EKG NCLEX Questions – Flashcards
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A 38-year-old female is brought to the Emergency Department with complaints of her "heart beating out of her chest". She is diaphoretic, tachypneic and her BP is 70/40. The cardiac monitor shows supraventricular tachycardia. Valsalva maneuvers and three doses of Adenosine have not been successful. The nurse should immediately: a.) prepare the patient for synchronized cardioversion. b.) give Epinephrine 1 mg IV and repeat in 3 minutes. c.) give Adenosine 6 mg IV per protocol. d.) perform unilateral carotid massage.
answer
a.) prepare the patient for synchronized cardioversion.
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Prior to discharge from the Emergency Department, the nurse prints a rhythm strip on a patient and notices that the P wave cannot be detected and the QRS complex is 0.24 seconds. This is a change in the patient's condition. What is the best action for the nurse to take? a.) Measure the PR interval. b.) Prepare the patient for discharge. c.) Notify the physician of this abnormal strip. d.) Continue to monitor for abnormalities.
answer
c.) Notify the physician of this abnormal strip. Rationale: c.) is correct because notifying the physician of the abnormal rhythm would be the most appropriate response. The patient has experienced a rhythm change and requires further treatment. a.) is not correct for measuring the PR would not be possible as there is no P wave present. Since the QRS interval and other parameters given are abnormal, discharging the patient would not be appropriate at this point. b.) is not correct as discharging the patient is not appropriate or safe practice. d.) is not correct because continuing to monitor the patient without any other actions would be inappropriate as the patient has experienced a change in condition.
question
A patient is to have synchronized cardioversion for treatment of atrial flutter. He has received Heparin 500 units subcutaneously. Which of the following interventions should now be performed? a.) Assist the MD in intubating the patient to stabilize airway. b.) Sedate the patient with Versed 2 mg IV push per protocol. c.) Set the defibrillator in asynchronous mode and charge to 300 joules. d.) Steadily increase the voltage until the beats are captured.
answer
b.) Sedate the patient with Versed 2 mg IV push per protocol. Rationale: b.) is correct since cardioversion is very painful, the patient should be sedated prior to the procedure. a.) is not correct as intubation is usually not indicated prior to cardioversion. c.) is not correct as synchronized cardioversion is performed at less voltage than defibrillation (360 joules). The defibrillator should be set in synchronous mode so the shock will be delivered on the R wave. d.) is not correct because steadily increasing the voltage until the beats are captured is indicative of pacemaker therapy and not synchronized cardioversion.
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When a patient has long-term atrial fibrillation, the nurse would expect to include which drug in the plan of care to minimize the greatest risk that is commonly associated with atrial fibrillation? a.) Beta blockers b.) Digitalis c.) Anticoagulants d.) Antiarrhythmics
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c.) Anticoagulants Rationale: c.) is correct because it reflects the greatest risk or complication of thrombi or emboli that occurs with long-term atrial fibrillation. Coumadin is often given prophylactically to prevent stroke, clots, or emboli from developing when hospitalizing a patient with long-term atrial fibrillation.
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The nurse should understand that which of the following treatments for Second Degree Type II AV Block would be appropriate? (Select all that apply) a.) Temporary pacemaker insertion b.) Close monitoring without intervention c.) Atropine to increase heart rate if symptomatic d.) Coronary stent placement to improve blood flow to myocardium e.) An implantable defibrillator surgically implanted
answer
a.) Temporary pacemaker insertion c.) Atropine to increase heart rate if symptomatic d.) Coronary stent placement to improve blood flow to myocardium Rationale: Rationale: a,c, and d are correct. Temporary pacing may be needed and atropine will temporarily improve heart rate cardiac output until the pacemaker can be inserted. b.) is incorrect because Type II has a tendency to develop complete heart block where adequate cardiac output is not maintained and arrest is likely. Type I can be monitored and minimal treatment is needed unless unstable hemodynamics are present. e.) is incorrect because a defibrillator is not called for since it is the ventricle that is trying to maintain the cardiac output from the decreased conduction between the atria and the ventricles. An implanted pacemaker may be needed permanently.
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The nurse would expect which of the following to be the first choice to treat a stable patient with ventricular tachycardia? a.) Amiodarone b.) Procainamide c.) Synchronized cardioversion d.) Atropine
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a.) Amiodarone
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A 21-year-old female is seen in the Emergency Department for vomiting and diarrhea for 3 days. Her BP is 94/64 and her EKG rhythm shows that she is sinus tachycardia. The best action for the nurse to take initially is to: a.) request pain medication for the patient. b.) cardiovert the patient immediately. c.) give Adenosine 6 mg IV push. d.) start IV and bolus normal saline per protocol.
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Rationale: d.) is correct because the patient is dehydrated due to vomiting and diarrhea and needs IV fluids. The rhythm strip is sinus tachycardia and the cause is treated. a.) is not correct because no information is given regarding the presence of pain. b.) is not correct because Cardioversion is not an appropriate action for sinus tachycardia. c.) is not correct Adenosine is only given for SVT.
