The drug most widely used for secondary prophylaxis against recurrent rheumatic fever is:

Benzathine penicillin G, intramuscular

A rhythm strip shows regular P waves at 80/min and regular wide QRS complexes at 36/min, with no fixed relationship between P waves and QRS complexes. The rhythm is:

Third-degree (complete) AV block

Second-degree AV block, Mobitz type II

Second-degree AV block, Mobitz type I

A 70-year-old on digoxin 0.25 mg daily and furosemide for heart failure with AF reports nausea and yellow-tinged vision. Pulse 48/min; serum potassium 2.9 mEq/L (reference 3.5-5.0). The morning digoxin dose is due. What is the nurse's most appropriate action?

Withhold the digoxin and inform the doctor at once

Give the digoxin with a potassium-rich breakfast

Give potassium chloride 20 mEq as an IV push

Withhold the furosemide and give the digoxin

Which electrical event of the cardiac cycle does the P wave on an ECG represent?

Conduction delay in the AV node

Cardiovascular: ECG, arrhythmias and hypertension

26 AIIMS NORCET (Nursing Officer) practice questions on Cardiovascular: ECG, arrhythmias and hypertension, part of Medical-Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A man's monitor shows sinus rhythm at 38/min; he is dizzy with a BP of 84/50 mmHg. Under the AHA 2020 algorithm, the nurse should prepare to give first:
1. AAmiodarone 300 mg IV
2. BEpinephrine 1 mg IV push
3. CAdenosine 6 mg IV
4. DAtropine 1 mg IV
Show answerHide answer
Answer: D · Atropine 1 mg IV
Atropine blocks vagal action on the SA and AV nodes and so raises the heart rate. The 2020 AHA guidelines give 1 mg IV, repeated every 3-5 minutes up to 3 mg. If atropine fails, transcutaneous pacing or an infusion of dopamine or epinephrine follows. It is less effective in high-grade AV block below the node and in heart transplant patients.
- A: Amiodarone 300 mg is the dose for shock-refractory VF or pulseless VT.
- B: Epinephrine 1 mg IV push is the cardiac arrest dose; in bradycardia it is given as an infusion.
- C: Adenosine slows AV conduction and would worsen a bradycardia.
Question 2 · Easy
The drug most widely used for secondary prophylaxis against recurrent rheumatic fever is:
1. ABenzathine penicillin G, intramuscular
2. BGentamicin, intramuscular
3. CCeftriaxone, intravenous
4. DAzithromycin, oral
Show answerHide answer
Answer: A · Benzathine penicillin G, intramuscular
Secondary prophylaxis prevents repeat streptococcal infections that would cause new attacks of rheumatic fever and further valve damage. Long-acting benzathine penicillin G given deep intramuscularly every 3-4 weeks is the regimen of choice because one injection keeps levels up for weeks. Prophylaxis continues for years, often into adulthood when the heart is involved. The nurse should ask about penicillin allergy and stress regular attendance.
- B: Gentamicin has no useful action against group A streptococci for this purpose.
- C: Ceftriaxone is a treatment drug for serious infections, not long-term prophylaxis.
- D: Oral macrolides are only an alternative for penicillin-allergic patients.
Question 3 · Medium
A rhythm strip shows regular P waves at 80/min and regular wide QRS complexes at 36/min, with no fixed relationship between P waves and QRS complexes. The rhythm is:
1. AFirst-degree AV block
2. BThird-degree (complete) AV block
3. CSecond-degree AV block, Mobitz type II
4. DSecond-degree AV block, Mobitz type I
Show answerHide answer
Answer: B · Third-degree (complete) AV block
In complete heart block no atrial impulse reaches the ventricles, so the atria and ventricles beat independently. The P-P and R-R intervals are each regular, but the PR interval varies at random. A ventricular escape rhythm with wide QRS complexes at 20-40/min results, often causing dizziness, syncope or hypotension. The usual treatment is pacing, temporary at first and then permanent.
- A: In first-degree block every P is conducted, only with a PR over 0.20 second.
- C: Mobitz II has a constant PR with sudden dropped QRS complexes, not dissociation.
- D: Mobitz I shows a PR that lengthens until one QRS is dropped, then the cycle repeats.
Question 4 · Hard
A 70-year-old on digoxin 0.25 mg daily and furosemide for heart failure with AF reports nausea and yellow-tinged vision. Pulse 48/min; serum potassium 2.9 mEq/L (reference 3.5-5.0). The morning digoxin dose is due. What is the nurse's most appropriate action?
1. AGive the digoxin with a potassium-rich breakfast
2. BWithhold the digoxin and inform the doctor at once
3. CGive potassium chloride 20 mEq as an IV push
4. DWithhold the furosemide and give the digoxin
Show answerHide answer
Answer: B · Withhold the digoxin and inform the doctor at once
Nausea, visual disturbance such as yellow or green vision, and a pulse below 60/min point to digoxin toxicity. Hypokalaemia from the loop diuretic increases digoxin binding to the myocardium and makes toxicity and arrhythmias more likely. The dose must be withheld and the doctor informed, with an ECG and serum digoxin and potassium levels expected. Potassium is replaced only as ordered, orally or by diluted slow infusion.
- A: Giving a further dose to a toxic patient could cause a dangerous arrhythmia.
- C: Potassium is never given as an IV push; it can cause cardiac arrest.
- D: Stopping the diuretic does not make it safe to give digoxin to a toxic patient.
Question 5 · Easy
Which electrical event of the cardiac cycle does the P wave on an ECG represent?
1. AVentricular repolarisation
2. BAtrial repolarisation
3. CAtrial depolarisation
4. DConduction delay in the AV node
Show answerHide answer
Answer: C · Atrial depolarisation
The P wave is produced by the impulse from the SA node spreading through both atria, that is, atrial depolarisation. It is normally upright in lead II and comes before every QRS complex in sinus rhythm. Absent or chaotic P waves point to rhythms such as atrial fibrillation. Its presence and relation to the QRS are the first things to check when reading a rhythm strip.
- A: Ventricular repolarisation produces the T wave.
- B: Atrial repolarisation is hidden within the QRS complex.
- D: The AV nodal delay forms the flat PR segment, not a wave.
Question 6 · Hard
A patient develops a regular wide-complex tachycardia at 180/min. A carotid pulse is present, but BP is 76/48 mmHg and the patient is newly confused and sweating. What should the nurse prepare for first?
1. ASynchronised cardioversion
2. BAmiodarone 150 mg IV over 10 minutes
3. CUnsynchronised defibrillation
4. DVagal manoeuvres and observation
Answer and explanation in LearnFree account
Question 7 · Medium
In a hypertensive emergency without aortic dissection, the initial goal is to reduce the mean arterial pressure in the first hour by:
1. AAt least 50 percent
2. BEnough to reach 120/80 mmHg
3. CNo more than 25 percent
4. DNo more than 5 percent
Answer and explanation in LearnFree account
Question 8 · Hard
A patient's ECG shows a regular rhythm with 15 small squares between consecutive R waves (paper speed 25 mm/s). What is the heart rate?
1. A100/min
2. B150/min
3. C75/min
4. D20/min
Answer and explanation in LearnFree account
Question 9 · Medium
A patient with chronic kidney disease has a serum potassium of 7.0 mEq/L (reference 3.5-5.0). Which ECG change is the nurse most likely to see first?
1. ATall, peaked T waves
2. BProlonged QT interval
3. CProminent U waves
4. DST depression with flat T waves
Answer and explanation in LearnFree account
Question 10 · Medium
A patient with atrial fibrillation of unknown duration is listed for elective cardioversion. Before the procedure, the nurse expects that the patient will need:
1. AAtropine IV to raise the ventricular rate
2. BThree weeks of anticoagulation, or a TEE to exclude atrial clot
3. CDigoxin loading to slow the rate before the shock
4. DNo preparation, as cardioversion converts AF at once
Answer and explanation in LearnFree account
Question 11 · Hard
A patient receiving IV erythromycin and haloperidol has a QTc of 560 ms. The monitor now shows brief runs of polymorphic VT whose QRS complexes twist around the baseline; he stays conscious with a pulse and a BP of 112/70 mmHg. Which drug should the nurse prepare?
1. AMagnesium sulphate IV
2. BProcainamide IV
3. CAmiodarone IV
4. DAdenosine 6 mg rapid IV push
Answer and explanation in LearnFree account
Question 12 · Easy
At the standard paper speed of 25 mm/s, each small (1 mm) square on ECG paper represents:
1. A0.04 second
2. B0.20 second
3. C0.10 second
4. D0.02 second
Answer and explanation in LearnFree account
Question 13 · Easy
The definitive treatment for ventricular fibrillation is:
1. ATranscutaneous pacing
2. BRapid IV push of adenosine
3. CUnsynchronised defibrillation
4. DSynchronised cardioversion
Answer and explanation in LearnFree account
Question 14 · Easy
In the first few weeks after a permanent pacemaker is inserted, the nurse teaches the patient to avoid:
1. ALying on the back while sleeping at night
2. BLifting the arm on the implant side above shoulder level
3. CHolding a mobile phone over the opposite ear
4. DWalking short distances inside the house
Answer and explanation in LearnFree account
Question 15 · Medium
On the monitor of a patient with a temporary ventricular pacemaker, pacing spikes appear at the set rate but none is followed by a QRS complex. This is:
1. ANormal demand pacing
2. BOversensing
3. CFailure to capture
4. DFailure to sense
Answer and explanation in LearnFree account
Question 16 · Hard
A patient has received a sodium nitroprusside infusion for 3 days for a hypertensive emergency. He becomes confused and restless, and his ABG shows a metabolic acidosis with a raised lactate. The most likely cause is:
1. AHypersensitivity to the drug's light shield
2. BRebound hypertension after the infusion
3. CHypokalaemia from prolonged infusion
4. DCyanide toxicity from nitroprusside
Answer and explanation in LearnFree account
Question 17 · Medium
Why is the defibrillator switched to synchronised mode for cardioversion of atrial flutter?
1. ATo lower the energy needed to below 10 joules
2. BTo prevent skin burns under the paddles or pads
3. CTo avoid delivering the shock during the T wave
4. DTo let the shock pace the ventricles afterwards
Answer and explanation in LearnFree account
Question 18 · Medium
A 28-year-old woman with rheumatic heart disease has a low-pitched, rumbling mid-diastolic murmur at the apex with an opening snap. The valve lesion is most likely:
1. AMitral regurgitation
2. BAortic regurgitation
3. CMitral stenosis
4. DAortic stenosis
Answer and explanation in LearnFree account
Question 19 · Hard
After a loading bolus for stable VT, maintenance amiodarone is prescribed: 900 mg diluted in 500 mL D5W, running at 1 mg per minute for the next 6 hours. What hourly rate should be programmed?
1. A18 mL/h
2. B60 mL/h
3. C108 mL/h
4. D33 mL/h
Answer and explanation in LearnFree account
Question 20 · Hard
A ward patient becomes unresponsive. The monitor shows a regular wide-complex tachycardia at 200/min, and no carotid pulse is felt. After calling for help, what is the most appropriate next action?
1. AGive atropine 1 mg IV and attach pacing pads
2. BPerform synchronised cardioversion at 100 joules
3. CGive amiodarone 150 mg IV over 10 minutes, then reassess
4. DStart CPR and defibrillate as soon as the defibrillator is ready
Answer and explanation in LearnFree account
Question 21 · Medium
A patient's monitor shows an irregularly irregular rhythm, a wavy baseline with no clear P waves and a ventricular rate of 130/min. The rhythm is:
1. AAtrial flutter
2. BAtrial fibrillation
3. CMultifocal atrial tachycardia
4. DSinus arrhythmia
Answer and explanation in LearnFree account
Question 22 · Medium
Progressive lengthening of the PR interval until a P wave is not followed by a QRS complex, after which the cycle repeats, describes:
1. ASecond-degree AV block, Mobitz type II
2. BSecond-degree AV block, Mobitz type I (Wenckebach)
3. CFirst-degree AV block
4. DThird-degree (complete) AV block
Answer and explanation in LearnFree account
Question 23 · Easy
On a standard 12-lead ECG, the normal PR interval in an adult is:
1. A0.36-0.44 second
2. B0.06-0.10 second
3. C0.20-0.28 second
4. D0.12-0.20 second
Answer and explanation in LearnFree account
Question 24 · Medium
A patient taking enalapril for hypertension complains of a persistent, dry, tickly cough. This side effect is due to:
1. AExcess angiotensin II
2. BBeta-2 receptor blockade
3. CAccumulation of bradykinin
4. DDrug-induced hypokalaemia
Answer and explanation in LearnFree account
Question 25 · Medium
Which finding is a MAJOR criterion in the Jones criteria for the diagnosis of acute rheumatic fever?
1. AErythema marginatum
2. BFever above 38.5 °C
3. CProlonged PR interval
4. DRaised ESR or CRP
Answer and explanation in LearnFree account

1 more Cardiovascular: ECG, arrhythmias and hypertension questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Medical-Surgical Nursing

Cardiovascular: ECG, arrhythmias and hypertension

A man's monitor shows sinus rhythm at 38/min; he is dizzy with a BP of 84/50 mmHg. Under the AHA 2020 algorithm, the nurse should prepare to give first:

The drug most widely used for secondary prophylaxis against recurrent rheumatic fever is:

A rhythm strip shows regular P waves at 80/min and regular wide QRS complexes at 36/min, with no fixed relationship between P waves and QRS complexes. The rhythm is:

A 70-year-old on digoxin 0.25 mg daily and furosemide for heart failure with AF reports nausea and yellow-tinged vision. Pulse 48/min; serum potassium 2.9 mEq/L (reference 3.5-5.0). The morning digoxin dose is due. What is the nurse's most appropriate action?

Which electrical event of the cardiac cycle does the P wave on an ECG represent?

A patient develops a regular wide-complex tachycardia at 180/min. A carotid pulse is present, but BP is 76/48 mmHg and the patient is newly confused and sweating. What should the nurse prepare for first?

In a hypertensive emergency without aortic dissection, the initial goal is to reduce the mean arterial pressure in the first hour by:

A patient's ECG shows a regular rhythm with 15 small squares between consecutive R waves (paper speed 25 mm/s). What is the heart rate?

A patient with chronic kidney disease has a serum potassium of 7.0 mEq/L (reference 3.5-5.0). Which ECG change is the nurse most likely to see first?

A patient with atrial fibrillation of unknown duration is listed for elective cardioversion. Before the procedure, the nurse expects that the patient will need:

A patient receiving IV erythromycin and haloperidol has a QTc of 560 ms. The monitor now shows brief runs of polymorphic VT whose QRS complexes twist around the baseline; he stays conscious with a pulse and a BP of 112/70 mmHg. Which drug should the nurse prepare?

At the standard paper speed of 25 mm/s, each small (1 mm) square on ECG paper represents:

The definitive treatment for ventricular fibrillation is:

In the first few weeks after a permanent pacemaker is inserted, the nurse teaches the patient to avoid:

On the monitor of a patient with a temporary ventricular pacemaker, pacing spikes appear at the set rate but none is followed by a QRS complex. This is:

A patient has received a sodium nitroprusside infusion for 3 days for a hypertensive emergency. He becomes confused and restless, and his ABG shows a metabolic acidosis with a raised lactate. The most likely cause is:

Why is the defibrillator switched to synchronised mode for cardioversion of atrial flutter?

A 28-year-old woman with rheumatic heart disease has a low-pitched, rumbling mid-diastolic murmur at the apex with an opening snap. The valve lesion is most likely:

After a loading bolus for stable VT, maintenance amiodarone is prescribed: 900 mg diluted in 500 mL D5W, running at 1 mg per minute for the next 6 hours. What hourly rate should be programmed?

A ward patient becomes unresponsive. The monitor shows a regular wide-complex tachycardia at 200/min, and no carotid pulse is felt. After calling for help, what is the most appropriate next action?

A patient's monitor shows an irregularly irregular rhythm, a wavy baseline with no clear P waves and a ventricular rate of 130/min. The rhythm is:

Progressive lengthening of the PR interval until a P wave is not followed by a QRS complex, after which the cycle repeats, describes:

On a standard 12-lead ECG, the normal PR interval in an adult is:

A patient taking enalapril for hypertension complains of a persistent, dry, tickly cough. This side effect is due to:

Which finding is a MAJOR criterion in the Jones criteria for the diagnosis of acute rheumatic fever?