Adult Care 3 Exam 1 Flashcards
SATA: Characteristics of normal sinus rhythm:
A. Regular atrial rhythm
B. Irregular ventricular rhythm
C. PR Interval < 0.20 seconds
D. QRS complex > 0.12 seconds
E. Equal atrial and ventricular rate
F. Atrial rate > than ventricular rate
G. First-Degree Heart Block
H. Sinus bradycardia
I. Normal Sinus Rhythm
A,C,E, and I
SATA: You’re analyzing an ECG strip. In order for the rhythm to be identified as Sinus Tachycardia, what must be present in the rhythm?
A. One p wave present in front of every QRS complex
B. Atrial rate >100 bpm
C. Ventricular rate >100 bpm
D. Regular atrial rate and irregular ventricular rate
E. Regular atrial and ventricular rate
F. Atrial rate <60 bpm
G. QRS complex <0.12 seconds
H. PR interval 0.12-0.20 seconds
I. PR interval >0.20 seconds
A, B, C, E, G, H
You are analyzing an ECG strip and the rhythm is ventricular tachycardia. The patient is presenting with a blood pressure of 70/42, mental status changes, and is clammy and pale. A pulse is present. The nurse preps the patient for?
A. CPR
B. Synchronized cardioversion
C. Defibrillation
D. Atropine IV
B
The patient is unstable and demonstrating signs and symptoms related to decreased cardiac output. A pulse is present. The patient is currently unstable; therefore, synchronized cardioversion needs to be performed to convert the patient to a normal rhythm. An antiarrhythmic like Amiodarone may be started to maintain the normal rhythm.
The nurse sees v-fib on the ECG. The patient is unresponsive and has no pulse. The nurse calls a code blue and takes what step next?
A. Prepares for defibrillation
B. Administers Epinephrine
C. Starts high-quality CPR
D. Notifies the physician
The answer is C. The nurse would want to immediately start high-quality CPR and continue this until help arrives.
You’re patient is in ventricular fibrillation (v-fib). You’ve started CPR and the airway is supported. A rhythm checked in performed and shows the patient is still in ventricular fibrillation. The NEXT action the code team will take in addition to performing high-quality CPR is to?
A. Administer Atropine
B. Defibrillate
C. Administer Epinephrine
D. Synchronized cardiovert
B
Call for help (code blue), CPR, and defibrillation (with v-tach or v-fib), and give epinephrine (every 3-5 min). Make sure to continue CPR when administering epinephrine so that medication can circulate around the body.
Your patient’s ECG shows atrial flutter. What complication can arise from this type of rhythm?
A. Pericarditis
B. Stroke
C. Hypoglycemia
D. Endocarditis
B.
Atrial flutter can increase the patient’s risk of developing a blood clot which can lead to a stroke. The clot can leave the heart and travel to the brain or lungs and cause a stroke or pulmonary embolism.
A 62-year-old patient’s ECG shows a PR interval of 0.24 seconds and a QRS duration of 0.12 seconds. Which of the following is the most appropriate interpretation and intervention for these findings?
A. First-degree AV block with a wide QRS complex; monitor the patient and assess for symptoms
B. Normal ECG findings; no further action is needed
C. Second-degree AV block with a narrow QRS complex; initiate pacing immediately
D. Third-degree AV block with a wide QRS complex; prepare for immediate cardioversion
Answer: A.
First-degree AV block with a wide QRS complex; monitor the patient and assess for symptoms
A 45-year-old patient is diagnosed with sinus tachycardia. The patient’s heart rate is consistently above 120 beats per minute, and the underlying cause is identified as dehydration. Which medication is most appropriate for this patient?
A. Beta blocker (e.g., metoprolol)
B. Calcium channel blocker (e.g., diltiazem)
C. Diuretic (e.g., furosemide)
D. Antipyretic (e.g., acetaminophen)
Answer: A. Beta blocker (e.g., metoprolol)
Rationale: In the case of sinus tachycardia where the underlying cause is not a primary cardiac issue but rather dehydration, a beta blocker like metoprolol may be used to manage the elevated heart rate. However, the primary treatment for sinus tachycardia due to dehydration is to address the dehydration by providing fluids. Calcium channel blockers are also used for rate control but are typically not first-line for this scenario. Diuretics and antipyretics are not appropriate for treating sinus tachycardia directly but may address underlying conditions.
A 72-year-old patient is diagnosed with sinus bradycardia and is unresponsive to initial treatment with intravenous atropine. The patient’s heart rate is 45 beats per minute, and they are experiencing severe symptoms, including hypotension and altered mental status. The healthcare provider decides to start an infusion of dopamine. What is the primary purpose of administering dopamine in this scenario?
A. Increase heart rate and improve cardiac output
B. Reduce the risk of arrhythmias by stabilizing the heart’s electrical system
C. Decrease blood pressure to reduce cardiac workload
D. Enhance renal perfusion and increase urine output
Answer: A. Increase heart rate and improve cardiac output
Rationale: Dopamine is used in the treatment of bradycardia, particularly when there is a need to increase heart rate and improve cardiac output in symptomatic patients. It is often administered when atropine is ineffective.
A patient is being monitored for cardiac arrhythmias. The nurse identifies premature atrial contractions (PACs) on the ECG. Which of the following could be a potential cause of PACs?
Select all that apply:
- Caffeine consumption
- Hyperkalemia
- Tobacco use
- Hypomagnesemia
- Myocardial hypertrophy
1, 3, 4, 5
Potential causes: caffeine, tobacco, myocardial hypertrophy, ischemia, hypokalemia, and hypomagnesemia
A nurse is reviewing a patient’s ECG strip and notices premature atrial contractions (PACs). Which ECG characteristics are commonly associated with PACs?
Select all that apply:
- Rhythm: Regular except for the area of the PAC
- PR interval: Prolonged in PAC
- P wave: May be hidden in the preceding T wave
- QRS complex: Wide and bizarre
- Compensatory pause following the premature beat
1, 3, 5
- A conductive PAC is characterized by a premature P wave followed by a narrow QRS complex, while a non-conducted PAC is characterized by a premature P wave that is not followed by a QRS complex
A nurse is assessing a patient with atrial fibrillation. Which of the following ECG findings would the nurse expect to observe in a patient with this dysrhythmia?
A. Regular rhythm with distinct P waves before every QRS complex
B. Irregular rhythm with no discernible P waves and irregular R-R intervals
C. Regular rhythm with prolonged PR intervals and narrow QRS complexes
D. Regular rhythm with sawtooth-pattern P waves and a normal QRS complex
B
A patient with a history of atrial fibrillation is at increased risk for which of the following complications?
A. Pulmonary embolism
B. Deep vein thrombosis
C. Stroke
D. Myocardial infarction
C. Stroke
Rationale:
Atrial fibrillation increases the risk of stroke due to clot formation in the atria, which can travel to the brain. Stroke is the most significant complication of AF, while other conditions like pulmonary embolism and myocardial infarction are less directly associated.
A nurse is caring for a patient with new-onset atrial fibrillation. Which of the following is a priority intervention to reduce the patient’s risk for complications?
A. Administer digoxin to control the heart rate
B. Prepare the patient for cardioversion
C. Initiate anticoagulation therapy as prescribed
D. Monitor the patient’s electrolyte levels
C. Initiate anticoagulation therapy as prescribed
Rationale:
The main complication of atrial fibrillation is the risk of stroke from clot formation. Anticoagulation therapy reduces this risk and is the priority intervention over heart rate control or cardioversion.
A patient with atrial fibrillation is being monitored for potential complications. Which of the following complications is most commonly associated with atrial fibrillation?
A. Hypertension
B. Palpitation
C. Stroke
D. Chronic kidney disease
C. Stroke
A patient with atrial fibrillation is scheduled for electrical cardioversion. Which of the following pre-procedure instructions should the nurse provide to the patient?
A. “You will be awake during the procedure, so be prepared to stay still and alert.”
B. “You will need to stop all your medications for a week before the procedure.”
C. “A sedative will be administered to you before the procedure to help you remain comfortable.”
D. “You should continue eating and drinking normally until the day of the procedure.”
C. “A sedative will be administered to you before the procedure to help you remain comfortable.”
A patient with atrial fibrillation is being treated with adenosine. Which of the following actions should the nurse take when administering this medication?
A. Administer adenosine slowly through an intravenous push over 10 minutes.
B. Ensure continuous cardiac monitoring is in place during and after administration.
C. Instruct the patient to take adenosine orally with a full glass of water.
D. Discontinue the medication immediately if the patient experiences a brief period of chest pain.
B. Ensure continuous cardiac monitoring is in place during and after administration.
Rationale:
Adenosine is used to convert certain types of supraventricular tachycardia, including atrial fibrillation with a rapid ventricular rate, to normal sinus rhythm. It is administered as a RAPID (adenosine has a less than 10 seconds of half life) intravenous push and requires continuous cardiac monitoring during and after administration to monitor for potential arrhythmias and adverse effects.
A patient with atrial fibrillation and has a history of heart failure is prescribed a combination of medications to manage their condition. Which of the following medication combinations is commonly used for the treatment of atrial fibrillation?
A. Digoxin and amiodarone
B. Ibuprofen and lorazepam
C. Metformin and lisinopril
D. Furosemide and prednisone
A. Digoxin and amiodarone
Rationale:
For atrial fibrillation, digoxin is often used to control heart rate, particularly in patients with heart failure, while amiodarone is an antiarrhythmic medication used to help restore and maintain a normal heart rhythm.
A patient presents with atrial flutter on an ECG. Which of the following is a characteristic finding associated with atrial flutter?
A. Irregularly irregular rhythm and absent P waves
B. Multiple P waves for every QRS complex and a chaotic baseline
C. Sawtooth-shaped flutter waves between QRS complexes
D. Prolonged PR interval and a widened QRS complex
C. Sawtooth-shaped flutter waves between QRS complexes
A patient with a history of atrial fibrillation is admitted to the emergency department with a rapid ventricular response (RVR). Which of the following findings is most indicative of RVR?
A. Heart rate of 60-100 bpm with a regular rhythm
B. Heart rate greater than 100 bpm with an irregularly irregular rhythm
C. PR interval greater than 0.20 seconds
D. Presence of normal P waves preceding every QRS complex
B. Heart rate greater than 100 bpm with an irregularly irregular rhythm
A patient diagnosed with atrial flutter is being evaluated for treatment. Which of the following interventions is most commonly used to restore normal sinus rhythm in patients with atrial flutter?
A. Beta-blockers
B. Synchronized cardioversion
C. Aspirin therapy
D. Calcium channel blockers
B. Synchronized cardioversion
Rationale:
Synchronized cardioversion is commonly used to restore normal sinus rhythm in patients with atrial flutter, especially when the patient is symptomatic or hemodynamically unstable. Medications like beta-blockers and calcium channel blockers are often used to control the heart rate, but cardioversion directly addresses the underlying rhythm disturbance.
A patient with atrial flutter is being managed with medications to control the heart rate and prevent complications. Which of the following medications are commonly used in the treatment of atrial flutter? (Select all that apply)
A. Metoprolol
B. Diltiazem
C. Amiodarone
D. Warfarin
E. Aspirin
A, B, C, D
A nurse is interpreting the ECG of a patient with atrial flutter. Which of the following findings is most characteristic of atrial flutter?
A. Absent P waves with a wavy baseline
B. Irregularly irregular rhythm with no discernible P waves
C. Absent P waves and an absent PR interval
D. Regular rhythm with sawtooth-shaped flutter waves and no measurable PR interval
D. Regular rhythm with sawtooth-shaped flutter waves and no measurable PR interval
Rationale: Atrial flutter can be characterized by a regular rhythm with sawtooth-shaped flutter waves, representing rapid atrial contractions. There are no true P waves present, and the PR interval is typically not measurable because the atrial activity occurs too rapidly.
Rhythm: regular if conduction ratio is constant; if conduction ratio is
variable, rhythm is irregular
A patient with persistent supraventricular tachycardia (SVT) is scheduled for an electrophysiology (EP) study. What is a potential outcome of this procedure?
A. The exact location of the abnormal electrical pathway is identified, and a targeted ablation may be performed.
B. Medications are given during the procedure to convert the abnormal rhythm back to sinus rhythm.
C. The EP study uses ultrasound to visualize the structure of the heart and assess for any valvular abnormalities.
D. A pacemaker is immediately implanted to regulate the heart’s rhythm.
A. The exact location of the abnormal electrical pathway is identified, and a targeted ablation may be performed.
Which arrhythmias can be diagnosed and treated using an Electrophysiology (EP) study? (Select all that apply)
A. Atrial Fibrillation (AFib)
B. Ventricular Tachycardia (VT)
C. Atrial Flutter
D. Supraventricular Tachycardia (SVT)
E. Sinus Bradycardia
A, C, D
A patient with atrial flutter has an atrial rate of 300 beats per minute (bpm) and a 1:3 atrial-to-ventricular conduction ratio. What would be the expected ventricular rate?
A. 50 bpm
B. 75 bpm
C. 100 bpm
D. 300 bpm
C. 100 bpm
Which of the following characteristics are typically observed in premature ventricular contractions (PVCs)? (Select all that apply)
A. Wide and bizarre QRS complexes
B. Presence of a P wave preceding the QRS complex
C. Compensatory pause following the PVC
D. Normal PR interval
E. Rhythm regularity interrupted by the PVC
A, C, E
Rationale: Premature ventricular contractions (PVCs) are characterized by wide and bizarre QRS complexes, typically greater than 0.10 seconds in duration. PVCs do not have a P wave preceding the QRS complex, and the PR interval is absent before the QRS complex in PVCs.
Which of the following statements accurately describe the differences between unifocal and multifocal premature ventricular contractions (PVCs)? (Select all that apply)
A. Unifocal PVCs originate from different areas in the ventricles, resulting in different QRS shapes.
B. Multifocal PVCs originate from a single site in the ventricles, resulting in the same QRS shape.
C. Unifocal PVCs have a consistent QRS, indicating a single ectopic focus.
D. Multifocal PVCs have varying QRS, indicating multiple ectopic foci.
E. The presence of unifocal PVCs generally suggests more severe underlying heart disease compared to multifocal PVCs.
C and D
The differences in QRS appearance help distinguish between these types of PVCs. Unifocal PVCs typically show uniform QRS complexes, whereas multifocal PVCs present with different shapes due to their multiple origins.
Under which of the following conditions are premature ventricular contractions (PVCs) considered to be most dangerous? (Select all that apply)
A. When PVCs occur frequently and are associated with symptoms such as dizziness or chest pain
B. When PVCs are unifocal and occur infrequently without any associated symptoms
C. When PVCs occur in pairs or triplets and are followed by a compensatory pause
D. When PVCs are multifocal and occur in a pattern that includes a couple of PVCs in a row
E. When PVCs occur during the period of the T wave, increasing the risk of ventricular tachycardia or fibrillation
A,C,D, E
When Are PVCS Dangerous?
Frequent
Multifocal
Two or more in a row
R on T
PVC falls into the vulnerable period of the T wave
Ventricular tachycardia or fibrillation can result
T-wave looks inverted
A nurse is reviewing the treatment options for a patient with frequent Premature Ventricular Contractions (PVCs). Which of the following interventions should the nurse include in the care plan for managing PVCs? (Select all that apply.)
A. Administration of beta-blockers
B. Use of antiarrhythmic medications such as amiodarone
C. Increase caffeine intake
D. Correction of electrolyte imbalances
E. Reduction of stress and anxiety
F. Patient education on monitoring heart rate
A,B,D,E
A nurse is reviewing the ECG of a patient and needs to differentiate between Ventricular Tachycardia (vTACH) and Supraventricular Tachycardia (SVT). Which of the following characteristics would help the nurse distinguish between vTACH and SVT?
A. Presence of a wide QRS complex
B. Narrow QRS complex with regular rhythm
C. Absence of P waves
D. Heart rate greater than 100 bpm
A
vTACH is characterized by a wide and bizarre QRS complex due to the ventricles being activated in an abnormal manner. In contrast, SVT usually presents with a narrow QRS complex because it originates above the ventricles and involves normal ventricular conduction.
A nurse is analyzing an ECG strip and suspects Ventricular Tachycardia (vTACH). Which of the following characteristics is most indicative of vTACH?
A. Presence of regular, wide QRS complexes without discernible P waves
B. Narrow QRS complexes with a consistent PR interval
C. Irregular rhythm with varying QRS durations and visible P waves
D. P waves and QRS complexes that are in a 1:1 ratio with a heart rate of 80-120 bpm
A
Rationale:
Presence of regular, wide QRS complexes without discernible P waves
A patient with Ventricular Tachycardia (vTACH) is at risk for several serious complications. Which of the following complications is most directly associated with sustained vTACH?
A. Pulmonary embolism
B. Myocardial infarction
C. Cardiac arrest
D. Stroke
C
Rationale:
Cardiac arrest: Sustained vTACH is a life-threatening arrhythmia that can lead to decreased cardiac output and potentially result in cardiac arrest and respiratory arrest if not treated promptly.
A patient presents with ventricular tachycardia (VT) in the emergency department. In managing this condition according to advanced cardiac life support (ACLS) guidelines, which of the following interventions are appropriate? Select all that apply.
A. Administering epinephrine
B. Providing high-quality chest compressions
C. Administering IV amiodarone
D. Performing defibrillation
E. Providing oxygen and ensuring a patent airway
F. Administering IV lidocaine
B,C,D,E
Order: Airway, oxygen, CPR, defibrillation, epinephrine, amiodarone, lidocaine
Administering IV lidocaine (F): Lidocaine is an alternative to amiodarone but is less commonly used; amiodarone is generally preferred for its broader efficacy.
Which of the following are characteristics of ventricular fibrillation (V-fib) on an ECG? Select all that apply.
A. Chaotic, irregular waveforms
B. No identifiable P, Q, R, S, or T waves
C. Regular, narrow QRS complexes
D. High amplitude, uniform waveforms
E. Absence of cardiac output
Answer: A, B, E
Rationale:
Ventricular fibrillation (V-fib) is characterized by chaotic and irregular waveforms with no discernible P, Q, R, S, or T waves, which reflects the disorganized electrical activity in the ventricles. This irregularity leads to a complete loss of effective cardiac output, making it a life-threatening emergency.
Which of the following is the correct order of treatment for ventricular fibrillation (V-fib) in a patient who has experienced a cardiac arrest? Arrange the options in the correct sequence.
A. Defibrillation
B. Call for help (code blue)
C. Administer epinephrine (every 3-5 minutes)
D. Perform CPR
B, D, A, C
Rationale:
In the event of ventricular fibrillation (V-fib), the immediate first step is to call for help (code blue) to ensure that the necessary medical team arrives quickly. Next, perform CPR to maintain circulation until further interventions can be applied. Defibrillation is then administered to attempt to restore a normal rhythm. Epinephrine is given every 3-5 minutes to help improve the chances of successful defibrillation and support overall cardiac function.
Which of the following characteristics are associated with asystole on an ECG? Select all that apply.
A. No discernible P waves
B. No QRS complexes
C. Wide and bizarre QRS complexes
D. Flatline or straight line on the ECG
E. No identifiable T waves
A, B, D, E
Rationale: Asystole is characterized by a complete absence of electrical activity in the heart.
A nurse is reviewing an ECG of a patient diagnosed with ventricular fibrillation (V-fib). The ECG shows a chaotic, irregular pattern with no discernible P, Q, R, S, or T waves. The nurse notes that the V-fib can be categorized into different types based on the pattern observed. Which of the following descriptions accurately differentiate between coarse and fine V-fib?
Select all that apply:
A. Coarse V-fib is characterized by a larger amplitude with a more irregular, erratic pattern.
B. Fine V-fib shows a smaller amplitude and a more subtle, less erratic pattern.
C. Coarse V-fib typically appears as a faint, low-amplitude, and smooth baseline.
D. Fine V-fib often has a more organized, repetitive pattern compared to coarse V-fib.
A, B
A patient is found to be in asystole upon assessment. The nurse is preparing to initiate treatment according to Advanced Cardiac Life Support (ACLS) guidelines. Which of the following actions are appropriate for the treatment of asystole?
Select all that apply:
A. Administer epinephrine every 3-5 minutes during the resuscitation attempt.
B. Perform defibrillation immediately as asystole is a shockable rhythm.
C. Initiate high-quality CPR to ensure effective chest compressions and maintain circulation.
D. Administer amiodarone as it is indicated for treating asystole.
E. Continue resuscitation efforts until a rhythm other than asystole is identified or there are signs of recovery.
A, C, E
or the treatment of asystole, the primary interventions are administering epinephrine every 3-5 minutes and performing high-quality CPR to maintain circulation. Asystole is NOT a shockable rhythm, so defibrillation is not indicated.
A patient presents with a rapid heart rate and an ECG shows characteristics consistent with Supraventricular Tachycardia (SVT). Which of the following are characteristic features of SVT on an ECG?
Select all that apply:
A. Regular rhythm with a rapid heart rate exceeding 100 beats per minute.
B. P waves that are not visible or are merged with the T waves.
C. QRS complex duration greater than 0.12 seconds.
D. Narrow QRS complexes (less than 0.12 seconds) with a distinct, regular rhythm.
E. Variable ventricular rate with intermittent pauses in the rhythm.
A, B, D
SVT is characterized by a regular, rapid heart rate typically greater than 100 beats per minute. The P waves are often obscured or merged with the T waves due to the rapid rate. The QRS complex is usually narrow and the rhythm is regular.
Patient is diagnosed with Supraventricular Tachycardia (SVT). Which of the following treatments are appropriate for managing SVT?
Select all that apply:
A. Vagal maneuvers
B. Intravenous adenosine administration.
C. Defibrillation.
D. Oral beta-blockers
E. Synchronized cardioversion.
A, B, D, E
Which of the following are risk factors for developing coronary artery disease (CAD)?
Select all that apply:
A. Hypertension
B. Hyperlipidemia
C. Smoking
D. Regular physical activity
E. Diabetes mellitus
F. Male gender
A, B, C, E, F
Rationale: Hypertension, hyperlipidemia (high cholesterol levels), smoking, diabetes mellitus, and male gender are recognized risk factors for CAD. Men are generally at higher risk for CAD compared to premenopausal women, though the risk increases for women after menopause.
A patient with stable angina reports chest pain that occurs with physical exertion and subsides with rest. Which characteristic is consistent with stable angina?
A. Pain is unpredictable and occurs at rest.
B. Pain is relieved by nitroglycerin or rest.
C. Pain is sudden, severe, and persists for more than 30 minutes.
D. Pain is accompanied by nausea, vomiting, and sweating.
B
Which symptom is indicative of unstable angina rather than stable angina?
A. Pain that occurs predictably with exertion.
B. Pain that improves with rest or nitroglycerin.
C. Pain that occurs at rest, is new in onset, or is worsening.
D. Pain that is consistent with previous episodes and lasts less than 5 minutes.
C
Rationale: Unstable angina is characterized by chest pain that occurs at rest, is new in onset, or has changed in pattern or intensity. It often indicates a more serious condition that requires immediate medical evaluation.
A patient experiencing a myocardial infarction (MI) may exhibit which of the following symptoms, which is not typically associated with stable angina?
A. Sudden onset of severe chest pain
B. Pain that radiates to the back and neck
C. Pain that resolves within minutes with rest
D. Shortness of breath, nausea, and profuse sweating
D
Which of the following diagnostic tests are commonly used to evaluate coronary artery disease (CAD) and acute coronary syndrome (ACS)? (Select all that apply.)
A. Electrocardiogram (ECG)
B. Chest X-ray
C. Cardiac Catheterization
D. Echocardiogram
E. Complete Blood Count (CBC)
A, C, D
Hint!
Cardioversion are used for Atrial dysrhythmias
Defib for ventricular
And asystole is not shockable
