Dysrhythmias & EKG Interpretation
Which rhythm requires CPR and epinephrine, not defibrillation?
A. Ventricular fibrillation
B. Pulseless VT
C. Asystole
D. SVT
Answer: C
Rationale: Asystole is non-shockable.
This ACS type shows ST elevation and indicates complete coronary artery occlusion.
Answer: What is STEMI?
Rationale:
ST elevation = transmural myocardial infarction requiring emergent reperfusion.
Peripheral edema, ascites, and hepatomegaly indicate failure of this side.
Answer: What is Right-sided heart failure?
Rationale:
Right HF → systemic venous congestion.
This valve disorder causes blood to flow backward due to incomplete closure.
Answer: What is Regurgitation?
Rationale:
Valve incompetence → backward blood flow.
This rhythm requires CPR and epinephrine, not defibrillation.
Answer: What is Asystole?
Rationale:
No electrical activity → no shockable rhythm.
Wide QRS, VT, HR 160, patient diaphoretic and hypotensive. Priority?
A. Amiodarone infusion
B. Synchronized cardioversion
C. Defibrillation
D. CPR
Answer: B
Rationale: Unstable VT with pulse → synchronized cardioversion.
The most specific lab marker for myocardial injury.
Answer: What is Troponin?
Rationale:
Troponin is cardiac-specific and remains elevated longer than CK-MB.
NSTEMI differs from STEMI because it:
A. Has no myocardial damage
B. Shows ST depression or T inversion
C. Does not elevate troponin
D. Requires no intervention
Answer: B
Rationale: Partial occlusion → ischemic ECG changes.
This diagnostic test best evaluates valve structure and function.
Answer: What is Echocardiogram?
Rationale:
Echo visualizes valves, chamber size, and flow patterns.
Why must anticoagulants be stopped before pericardiocentesis?
Answer: What is to prevent life-threatening bleeding?
Rationale:
The procedure involves needle insertion near the heart.
This rhythm has irregularly irregular R-R intervals, absent P waves, and increases stroke risk.
Answer: What is Atrial Fibrillation?
Rationale:
A-fib causes chaotic atrial activity → blood stasis in atria → ↑ thromboembolism risk.
Chest pain relieved by rest and nitroglycerin most commonly indicates this condition.
Answer: What is Stable Angina?
Rationale:
Predictable ischemia with exertion = stable angina, not infarction.
Why is pericarditis pain relieved by leaning forward?
A. Increases venous return
B. Decreases pericardial friction
C. Improves oxygenation
D. Lowers HR
Answer: B
Rationale: Reduces inflammation contact.
Classic murmur of aortic stenosis is heard:
A. At apex
B. At left sternal border
C. At right second intercostal space
D. Over carotids
Answer: C
Rationale: Aortic area auscultation point.
Which manifestation best indicates worsening cardiac tamponade?
A. Wide Pulse Pressure
B. Pulses Paradoxes
C. Hypertension
D. Bradycardia
Answer: What is Pulses Paradoxes/ hypotension with muffled heart sounds?
Rationale:
Fluid restricts ventricular filling → ↓ cardiac output.
Which findings suggest poor perfusion from a dysrhythmia?
☐ Cool extremities
☐ Decreased urine output
☐ Bounding pulses
☐ Altered mental status
☐ Hypertension
Correct: ☑ Cool extremities, ☑ Decreased urine output, ☑ Altered mental status
Rationale: End-organ hypoperfusion = low cardiac output.
Which findings suggest a patient is progressing from ischemia to infarction?
☐ Rising troponin
☐ Persistent chest pain
☐ ST elevation
☐ Pain relieved by rest
☐ New ventricular dysrhythmias
Correct: ☑ Rising troponin, ☑ Persistent chest pain, ☑ ST elevation, ☑ New ventricular dysrhythmias
Rationale: These reflect myocardial cell death.
Which findings support unstable angina? SATA
☐ Chest pain at rest
☐ Increasing frequency of pain
☐ Normal troponin levels
☐ ST elevation
☐ Pain relieved by rest only
Correct: ☑ Chest pain at rest, ☑ Increasing frequency of pain, ☑ Normal troponin levels
Rationale: Unstable angina has ischemia without infarction.
Which complication is common with mitral stenosis?
A. Stroke
B. Pulmonary edema
C. Ventricular tachycardia
D. Endocarditis
Answer: B
Rationale: Blood backs up into lungs due to narrowing
Cardiac Tamponade includes all EXCEPT:
A. Hypotension
B. JVD
C. Muffled heart sounds
D. Pulmonary crackles
Answer: D
Rationale: Tamponade limits filling, not lung congestion.
A patient in sinus bradycardia has HR 40 and BP 86/50. Priority intervention?
A. Observe
B. Atropine
C. Adenosine
D. Defibrillation
Answer: B
Rationale: Symptomatic bradycardia → atropine.
Which nursing actions are appropriate in suspected ACS?
☐ Obtain 12-lead ECG within 10 minutes
☐ Administer aspirin if no contraindications
☐ Delay labs until pain resolves
☐ Continuous cardiac monitoring
☐ Encourage ambulation
Correct: ☑ Obtain 12-lead ECG within 10 minutes, ☑ Administer aspirin if no contraindications, ☑ Continuous cardiac monitoring
Rationale: Early recognition and monitoring reduce mortality.
A patient with heart failure and suspected ACS has BP 84/50. Which MONA medication should be held?
A. Oxygen
B. Aspirin
C. Nitroglycerin
D. Morphine
Answer: C
Rationale: Nitroglycerin reduces preload and BP; in hypotension it can worsen shock and decrease cardiac output.
Why are antibiotics sometimes required before dental work?
A. Prevent bacteremia
B. Prevent IE
C. Prevent MI
D. Prevent HF
Answer: B
Rationale: Prosthetic valves ↑ IE risk.
Which findings are consistent with cardiac tamponade?
☐ Hypotension
☐ JVD
☐ Muffled heart sounds
☐ Pulmonary crackles
☐ Narrow pulse pressure
Correct: ☑ Hypotension, ☑ JVD, ☑ Muffled heart sounds, ☑ Narrow pulse pressure
Rationale: reduced ventricular filling.