Fy2016 - RN Annual Rhythm Examination - BLS Providers (Please Provide You First And Last Name Only; No Initials. )
Annual Rhythmn Examination for Med-Surg / BLS providers
- 1.
Identify the cardiac rhythm as being lethal or non-lethal.
- A.
Non - lethal
- B.
Lethal
Correct Answer
A. Non - lethalExplanation
Rhythm = Sinus bradycardia with first degree AV heart block. This is s stable rhythm.Rate this question:
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- 2.
Identify the cardiac rhythm.
- A.
Normal Sinus Rhythm
- B.
Atrial Fibrillation
- C.
Atrial Flutter
- D.
Sinus Bradycardia
Correct Answer
B. Atrial FibrillationExplanation
Atrial fibrillation is the most common dysrhythmia seen. the atria do not contract as evidenced by the wavey baseline and no P wave. random signals get thru the AV node resulting in normal ventricular contraction. if conversion to SR is not attainable the next best goal is rate control and therapeautic anti-coagulation levels.Rate this question:
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- 3.
You see this rhythm on the screen. Your response is - [CHECK ALL THAT APPLY]
- A.
Check the patient ASAP, this looks like the lethal rhythm Torsades de Pointe
- B.
Wait for Telemetry to call and tell you what to do
- C.
Anticipate CPR / using the AED / caling a Dr. Heart
- D.
VOCERA the primary nurse to check the patient - it's probably just artifact
Correct Answer(s)
A. Check the patient ASAP, this looks like the lethal rhythm Torsades de Pointe
C. Anticipate CPR / using the AED / caling a Dr. HeartExplanation
assume the worst - this is torsades de pointe until proven otherwise. it is a lethal rhythm - follow BLS / ACLS protocols - call for help - start CPR - attach AED - early defibrillation is the best treament for survivalRate this question:
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- 4.
Identify the rhythm strip.
- A.
Ventricular tachycardia
- B.
Ventricular fibrillation
Correct Answer
A. Ventricular tachycardiaExplanation
VT is a lethal rhythm; however, because it is so regular, the heart may continue a 'normal' cardiac cycle resulting in a pulse / BP. YOU WON"T KNOW UNTIL YOU CHECK THE PT! If the patient is conscious w/ this rhythm - check VS, have him vagal - CALL MD, ASAP. If the patient is unconscious w/ this rhythm: call for help, start CPR, place on AED, ASAP.Rate this question:
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- 5.
False alarms can lead to rhythm misinterpretation. The following are way to decrease/troubleshoot false alarms. Check all that apply.
- A.
Prepare skin prior to placement of electrodes
- B.
Ensure lead placement is correct
- C.
Use surgical scrub on entire chest
- D.
Place leads in the appropriate sites
Correct Answer(s)
A. Prepare skin prior to placement of electrodes
B. Ensure lead placement is correct
D. Place leads in the appropriate sitesExplanation
Troubleshooting false alarms makes for a safer / quieter environment for all.Rate this question:
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- 6.
When should the nurse obtain an apical pulse and NOT rely upon the vital sign machine for heart rate. Check all that apply.
- A.
Irregular Heart Rhythm
- B.
Normal Sinus Rhythm
- C.
Atrial Fibrillation
- D.
Prior to administration of cardiac medications
Correct Answer(s)
A. Irregular Heart Rhythm
C. Atrial Fibrillation
D. Prior to administration of cardiac medicationsExplanation
Apical pulses are indicated for irregular rhythms, including A-fib or prior to the administration of cardiac meds like Digoxin or beta blockers. VS machines may not provide an accurate HR reading b/c not all cardiac impulses in an irregular rhythm may be perfused peripherally.Rate this question:
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- 7.
You notify the MD that the patient has a rhythm change; s/he asks if the patient is symptomatic; what does symptomatic mean? Check all that apply.
- A.
Decreased Blood Pressure
- B.
Altered Mental Status
- C.
Increased Appetite
- D.
Chest Pain
- E.
Diaphoretic
Correct Answer(s)
A. Decreased Blood Pressure
B. Altered Mental Status
D. Chest Pain
E. DiapHoreticExplanation
All the above (except increase appetite) are signs of an unstable patient. Knowing the clinical signs of an unstable patient allows you to “CLEARLY" communicate to the medical team the gravity of the situation. When notifying them the MD, request that s/he come to the pt's bedside ASAP or call a RRT.Rate this question:
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- 8.
What are the signs and symptoms of hypoxia? Check all that apply.
- A.
Altered Mental Status
- B.
Decreased O2 Level
- C.
Cyanosis
- D.
Tachycardia
Correct Answer(s)
A. Altered Mental Status
B. Decreased O2 Level
C. Cyanosis
D. TachycardiaExplanation
All the above are signs of hypoxia - knowing these will enable you to better manage the care for this patient as well communicate the patient's condition to the medical team.Rate this question:
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- 9.
List appropriate interventions for a patient who is hypoxic. Check all that apply.
- A.
Sit in upright position
- B.
Place patient in prone position
- C.
Call respiratory to administer hand held nebulizer if ordered PRN or due soon
- D.
Cough and Deep Breath
- E.
Ascultate bilateral breath sounds
Correct Answer(s)
A. Sit in upright position
C. Call respiratory to administer hand held nebulizer if ordered PRN or due soon
D. Cough and Deep Breath
E. Ascultate bilateral breath soundsExplanation
ressoving hypoxia by sitting the patient in high fowlers, opening constricted airways, opening collapsed alveoli and being proacive for early signes of heart failure / pulmonary edema / pneumonia - will help the patient the paitnet towards a more speedy recovery.Rate this question:
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- 10.
After admitting a patient and placing them on telemetry you interpret the rhythm as atrial fibrillation. Your intial nurisng actions are to [CHECK ALL THAT APPLY]
- A.
Initiate CPR
- B.
Call a Rapid Response
- C.
Check the patient including vital signs
- D.
Determine if this is an existing condition or not
Correct Answer(s)
C. Check the patient including vital signs
D. Determine if this is an existing condition or notExplanation
Atrial fibrillation is the most common dysrhythmia seen. The atria do not contract as evidenced by the wavy baseline and no P wave. Random signals get thru the AV node resulting in normal ventricular contraction. If conversion to SR is not attainable the next best goal is rate control and therapeutic anti-coagulation levels.Rate this question:
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- 11.
The telemetry technicians notifies you of your patients rhythm changing from Normal Sinus in the 80's to Sinus Tachycardia in the 150's. Your initial nursing action is to....
- A.
Assess the patient, recent medications and other causes
- B.
Call 7911 - this is a lethal rhythm
- C.
Remove the telemetry monitor to avoid the disruptive calls from telemetry
Correct Answer
A. Assess the patient, recent medications and other causesExplanation
Always assess the patient first. ST has many causes - investigate and troubleshoot causes. Sinus tachycardia increases the workload of the heart causing an increase of myocardial oxygen demand. There are many causes for ST: dehydration, anxiety, pain, stimulating drugs, exercise, smoking, and hypoxia - to name a few.Rate this question:
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- 12.
Your patient is taking warfarin (coumadin) for treatment of Atrial Fibrillation. His rhythm on the cardiac monitor reads Atrial Fibrillation, Heart Rate 85. Your initial nursing action is to...
- A.
Notify MD
- B.
Call a Rapid Response
- C.
Instruct patient to vagal down and prepare for mechanical or chemical cardioversion
- D.
Check vital signs including & apical pulse; continue to monitor
Correct Answer
D. Check vital signs including & apical pulse; continue to monitorExplanation
The goals for chronic A-fib include controlled heart rate and therapeutic anticoagulation. HR of 85 is considered controlled.Rate this question:
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- 13.
After assessing your patients you then call telemetry for a recent report. The telemetry technician notifies you your patient has had no changes and is in Normal Sinus Rhythm. When you go into the patients room you find him unconscious and pulseless. This patient is experiencing Pulseless Electrical Activity and your immediate nursing action is to...
- A.
Call telemetry to confirm their reading.
- B.
Initiate CPR and call a Dr. Heart
- C.
Attempt to awaken patient with a sternal rub or ammonia capsule
- D.
Write up the telemetry technition for providing you with false information
Correct Answer
B. Initiate CPR and call a Dr. HeartExplanation
Pulseless electrical activity also called electrical-mechanical disassociation - will produce an electrical rhythm on the monitor; however, the heart has ceased to mechanically contract to produce a pulse / BP. PEA / EMD is a lethal rhythm. Urgent CPR is the treatment of choice.Rate this question:
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- 14.
Telemetry calls and tells you Mr. Smith's leads are off and the battery needs to be changed. What do you do? Check all that apply:
- A.
Place the leads on cleaned skin
- B.
Change the battery
- C.
Assess to determine if additional hair needs to be clipped or cut from the area where leads should be placed.
- D.
Put the leads on the easy to reach spots on the chest - lead placement is irrelevant
Correct Answer(s)
A. Place the leads on cleaned skin
B. Change the battery
C. Assess to determine if additional hair needs to be clipped or cut from the area where leads should be placed.Explanation
Proper skin preparation (clipping hair/cleaning w/alcohol/skin prep) and lead placement is important for proper transmission of rhythms. Changing the battery allow for transmission.Rate this question:
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- 15.
Causes for sinus bradycardia include [CHECK ALL THAT APPLY]
- A.
Medications like beta blockers
- B.
Well conditioned heart (like an athlete)
- C.
As a result of a vasovagal response - from vomiting or coughing
- D.
Smoking
Correct Answer(s)
A. Medications like beta blockers
B. Well conditioned heart (like an athlete)
C. As a result of a vasovagal response - from vomiting or coughingExplanation
Knowing the causes of bradycardia allows for appropriate patient care. Decreasing the heart rate w/ medications decreases the myocardial workload and oxygen demand. Brady rhythms are OK as long as the patient isn't symptomatic.Rate this question:
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- 16.
Causes for sinus tachycardia include [CHECK ALL THAT APPLY]
- A.
Medications like cocaine, albuterol, epinephrine
- B.
Smoking
- C.
Anxiety
- D.
Pain
Correct Answer(s)
A. Medications like cocaine, albuterol, epinepHrine
B. Smoking
C. Anxiety
D. PainExplanation
Sinus tachycardia refers to a faster than normal heart rate originating from the sinus node in the heart. This can be caused by various factors, including medications such as cocaine, albuterol, and epinephrine, which can stimulate the heart and increase its rate. Smoking can also contribute to sinus tachycardia due to the nicotine and other chemicals affecting the cardiovascular system. Anxiety and pain can both trigger a stress response in the body, leading to an increased heart rate. Therefore, all of the listed options can cause sinus tachycardia.Rate this question:
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- 17.
I pledge to demonstrate the core values of the American Nurses Association Code of Ethics by upholding the standards of honesty and integrity. By answering yes, you certify that you are the person taking this test.
- A.
Yes
- B.
No
Correct Answer
A. YesExplanation
The given correct answer is "Yes" because by selecting "Yes", the individual is confirming that they pledge to demonstrate the core values of the American Nurses Association Code of Ethics by upholding the standards of honesty and integrity. Additionally, they are certifying that they are the person taking the test.Rate this question:
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- 18.
Identify the lethal rhythm.
- A.
Pulseless electrical activity
- B.
Torsades de pointe
- C.
Asystole
- D.
Sinus bradycardia
Correct Answer
C. AsystoleExplanation
Asystole is cardiac standstill with no cardiac output and no ventricular depolarization.Rate this question:
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- 19.
Identify the lethal rhythm.
- A.
Ventricular tachycardia
- B.
Ventricular fibrillation
- C.
PEA (pulseless electrical activity)
- D.
Torsades de pointe
Correct Answer
C. PEA (pulseless electrical activity)Explanation
Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity. Pulseless electrical activity has previously been referred to as electromechanical dissociation (EMD).Rate this question:
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- 20.
Identify the rhythm strip.
- A.
PEA (pulseless electrical activity)
- B.
Sinus tachycardia
- C.
Ventricular tachycardia
- D.
Torsades de pointe
Correct Answer
D. Torsades de pointeExplanation
Torsades de Pointes is an uncommon variant of ventricular tachycardia that can be the result of lengthening the QT interval. Torsades refers to the repeating continuum of upward then downward pointing ventricular complexes.Rate this question:
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![You see this rhythm on the screen. Your response is - [CHECK ALL THAT APPLY] - ProProfs](/api/ckeditor_images/Step 12.png "You see this rhythm on the screen. Your response is - [CHECK ALL THAT APPLY]")
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Feb 01, 2023Quiz Edited by
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Dec 01, 2015Quiz Created by
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