Basic Rhythm Review
Bradyarrhythmia
Tachyarrhythmia
ACLS Drugs &
Algorithms
Nursing Interventions & Delegation
100

What is the normal length of a PR interval?

0.12 to 0.20 seconds

100

Define sinus bradycardia (rate and rhythm).

Regular rhythm, rate <60 bpm, normal P waves, PR, and QRS

100

Define sinus tachycardia (rate and rhythm).

Regular rhythm, rate 101–150 bpm, normal P waves, PR, and QRS

100

Which drug is first-line for ventricular fibrillation?

Epinephrine

100

True or False: A UAP can place defibrillator pads on a patient.

True

200

Which part of the conduction system is considered the “pacemaker” of the heart?

Sinoatrial (SA) node

200

What drug is first-line treatment for symptomatic sinus bradycardia?

IV Atropine 1 mg every 3–5 min (max 3 mg)

200

What is the first-line vagal maneuver for stable SVT?

Valsalva maneuver

200

What dose and frequency of epinephrine is used in cardiac arrest?

1 mg IV/IO every 3–5 minutes

200

Which tasks can be delegated to a UAP for a patient with sinus bradycardia who is asymptomatic?

Obtain vital signs, apply oxygen, place monitor leads; RN interprets rhythm and manages treatment

300

A QRS complex wider than ___ seconds is considered abnormal.

>0.12 seconds

300

In second-degree type I AV block, what happens to the PR interval before a dropped QRS?

PR interval progressively lengthens until a beat is dropped

300

Which medication is given rapidly (with a fast IV push and flush) for SVT?

First dose: 6 mg rapid IV push; follow with 20 mL NS flush.
Second dose: 12 mg if required; follow with 20 mL NS flush.

300

What antiarrhythmic drug can be used if amiodarone is unavailable during VF/VT arrest?

Lidocaine

300

During a code, what is the respiratory therapist’s primary role?

Manage airway and ventilation (bag-mask, advanced airway placement)

400

What is the hallmark EKG finding of atrial fibrillation?

Irregularly irregular rhythm with absent P waves (fibrillatory waves)

400

A patient with complete heart block becomes unresponsive and pulseless. What is your immediate action?

Start CPR and follow ACLS cardiac arrest algorithm (not bradycardia algorithm)

400

A patient with atrial fibrillation with RVR is unstable (hypotension, chest pain). What is the priority treatment?

Immediate synchronized cardioversion

400

Which drug is used to treat polymorphic VT (torsades de pointes)?

IV Magnesium sulfate

400

Which tasks must remain the responsibility of the RN during ACLS?

Rhythm interpretation, medication administration, defibrillation/cardioversion, leadership/decision-making

500

Describe the difference between monomorphic and polymorphic ventricular tachycardia.

Monomorphic = QRS complexes uniform in shape/size; Polymorphic = QRS complexes vary in shape/size (e.g., torsades de pointes)

500

Which ACLS drugs can be used as an infusion when atropine is ineffective for bradycardia?

Dopamine infusion or Epinephrine infusion

500

What is the difference in treatment between stable VT with a pulse and pulseless VT?

  • Stable VT with a pulse: Amiodarone, synchronized cardioversion if needed

  • Pulseless VT: CPR, defibrillation, epinephrine, amiodarone

500

List the reversible causes (Hs & Ts) that should always be considered during cardiac arrest.

Hs: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/hyperkalemia, Hypothermia

Ts: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (coronary or pulmonary)

500

A patient is found unresponsive, pulseless, and in ventricular fibrillation. Walk through the ACLS algorithm for the first 2 cycles, including drugs, interventions, and defibrillation timing.

Start CPR, attach monitor/defibrillator

Defibrillate immediately

Resume CPR for 2 min

Give Epinephrine 1 mg IV/IO every 3–5 min (after second shock)

Defibrillate again, resume CPR

Consider Amiodarone 300 mg IVP, then 150 mg if VF/pulseless VT persists

Continue cycles with CPR, defibrillation every 2 min, and alternating drugs

Always consider Hs & Ts