR interval is constant.
   2. The PR interval gets longer with each beat until a QRS is dropped.
   3. Some of the QRSs are blocked.
   4. The pattern repeats like Mobitz I.
   5. The PR interval is consistently greater than 0.20 seconds while QRS is normal and regular.

   Answer: The PR interval is constant., Some of the QRSs are blocked.

   For Mobitz II, the section states that the PR interval is constant and some QRSs are blocked. Progressive PR lengthening with a repeating dropped QRS pattern describes Mobitz I, while a consistently prolonged PR interval with normal regular QRS describes first-degree heart block.

7. At 0630, a patient admitted with HF tells you, “I couldn’t breathe lying flat, so I slept upright in the recliner and used three pillows.” Which nursing documentation best captures this finding?

   1. Reports difficulty breathing when lying flat; slept upright in recliner with three pillows; finding consistent with orthopnea.
   2. Reports chest pain with activity relieved by rest; assess using PQRST.
   3. Reports fatigue with activities of daily living; no respiratory concern documented.
   4. Reports edema from fluid retention; socks and shoes fit poorly.

   Answer: Reports difficulty breathing when lying flat; slept upright in recliner with three pillows; finding consistent with orthopnea.

   The correct note documents the patient’s breathing difficulty when lying flat and the need to sleep upright/on pillows, which matches orthopnea. The other options describe possible HF-related findings, but they do not capture what the patient actually reported in this situation.

8. At 0600 you need a daily weight for a patient with HF who has been receiving diuretic therapy. Which measurement steps are consistent with the section? Select all that apply.

   1. Ask the patient to void before obtaining the morning weight.
   2. Use the same garments as prior weights when possible, or weigh nude if appropriate.
   3. Obtain the weight after the patient has been drinking morning fluids to reflect the day’s intake.
   4. Document today’s weight without noting that the patient wore heavy shoes instead of usual garments.
   5. Delay the weight until later in the day if the patient already voided before you entered.

   Answer: Ask the patient to void before obtaining the morning weight., Use the same garments as prior weights when possible, or weigh nude if appropriate.

   The section recommends a morning weight after voiding and with consistent clothing, or nude if possible, to make weight comparisons meaningful. The other options introduce avoidable variation in timing, fluid intake, or clothing, which makes the documented weight less reliable.

9. At 2100, a patient with HF is sitting low in bed, reports shortness of breath, and the oxygen saturation is 90%. There is an order for supplemental oxygen. What should you document as the priority nursing action?

   1. Raised patient to high Fowlers and applied ordered supplemental oxygen for dyspnea.
   2. Started the daily weight early to evaluate response to diuretic therapy.
   3. Completed abdominal assessment for ascites before addressing dyspnea.
   4. Encouraged activity to test whether dyspnea worsens with exertion.

   Answer: Raised patient to high Fowlers and applied ordered supplemental oxygen for dyspnea.

   The correct action addresses dyspnea directly by positioning the patient in high Fowlers and using ordered oxygen. Daily weight and abdominal assessment may be relevant to HF care, but they do not take priority over the patient’s current oxygenation problem; encouraging activity is not supported here.

10. During an evening chart review, you see BNP results of 500 pg/mL at 0800, 750 pg/mL at 1700, and 1500 pg/mL at 2300 for a patient admitted with acute left-sided HF. Which note best interprets this trend based on the section?

    1. Rising BNP may reflect increased myocardial stretch as atrial and ventricular pressure gradients rise; correlate with clinical presentation.
    2. Rising BNP confirms coronary artery blockage and should be charted as the cause of HF.
    3. Rising BNP is expected only from age and does not require comparison with symptoms.
    4. Rising BNP primarily documents hepatic congestion from right-sided heart failure.

    Answer: Rising BNP may reflect increased myocardial stretch as atrial and ventricular pressure gradients rise; correlate with clinical presentation.

    The section links rising BNP with increased myocardial stretch and rising pressure gradients, and it also emphasizes assessing levels with clinical presentation. BNP alone is not documented as confirming coronary blockage, age is not the only explanation, and hepatic congestion is tied to liver function tests rather than BNP in this section.

11. At the start of shift, a patient with HF has a wet cough and crackles at the bases. Which details should you include in the respiratory assessment note according to the section? Select all that apply.

    1. Any adventitious lung sounds heard.
    2. Whether a cough is present and sputum color, consistency, and amount.
    3. Where the adventitious breath sounds are heard.
    4. A statement that lung findings are unrelated to HF unless chest pain is present.
    5. Only the oxygen saturation, because breath-sound location is not part of the assessment.

    Answer: Any adventitious lung sounds heard., Whether a cough is present and sputum color, consistency, and amount., Where the adventitious breath sounds are heard.

    The correct choices reflect the section’s respiratory assessment details: abnormal sounds, cough and sputum characteristics, and location of sounds. The other options minimize or misstate the assessment; the section specifically includes lung findings as part of HF assessment.

12. At 0900, before administering an ordered HF medication, you document pulse 58 bpm. Which nursing action/documentation best matches the section?

    1. Use clinical judgment and question whether the medication should be held because the pulse is less than 60 bpm.
    2. Administer the medication without further consideration because HF therapy centers on pharmacology.
    3. Hold all HF medications for the shift without documenting hemodynamic assessment.
    4. Base the decision only on the patient’s last daily weight and intake/output record.

    Answer: Use clinical judgment and question whether the medication should be held because the pulse is less than 60 bpm.

    The correct option applies the section’s direction to monitor response and use clinical judgment when the pulse is below 60 bpm. The other choices either ignore the hemodynamic finding, overgeneralize by holding everything, or rely on unrelated monitoring data alone.

13. At 1900 shift change, you are receiving a patient who has a morphine PCA running. The outgoing nurse says the pump was checked earlier and the settings have not changed. What should happen before handoff documentation is complete?

    1. Both nurses independently confirm the PCA pump settings, including the ordered drug, concentration, doses, and lockout interval.
    2. The incoming nurse reviews only the medication administration record and documents that the PCA was continued.
    3. The outgoing nurse asks the patient to confirm that the PCA button works and documents patient understanding.
    4. The nurses wait to verify settings until the medication syringe is replaced.

    Answer: Both nurses independently confirm the PCA pump settings, including the ordered drug, concentration, doses, and lockout interval.

    The section states that both incoming and outgoing nurses should confirm PCA settings during shift change, with independent double-checking of key pump details. The other options rely on the MAR, the patient, or a later syringe change, none of which replaces the required shift-change confirmation.

14. At 0815, you initiate a PCA and begin the required early reassessments. Which patient data belong in the typical PCA monitoring after the initial setup? Select all that apply.

    1. Pain level
    2. Alertness
    3. Respiratory rate
    4. Oxygen saturation
    5. Oral intake
    6. Ambulation distance

    Answer: Pain level, Alertness, Respiratory rate, Oxygen saturation

    The passage specifically lists pain level, alertness, respiratory rate, and oxygen saturation as typical monitoring data after PCA setup. Oral intake and ambulation distance may be documented in other contexts, but they are not listed here as part of the typical PCA monitoring sequence.

15. At 1600, you are reviewing the MAR before giving Percocet 5/325 for pain. The patient also has acetaminophen 500 mg ordered for fever and received a dose earlier in the shift. What should guide your medication review before administration?

    1. Count only the separate acetaminophen order toward the acetaminophen total because Percocet is documented as a pain medication.
    2. Recognize that both medications contain acetaminophen and consider the amount given in the four-to-six-hour window and the twenty-four-hour total.
    3. Give the Percocet as ordered and review the acetaminophen total only at the end of the shift.
    4. Track the oxycodone component of Percocet, but do not include the acetaminophen component unless liver failure is documented.

    Answer: Recognize that both medications contain acetaminophen and consider the amount given in the four-to-six-hour window and the twenty-four-hour total.

    The correct response applies the section’s warning that combination medications such as Percocet contribute to the daily acetaminophen total. The other choices incorrectly separate combination medications from acetaminophen tracking or delay the review until after administration.

16. At 2230, you reassess a patient after an opioid dose and are watching for possible opioid-induced respiratory depression. Which decreased findings would be relevant to document and report as warning signs? Select all that apply.

    1. Respiratory rate
    2. Oxygen saturation
    3. Heart rate
    4. Itching
    5. Nausea and vomiting

    Answer: Respiratory rate, Oxygen saturation, Heart rate

    The section identifies decreased respiratory rate, oxygen saturation, and heart rate as findings to monitor for respiratory depression. Itching and nausea/vomiting are opioid side effects discussed in the section, but they are not the listed signs of respiratory depression.

17. At 0930, the physical therapist tells you the patient’s therapy session will begin at 1000 and asks whether the ordered PRN pain medication can be given to improve participation. Which timing best matches the section’s guidance?

    1. Administer the ordered pain medication now, because the session is thirty minutes away.
    2. Wait until the therapist arrives and administer the medication at the start of the session.
    3. Hold the medication until after therapy so the patient can describe the full pain level during exercises.
    4. Schedule the medication for two hours before future sessions.

    Answer: Administer the ordered pain medication now, because the session is thirty minutes away.

    The text states that pharmacological pain management may be given thirty to sixty minutes before therapy to allow time for effect. Giving it at the start, after therapy, or two hours before does not match the timing described.

18. A patient using a PCA is drowsy but arousable. The patient’s spouse says, “If they fall asleep, I’ll press the button for them so the pain doesn’t get ahead.” What education should you provide?

    1. Explain that only the patient should press the PCA button.
    2. Allow the spouse to press the button if the lockout interval has passed.
    3. Tell the spouse to press the button only when the patient is asleep and appears uncomfortable.
    4. Instruct the spouse to ask the nurse to press the PCA button during hourly rounds.

    Answer: Explain that only the patient should press the PCA button.

    The PCA safety teaching in the section is that no one except the patient should press the button. The other options allow a caregiver or nurse to activate patient-controlled dosing, which conflicts with the stated education.