Fy2016 - RN Annual Rhythm Examination - BLS Providers (Please Provide You First And Last Name Only; No Initials. )

1. 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....

Assess the patient, recent medications and other causes

Call 7911 - this is a lethal rhythm

Remove the telemetry monitor to avoid the disruptive calls from telemetry

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.

Explanation

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.

2. 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...

Call telemetry to confirm their reading.

Initiate CPR and call a Dr. Heart

Attempt to awaken patient with a sternal rub or ammonia capsule

Write up the telemetry technition for providing you with false information

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.

Explanation

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.

3. 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.

Yes

No

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.

Explanation

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.

4. Identify the lethal rhythm.

Pulseless electrical activity

Torsades de pointe

Asystole

Sinus bradycardia

Asystole is cardiac standstill with no cardiac output and no ventricular depolarization.

Explanation

Asystole is cardiac standstill with no cardiac output and no ventricular depolarization.

5.

Identify the cardiac rhythm as being lethal or non-lethal.

Non - lethal

Lethal

Rhythm = Sinus bradycardia with first degree AV heart block. This is s stable rhythm.

Explanation

Rhythm = Sinus bradycardia with first degree AV heart block. This is s stable rhythm.

6. False alarms can lead to rhythm misinterpretation. The following are way to decrease/troubleshoot false alarms. Check all that apply.

Prepare skin prior to placement of electrodes

Ensure lead placement is correct

Use surgical scrub on entire chest

Place leads in the appropriate sites

Troubleshooting false alarms makes for a safer / quieter environment for all.

Explanation

Troubleshooting false alarms makes for a safer / quieter environment for all.

Submit

7. 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...

Notify MD

Call a Rapid Response

Instruct patient to vagal down and prepare for mechanical or chemical cardioversion

Check vital signs including & apical pulse; continue to monitor

The goals for chronic A-fib include controlled heart rate and therapeutic anticoagulation. HR of 85 is considered controlled.

Explanation

The goals for chronic A-fib include controlled heart rate and therapeutic anticoagulation. HR of 85 is considered controlled.

8. 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]

Initiate CPR

Call a Rapid Response

Check the patient including vital signs

Determine if this is an existing condition or not

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.

Explanation

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.

Submit

9. Causes for sinus tachycardia include [CHECK ALL THAT APPLY]

Medications like cocaine, albuterol, epinephrine

Smoking

Anxiety

Pain

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.

Explanation

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.

Submit

10. 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:

Place the leads on cleaned skin

Change the battery

Assess to determine if additional hair needs to be clipped or cut from the area where leads should be placed.

Put the leads on the easy to reach spots on the chest - lead placement is irrelevant

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.

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.

Submit

11. Identify the rhythm strip.

PEA (pulseless electrical activity)

Sinus tachycardia

Ventricular tachycardia

Torsades de pointe

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.

Explanation

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.

12. 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.

Decreased Blood Pressure

Altered Mental Status

Increased Appetite

Chest Pain

Diaphoretic

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.

Explanation

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.

Submit

13.

Identify the cardiac rhythm.

Normal Sinus Rhythm

Atrial Fibrillation

Atrial Flutter

Sinus Bradycardia

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.

Explanation

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.

14.

Identify the rhythm strip.

Ventricular tachycardia

Ventricular fibrillation

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.

Explanation

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.

15. Causes for sinus bradycardia include [CHECK ALL THAT APPLY]

Medications like beta blockers

Well conditioned heart (like an athlete)

As a result of a vasovagal response - from vomiting or coughing

Smoking

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.

Explanation

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.

Submit

16. What are the signs and symptoms of hypoxia? Check all that apply.

Altered Mental Status

Decreased O2 Level

Cyanosis

Tachycardia

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.

Explanation

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.

Submit

17. When should the nurse obtain an apical pulse and NOT rely upon the vital sign machine for heart rate. Check all that apply.

Irregular Heart Rhythm

Normal Sinus Rhythm

Atrial Fibrillation

Prior to administration of cardiac medications

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.

Explanation

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.

Submit

18. List appropriate interventions for a patient who is hypoxic. Check all that apply.

Sit in upright position

Place patient in prone position

Call respiratory to administer hand held nebulizer if ordered PRN or due soon

Cough and Deep Breath

Ascultate bilateral breath sounds

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.

Explanation

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.

Submit

19.

You see this rhythm on the screen. Your response is - [CHECK ALL THAT APPLY]

Check the patient ASAP, this looks like the lethal rhythm Torsades de Pointe

Wait for Telemetry to call and tell you what to do

Anticipate CPR / using the AED / caling a Dr. Heart

VOCERA the primary nurse to check the patient - it's probably just artifact

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 survival

Explanation

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 survival

Submit

20. Identify the lethal rhythm.

Ventricular tachycardia

Ventricular fibrillation

PEA (pulseless electrical activity)

Torsades de pointe

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).

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).

21.

Please match the normal with the appropriate portion of the ECG.

PR Interval - atrial contraction

QRS Complex - ventricle contraction

Rate - R to R interval

QT Interval - ventricular repolarization

Submit