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13 Cards in this Set
- Front
- Back
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1. A patient with chest palpitations becomes unresponsive. The monitor shows a wide-complex, non-perfusing tachycardia. What is the most likely interpretation of the patient's cardiac rhythm? A. Ventricular tachycardia B. Supraventricular tachycardia C. Atrial fibrillabtion D. Idioventricular rhythm |
A. Ventricular tachycardia is a wide-complex tachycardia that may or may not perfuse. In this instance, the rhythm is not perfusing, as demonstrated by the loss of consciousness. If the pulse was checked, the patient would have been pulseless. |
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2. Left ventricular heart failure commonly produces which one of the following symptoms? A. S1 and S2 heart tones B. Enlarged liver C. Pulmonary edema D. Weight loss |
C. Pulmonary edema - the left ventricle is responsible for ejecting blood into the aorta and then the central circulation. When there is left ventricular failure, the blood in the left ventricle has difficulty with forward flow. This results in engorgement in the left atria and engorgement in the pulmonary return. This causes pulmonary edema |
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What medications are contraindicated in right ventricular myocardial infarction? |
Nitroglycerin and morphine because they decrease preload |
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3. The nurse should prepare to administer which of the following to maintain cardiac output in a patient with an acute right ventricular myocardia infarction (RVMI)? A. IV colloid fluids B. Nitroglycerin (Tridil) IV C. Morphine sulfate IV D. IV crystalloid fluids |
D. IV crystalloid fluids - with right ventricular injury or infarction, the pump function of the right ventricle is damaged, and blood is not pumped efficiently. This leads to decreased left ventricular filling and decreased cardiac output. INcreasing preload, or the volume of blood entering the right ventricle, will result in increased blood volume ejected, leading to increased stroke volume and cardiac output. If the patient is hypotensive agter 2 liters of crystalloid fluids such as normal saline, an inotropic medication such as dobutamine IV may be considered. Any treatment that decreases preload in a patient with a right ventricular MI will decrease cardiac output and can cause acute hypotension and patient deterioration. |
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4. The classic symptom of acute myocardial infarction in patients 85 years of age and older is: A. elevated temperature B. shortness of breath C. palpitations D. hypertension |
B. shortness of breath - atypical symptoms for myocardial infarction are characteristic in the elderly. Shortness of breath is usually experienced instead of chest pain |
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5. The QRS complex represents what mechanical event in the heart? A. Atrial contraction B. Ventricular contraction C. Ventricular relaxation D. Atrial relaxation |
B. Ventricular contraction is represented by the QRS complex. |
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6. A patient, who was successfully defiribrillated, now has a regular rhythm with 86 beats/min. The patient is unresponsive with no palpable pulses. These findings are associated with which of the following? A. Pulseless electrical activity B. Cardiac tamponade C. Mechanical monitor failure D. Aortic aneurysm |
A. Pulseless electrical activity (PEA) is a disturbance in the electrical/mechanical activity of the heart. The term "PEA" is used to describe the condition when electrical activity displayed on a cardiac monitor, but the patiens has no detectable pulse. |
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7. Which of the following indicates that fibrinolytic therapy has been effective for treatment of a ST-elevation myocardial infarction (STEMI)? A. Elevation of cardiac markers B. Development of Q waves C. Reperfusion dysrhythmias D. St-segment elevation |
C. Reperfusion dysrhythmias- although the best evidence of reperfusion is angiography, typical signs that reperfusion has occurred include relief from pain, resolution of the ST-segments and reperfusion dysrhythmias such as accelerated idoventricular rhythms. Fibrolytic therapy is not specific for coronary thromboses. Therefore, it is anticipated that bleeding may occur at puncture and injection sites. Reperfusion dysrhythmias may be seen following fibrinolytic administration |
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8. If peripheral access is not available during cardiac arrest, the best and most rapid alternate route for medication administration is: A. intracardiac B. endotracheal tube (ET) C. central venous D. intraosseous (IO) |
D. Intraosseous (IO) needles provide to a non-collapsible marrow venous plexus, which serves as a rapid, safe, and reliable route for administration of drugs, crystalloids, colloids, and blood during resuscitation |
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9. What is the rationale for administration of heparin or low-molecular weight heparin agent to a patient with acute coronary syndrome (ACS)? A. It acts as a clot "buster" for current blood clots B. It decreases clotting time C. It inhibits further thrombin (clot) formation D. It may cause a high platelet count |
C. It inhibits further thrombin (clot) formation - heparin or a low-weight heparin does not lyse current clots. Its primary action is as an anti-thrombin which inhibits new clot development |
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10. A patient's cardiac monitor shows a poor electrocardiogram waveform with artifact. The monitor message says "cannot analyze electrocardiogram." The cable is connected appropriately to the monitor and the patient is lying still. Which of the following interventions can correct this problem? A. Place the black (left arm) and white (right arm) electrodes at the level of the 2nd intercostal space B. Increase the gain setting on the cardiac monitor C. Pull the cable attached to the electrodes taut D. Ensure adequate skin preparation and accurate electrode placement |
D. Ensure adequate skin preparation and accurate electrode placement - inadequate skin preparation interferes with donduction of the electrocardiogram signal. Inaccurate electrode placement is a common cause of artifact or inability of the monitor to interpret the rhythm |
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11. An asthmatic patient arrives with new onset atrial fibrillation with a rapid ventricular response. The patient is awake, alert and oriented with a blood pressure of 119/62 mmHg, HR 158 beats/minute, and RR 22 breaths/minute. What first-line medication is anticipated for this patient? A. Lidocaine (Xylocaine) B. Metoprolol (Lopressor) C. Adenosine (Adenocard) D. Diltiazem (Cardizem) |
D. Diltiazem (Cardizem) is the first-line therapy for treatment of atrial fibrillation in patients with asthma |
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12. A patient with an implantable cardioverter/defibrillator (ICD) is being monitored for reported syncopy. The patient is in normal sinus rhythm on the cardiac monitor and suddenly yells that the device "went off" and gave a shock. The nurse should anticipate which change in the treatment plan? A. Place a magnet over the device B. Initiate transcutaneous pacing C. Tell the patient that the ICD just saved his life D. Inform the patient that this is an expected occurrence with an ICD |
A. Place a magnet over the device - placing a magnet over the device will temporarily deactivate it and prevent inapporpriate firing of the defibrillator until the device can be interrogated and corrected if necessary |
