Telemetry-Capstone Nursing Exam 54 Questions with Verified Answers,100% CORRECT

Telemetry-Capstone Nursing Exam 54 Questions with Verified Answers Normal Sinus Rhythm - CORRECT ANSWER Heart Rate: 60-100 bpm Regularity: Regular PRI: .12-.20 seconds QRS:

Telemetry-Capstone Nursing Exam 54 Questions with Verified Answers Normal Sinus Rhythm - CORRECT ANSWER Heart Rate: 60-100 bpm Regularity: Regular PRI: .12-.20 seconds QRS: <.12 seconds Normal Sinus Bradycardia - CORRECT ANSWER Heart Rate: <60 bpm Regularity: Regular PRI: .12-.20 seconds QRS: <.12 seconds Normal Sinus Tachycardia - CORRECT ANSWER Heart Rate: >100 bpm Regularity: Regular PRI: .12-.20 seconds QRS: <.12 seconds Normal Sinus Arrhythmia - CORRECT ANSWER Heart Rate: 60-100 bpm; can be <60 Regularity: Irregular PRI: .12-.20 seconds QRS: <.12 seconds Premature Atrial Contraction (PAC) - CORRECT ANSWER Heart Rate: Depends on underlying rhythm Regularity: Interrupts the regularity of underlying rhythm P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes QRS: <.12 seconds Atrial Tachycardia (SVT) - CORRECT ANSWER Regularity: R-R intervals are constant; Regular Rate: artial/ventricular rates are equal; heart rate is between 150-250 bpm. P-Wave: One P Wave in front of every QRS; may be flattened or notched; because of the rapid rate, the P waves can be hidden within the T waves PRI: .12-.20 seconds and constant QRS: <.12 seconds Atrial Flutter - CORRECT ANSWER Rhythm: Regular atrial rhythm; irregular ventricular rate Rate: 250-350 bpm P-Wave: well defined P waves; "sawtooth" appearance PRI: Usually impossible to determine the PR in this arrhythmia. QRS: <.12 seconds Atrial Fibrillation (Uncontrolled) - CORRECT ANSWER Regularity: Irregular; no pattern to it's irregularity Rate: Majority of time is >350 bpm P Waves: No P Waves Present PRI: Since no P Waves, no PRI can be determined QRS: Should be <.12 seconds Atrial Fibrillation (controlled) - CORRECT ANSWER Regularity: Irregular; no pattern to it's irregularity Rate: <100 bpm P-Wave: Not present PRI: Since no P wave is present, PRI is not determined QRS: <.12 seconds Junctional Rhythms - CORRECT ANSWER -Occurs when the AV node takes over as the primary pacemaker in the heart rather than the SA node. AV node takes over when is moves faster than SA node. Rate: 40-60 bpm; Accelerated Junctional: 60-100 bpm; Junctional Tachycardia: 100 bpm or greater P Wave: If before QRS, P wave will be inverted. P Wave can also be hidden within the QRS complex. P Wave is usually <.12 seconds QRS: <.12 seconds What are the four Supra-Ventricular Tachycardias (SVT)? - CORRECT ANSWER Sinus Tachycardia (100-160 bpm) Atrial Tachycardia (150-250 bpm) Atrial Flutter (150-250 bpm) Junctional Tachycardia (100-180 bpm) First Degree Heart Block - CORRECT ANSWER Regularity: depend on the rhythm Rate: Depend on underlying rhythm P Waves: Upright and Uniform; each P Wave will be followed by a QRS complex PRI: constant across entire strip, but always > .20 seconds. QRS: < .12 seconds Second Degree Heart Block (Wenckebach) - CORRECT ANSWER Regularity: R-R Wave is irregular; R-R interval gets progressively shorter as PRI gets progressively longer Rate: Ventricular rate is slightly slower than normal; atrial rate is normal P-Waves: upright and uniform; some p waves are not followed by the QRS complex PRI: gets progressively longer until one p wave is not followed by a QRS complex; after the blocked beat, cycle starts over QRS: < .12 seconds Second Degree Heart Block (Morbitz) - CORRECT ANSWER Regularity: if conduction ratio is consistent, R-R interval will be constant and rhythm, regular. If conduction ratio varies, the R-R will be irregular Rate: atrial rate is usually normal; ventricular rate will be in bradycardia P Waves: upright and uniform; always be more P waves than QRS PRI: constant; might be longer than normal QRS: <.12 seconds Premature Ventricular Contraction (PVC) - CORRECT ANSWER Regularity: Regular or Irregular Rate: Determined by underlying rhythm; but frequently do not produce a pulse P-Waves: Ectopic is not preceded by a P-Wave PRI: None QRS: Wide and Bizarre; measuring at least .12 seconds; T wave is often in opposite direction from QRS. Ventricular Tachycardia - CORRECT ANSWER Regularity: Usually regular Rate: Ventricular Rate: 150-250 bpm; if rate is <150 bpm, it's a slow VT; if exceeds 250 bpm, Ventricular Flutter P Waves: None of QRS will be preceded by P Waves PRI: no PRI QRS: wide and bizarre measuring at least .12 seconds; hard to tell between QRS and T wave Ventricular Fibrillation - CORRECT ANSWER Regularity: chaotic Rate: cannot be determined P Waves: no P waves present PRI: no PRI QRS: no discernible QRS complexes Asystole - CORRECT ANSWER No electrical activity; only a straight line 3rd Degree Heart Block - CORRECT ANSWER Regularity: Regular Rate: 40-60 bpm if junctional; 20-40 bpm if focus is ventricular. P Wave: upright and uniform; more p waves than QRS complexes PRI: no relationship between p waves and QRS complexes QRS: < .12 seconds if junctional; > .12 seconds if ventricular Bundle Branch Block (Left) - CORRECT ANSWER Wide QRS (>.12 seconds) Left Bundle Branch ("M") Can deteriorate to a 3rd Degree HB Bundle Branch Block (Right) - CORRECT ANSWER Wide QRS (>.12 seconds) Right Bundle Branch Block ("V") Can deteriorate to a 3rd Degree HB Lead Placement - CORRECT ANSWER Left: Smoke (Black) over Fire (Red) Right: Snow (White) over Grass (Green) Center: Chocolate (place a little off center for possible CPR) Sinus Tachycardia Etiology/Clinical Signs - CORRECT ANSWER Etiology: -Physiologic demand for oxygen -Sympathomimetric Drugs -Fever -Pain Clinical Signs: -increased HR; increased oxygen demand Sinus Tachycardia Treatment - CORRECT ANSWER -May resolve with treatment of underlying cause -Digoxin, Beta Blockers (-olol), Verapamil -Vagal Maneuver Sinus Bradycardia Etiology/Clinical Signs - CORRECT ANSWER Etiology: -response to myocardial ischemia -vagal stimulation -electrolyte imbalance -drugs -increased intracranial pressure -highly trained athlete Clinical Signs: -decreased CO if body can't compensate; improved CO due to diastolic filling time Sinus Bradycardia Treatment - CORRECT ANSWER -Atropine -Avoid Valsalva -Hold Rate Slowing Drugs (Digoxin, Beta Blockers) Sinus Bradycardia: Example: Your pt is pale, c/o dizziness and fatigue; pulse 56, BP 86/60. How would you follow protocol according to ACLS? - CORRECT ANSWER 1. Airway 2. Oxygen 3. ECG, BP, Oximetry 4. IV Access 5. If s/s of perfusion, altered mental status, CP, hypotension, signs of shock: a. prepare for transcutaneous placing b. atropine 0.5mg IV while waiting for pacer (may repeat for total of 3mg IV) c. epi or dopamine drip while waiting pacer Atrial Flutter Etiology/ Clinical Signs - CORRECT ANSWER Etiology: -occurs w/ heart disease -CAD -Valve Disorders Clinical Signs: -may cause thrombus -"saw tooth" -250-400 bpm Atrial Flutter Treatment - CORRECT ANSWER -Give anticoagulants (faster the HR, more risk for thrombus) -treat underlying cause -digoxin (slows rate by enhancing AV block) -Quinidine (supresses atrial ectopic block) -Amiodarone -Calcium Channel Blockers (Cardizem)/Beta Blockers (-olol) -consider cardioversion Atrial Fibrillation Etiology/Causes - CORRECT ANSWER Etiology: -Advanced Age -Valve Disorders -cardiomyopathy Causes: -chocolate (theobromine-stimulant) -sleep apnea -athletes -tall athletes -aging heart -men more than women Atrial Fibrillation Treatment - CORRECT ANSWER 1. Amiodarone 2. Calcium Channel Blockers, Beta Blockers, digoxin 3. Synchronized cardioversion if unstable 4. radio frequency catheter ablation 5. anti-coagulation therapy 6. Cardizem Amiodarone - CORRECT ANSWER May cause liver, lung damage, and worsening of arrhythmias. Pt to report SOB, wheezing, jaundice, palpitations, lightheadedness Rhythms for cardioversion - CORRECT ANSWER 1. A-Fib 2. A-Flutter 3. SVT Electrical Cardioversion - CORRECT ANSWER Tx of choice if pt has a hemodynamically unstable tachydysrhythmia; unstable ventricular tachycardia w/ a pulse; prevention of life-threatening dysrhythmias; cardioversion can be planned or emergent; proper cardioversion will correct pt dysrhythmia w/ minimal discomfort and maximum safety Post Cardioversion Care - CORRECT ANSWER Same as when a pt is in A-Fib If elective, digoxin is usually withheld for 48hrs prior to cardioversion to prevent dysrhythmias after procedure airway patency should be maintained and the patient state of consciousness should be evaluated Paroxysmal SVT Treatment - CORRECT ANSWER 1. treat underlying cause 2. adenosine, beta blockers, digoxin, quinidine, MS 3. Carotid/Vagal Maeuver 4. Synchronized cardioversion if unstable Premature Ventricular Contraction Etiology - CORRECT ANSWER 1. Hypoxia 2. Digoxin Toxicity 3. Mechanical Stimulation 4. Electrolyte Imbalance (potassium) 5. MI Premature Ventricular Contraction Clinical Signs - CORRECT ANSWER 1. Depends on frequency 2. short diastolic filling time, decreased cardiac output 3. sensation of palpitations, skipped beats 4. Bigeminy (pvc every other beat) 5. Trigeminy (pvc every 3rd beat) Premature Ventricular Contraction Treatment - CORRECT ANSWER 1. treat impaired hemodynamics 2. antiarrythmics 3. oxygen 4. monitor for PVC on T-Wave Ventricular Arrythmias Etiology - CORRECT ANSWER Same as PVC but also cardiomyopathy, myocardial irritability Ventricular Arrythmias Treatment - CORRECT ANSWER 1. VT w/ a pulse: cardiovert 2. monitor more closely 3. prepare cardioversion (oxygen, lidocaine, treat cause) 4. VT w/o a pulse: defibrillate (call code) Torsades De Pointes Treatment - CORRECT ANSWER IV Magnesium Ventricular Fib (Etiology, Clinical Signs) - CORRECT ANSWER 1. Same as VT, PVC 2. Surgical Manipulation of heart 3. Failed cardioversion 1. Same as cardiac arrest 2. EKG is disorganized rhythm Ventricular Fib Treatment - CORRECT ANSWER 1. IMMEDIATE DEFIBRILLATION X3 2. CPR 3. SURVIVAL IS <10% FOR EVERY MINUTE THE PT REMAINS IN V-FIB SCREAM (acronym) for VFib and VTach - CORRECT ANSWER 1. Shock Q2min 2. CPR after shock (compressions followed by resp 30:2) for 2min 3. Rhythm check after 2 min of CPR and shock again if indicated 4. Epinephrine or vasopressin 5. Antiarrythmic medications: Amiodarone/Lidocaine 6. Magnesium Sulfate Cardiac Arrest - CORRECT ANSWER Ventricular Asystole due to VFib Etiology: trauma, overdose, MI Clinical Signs: asystole or VFib, no definable waves, absence of VS Ventricular Asystole - CORRECT ANSWER TEA: trans-cutaneous pacemaker, epinephrine, atropine 1st Degree Heart Block Causes - CORRECT ANSWER May be normal variant; inferior wall MI; drugs: verapamil or digoxin 1st Degree Heart Block Treatment - CORRECT ANSWER Monitor; Observe for symptoms 2nd Degree Heart Block Causes - CORRECT ANSWER organic heart disease, MI, Dig Toxicity, Beta and Calcium Blockers 2nd Degree Heart Block Treatment - CORRECT ANSWER Monitor HR, Atropine, Temp Pacemaker, Avoid meds that decrease conductivity 3rd Degree Heart Block Causes - CORRECT ANSWER Organic Heart Disease, MI, Drugs, Electrolyte Imbalance, Excess Vagal Tone 3rd Degree Heart Block Signs & Symptoms - CORRECT ANSWER Extreme Dizziness, Hypotension, Syncope, Decrease CO, Altered Mental Status 3rd Degree Heart Block Treatment - CORRECT ANSWER Pacemaker (temporary or permanent)