Quiz Questions

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The patient is a 53-year-old man who says he feels weak and shaky and started feeling dizzy during a training session at work. A co-worker drove him to the ED. The patient is lying down with his eyes closed. You notice the rise and fall of his chest. The patient is pale, and he is breathing about 18 times per minute.

1. In what order should the following tasks be completed?

1. Check his pulse.
2. Attach a pulse oximeter.
3. Place the patient on a cardiac monitor.
4. Start oxygen.

1. 1, 2, 3, 4
2. 3, 4, 1, 2
3. 1, 4, 2, 3
4. 2, 3, 4, 1

A team member obtains the patient's vital signs, and you go through a history and perform a physical exam. The patient has the following vital signs: BP 58/32, heart rate is about 45, and respirations are 18. Breath sounds are clear and equal bilaterally.

2. Which are possible causes for symptomatic bradycardia?

1. Sick sinus syndrome
2. Hypoxia
3. Pulmonary embolism
4. Tension pneumothorax
5. All of the above
6. None of the above

3. What do you do next?

1. Order a chest x-ray.
2. Administer a dose of atropine.
3. Start an IV.
4. Check his rhythm on the monitor.

You notice the following rhythm on the monitor:

4. What is the rhythm?

1. Sinus bradycardia
2. First-degree AV block
3. Mobitz type II second-degree block
4. Third-degree AV block

The patient now has an IV. You have ordered a 12-lead ECG. You have a defibrillator nearby.

5. Which of the following is your next step?

1. Epinephrine
2. Transcutaneous pacing
3. Atropine
4. Expert consultation

6. If you chose to administer atropine rather than start transcutaneous pacing, what was your rationale for this decision?

7. If atropine is unsuccessful, what are your other medication options?

1. epinephrine alone
2. dopamine alone
3. epinephrine and dopamine, if needed
4. another dose of atropine, after 3 to 5 minutes
5. A, B, and D
6. All of the above

You obtain another set of vital signs: the patient's BP is 112/72, his heart rate is 88, and respirations are 16. The patient says he feels much better. You continue to monitor the patient's ECG and vital signs, and you try to figure out what caused the patient's bradycardia.

Quiz Answers

1. Answer: A. They are listed in the correct order according to the algorithm.
2. Answer: E. all of the above
3. Answer: D. Check his rhythm on the monitor.
4. Answer: A. Sinus bradycardia
5. Answer: C. Atropine
6. Answer: Because the sinus bradycardia shows a narrow QRS interval, it is reasonable to try atropine to increase the patient's heart rate.
7. Answer: E. All of the above