Quiz Questions

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A 53-year-old man complains that he is dizzy and lightheaded. You begin a primary survey and request a team member to attach an oximeter and place the man on a cardiac monitor. You make sure a defibrillator is close at hand. His blood pressure is 159/96 and his heart rate is 214.

1. You note the following rhythm on the monitor, which is ____________________.

You conduct a physical exam and run through his history, asking about signs and symptoms, allergies, medications, past medical history, last oral intake, and events prior. The patient appears to be stable.

2. What treatment do you try first?

1. Synchronized cardioversion
2. Observe and monitor
3. Vagal maneuvers
4. Administer adenosine

3. Is carotid sinus massage appropriate for this patient? Select the correct answer and explain why it is correct.

1. Yes, because ________________________
2. No, because _________________________

The patient tries blowing through a straw and coughing, without success.

4. It appears these vagal maneuvers are not successful in his case. What treatment would you try next?

1. Continue with other vagal maneuvers.
2. Administer amiodarone.
3. Perform synchronized cardioversion.
4. Administer adenosine.

5. The patient becomes unresponsive with a BP of 62/39. What is your next step?

1. You quickly repeat the primary survey.
2. You administer another dose of adenosine.
3. You observe the patient for several minutes.
4. You check the rhythm on the monitor.

6. The patient has the same rhythm on the monitor but is now unstable. Which treatment would you select?

1. Defibrillation
2. Synchronized cardioversion

7. Explain why you chose either A or B.

Scenario

A 31-year-old woman comes in because her heart has been "pounding" over several weeks. Her BP is 100/54 and her heart rate is 137 bpm. She recently transferred to a new division in her company and has taken over the role of marketing manager. She has been feeling anxious and worried about her performance. She usually keeps a can of Cola on her desk and recently has been drinking more caffeinated beverages. The following rhythm appears on the monitor:

8. The rhythm is which of the following?

1. Supraventricular tachycardia
2. Polymorphic ventricular tachycardia
3. Sinus tachycardia
4. Monomorphic ventricular tachycardia

9. List the characteristics of this rhythm:

• Rate
• Rhythm
• PR interval
• QRS duration

10. The patient is stable. Which treatment do you recommend for this patient?

1. Begin CPR.
2. Give high-energy unsynchronized shock
3. Give amiodarone 150 mg IV
4. Treat the underlying cause.

Quiz Answers

1. Answer: AV nodal reentrant tachycardia.
2. Answer: C. Vagal maneuvers. Vagal maneuvers are the recommended initial treatment for a patient who is stable with a narrow-complex tachycardia.
3. Answer: A. Yes, because he is in reasonably good health and is fairly young. Carotid sinus massage is contraindicated for older patients.
4. Answer: D. Administer adenosine.
5. Answer: A. You quickly repeat the primary survey.
6. Answer: B. Synchronized cardioversion
7. Answer: The patient became unstable. He has a pulse and a narrow-complex tachycardia. Synchronized cardioversion is the recommended treatment.
8. Answer: C. Sinus tachycardia
9. Answers:
   Rate between 101 and 180 bpm
   Regular rhythm
   PR interval from 0.12 to 0.20 second
   QRS duration is 0.10 second or less
10. Answer: D. Treat the underlying cause. Sinus tachycardia is likely brought on by stress and increased caffeine intake. Reducing both should resolve the tachycardia.