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The "Lethal Rhythm" Priority (Safety) Scenario: You are watching the central monitor and see a patient go into Ventricular Fibrillation (V-Fib). The patient is unresponsive and pulseless. According to your notes, what is the priority intervention after starting CPR?
A. Administer Atropine IV push.
B. Synchronized Cardioversion.
C. Defibrillation (Unsynchronized).
D. Administer Adenosine rapid push.
C (Defibrillation)
Rationale: Your notes are clear on the "Order of intervention" for pulseless V-Fib/V-Tach. The priority is Defibrillation.
Note: Meds like Epinephrine come after CPR and Defibrillation.
The "Fluid Status" Connection (Hemodynamics) Scenario: A patient with sepsis has a Central Venous Pressure (CVP) reading of 2 mmHg. Based on your notes, how do you interpret this finding and what is the likely treatment?
A. The patient has Right Heart Failure; prepare diuretics.
B. The patient has fluid volume deficit (dehydration); prepare IV fluids.
C. The patient has fluid volume overload; restrict oral fluids.
D. The patient has pulmonary hypertension; prepare vasodilators.
Correct Answer: B (Fluid Volume Deficit / Fluids)
Rationale: A "Low CVP" specifically means "not enough fluid in the body (dehydration/sepsis)" and the treatment listed is IV fluids
You are setting up a transducer for an arterial line to ensure accurate blood pressure readings. According to your notes, where must the "Phlebostatic Axis" be leveled?
A. 2nd Intercostal space, mid-clavicular line.
B. 5th Intercostal space, left sternal border.
C. 4th Intercostal space, mid-axillary line.
D. 4th Intercostal space, mid-clavicular line.
Correct Answer: C (4th ICS, Mid-Axillary)
Rationale: The Phlebostatic Axis must be at the 4th intercostal space, mid-axillary line to ensure accuracy
A patient arrives at the ED with ST-elevation on their ECG (STEMI). According to the "Cardiac Diagnostic Testing" section of your notes, what is the goal time for "Door-to-Balloon" (PCI)?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
Correct Answer: C (90 mins)
Rationale: Check the "Cardiac Diagnostic Testing" table on Page 3. Under "PCI" (Percutaneous Coronary Intervention), it lists "Door - balloon 90 mins".
Correction: 30 minutes is often the target for fibrinolytics (clot-busting drugs) if PCI isn't available, but for the balloon procedure itself, the standard in your notes is 90 minutes.
which extra heart sound is specifically associated with "Ventricular Dysfunction / Heart Failure"?
A. S3 (Ventricular Gallop)
B. S4 (Atrial Gallop)
C. Pericardial Friction Rub
D. Systolic Click
Your Answer: A
Correct Answer: A (S3 Ventricular Gallop)
Rationale: Your notes explicitly link S3 (Ventricular Gallop) to "Ventricular dysfunction - heart failure".
A nurse is caring for a client who has SIRS. The client is hemodynamically unstable due to septic shock. Which of the following IV fluids should the nurse expect to administer?
a Hypertonic
b Hypotonic
c Isotonic
d Colloid
The nurse should expect to administer an isotonic IV solution to this client. This type of fluid is administered to clients experiencing fluid volume deficit to increase the blood pressure. It is used to treat most all types of shock. Hypertonic solutions are administered to increase intravascular fluid volume and would not be expected for a client experiencing septic shock. Hypotonic solutions are administered to treat cellular dehydration and would not be expected for a client experiencing septic shock. A colloid solution is administered to a client experiencing profound or refractory shock and would not be expected for a client experiencing septic shock
Which manifestations indicate respiratory dysfunction in MODS? Select all that apply.
Dyspnea is a common sign of respiratory failure in MODS.
Diaphoresis often accompanies respiratory distress in MODS.
Cyanosis indicates poor oxygenation, a hallmark of respiratory dysfunction in MODS.
A nurse is caring for a client who has aortic regurgitation. Which of the following should the nurse understand is a possible cause of the increase in preload in the heart?
a ST-elevation myocardial infarction
b Left ventricular hypertrophy
c Mitral valve regurgitation
d Marfan syndrome
A possible cause of preload in the heart in a client who has aortic regurgitation is left ventricular hypertrophy. AR causes volume overload in the left ventricle that causes dilation and hypertrophy of the left ventricle, which increases preload. ST-elevation myocardial infarction, mitral valve regurgitation, and Marfan syndrome are associated with mitral regurgitation.
A nurse is monitoring cardiac rhythms of a group of clients receiving continuous cardiac monitoring. Which of the following rhythms should the nurse identify as a nonshockable rhythm?
a Sustained ventricular tachycardia
b Pulseless ventricular tachycardia
c Pulseless electrical activity
d Ventricular fibrillation
Well done!
Pulseless electrical activity is a nonshockable rhythm in which the ventricles are not contracting, or the electrical activity of the heart is not strong enough to stimulate a contraction. PEA and asystole will not respond to defibrillation and are termed nonshockable rhythms. Sustained ventricular tachycardia, ventricular fibrillation, and pulseless ventricular tachycardia are all rhythms that can respond to defibrillation.
Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
A. Plaques obstruct the vein.
B. Plaques obstruct the artery.
C. Blood clots form outside the vessel wall.
D. Hardened vessels dilate to allow blood to flow through.
Correct Answer: B. Plaques obstruct the artery
Atherosclerosis is a chronic inflammatory disease in which there is a build up of plaques inside arteries. These plaques are principally composed of lipids that induce an inflammatory reaction causing turbulent flow with atherosclerotic cardiovascular disease (ASCVD) as a result.
Select the true statements about pulmonary artery catheter complications. (Select all that apply)
1 Air embolism can occur due to trapped air in infusion ports.
2 Thromboembolism is caused by electrolyte imbalances.
3 Arrhythmias can result from cardiac wall irritation.
4 Hyperkalemia is a common complication of these catheters.
5 The catheter itself does not alter lab values.
Air embolism, arrhythmias, and the fact that the catheter does not alter lab values are accurate statements.
A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery two (2) days ago. Which of the following surgical complications should the nurse suspect?
A. Left-sided heart failure
A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration) signals pericardial tamponade, a complication of CABG surgery. Cardiac tamponade is a medical or traumatic emergency that happens when enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock.
The adaptations of a client with complete heart block would most likely include:
Correct Answer: D. Syncope and slow ventricular rate
In complete atrioventricular block, the ventricles take over the pacemaker function in the heart but at a much slower rate than that of the SA node. As a result, there is decreased cerebral circulation, causing syncope. Patients with third-degree blocks can have varying clinical presentations. Rarely, patients are asymptomatic. Usually, they may present with generalized fatigue, tiredness, chest pain, shortness of breath, presyncope, or syncope. They may have significant hemodynamic instability and can be obtunded.
What criteria should the nurse use to determine normal sinus rhythm for a client on a cardiac monitor? Select all that apply.
Correct Answers: A, B.
The consistency of the RR interval indicates regular rhythm. A normal P wave before each complex indicates the impulse originated in the SA node. Sinus arrhythmia is most typically present in young, healthy individuals. Studies have attempted to establish an increased prevalence in patients with underlying hypertension, obesity, and diabetes
A nurse is watching the cardiac monitor, and a client’s rhythm suddenly changes. There are no P waves; instead, there are wavy lines. The QRS complexes measure 0.08 second, but they are irregular, with a rate of 120 beats a minute. The nurse interprets this rhythm as:
A. Sinus tachycardia
B. Atrial fibrillation
C. Ventricular tachycardia
D. Ventricular fibrillation
Correct Answer: B. Atrial fibrillation
Atrial fibrillation is characterized by a loss of P waves; an undulating, wavy baseline; QRS duration that is often within normal limits; and an irregular ventricular rate, which can range from 60 to 100 beats per minute (when controlled with medications) to 100 to 160 beats per minute (when uncontrolled). Atrial fibrillation is the most common type of cardiac arrhythmia. It is the leading cardiac cause of stroke. Risk factors for atrial fibrillation include advanced age, high blood pressure, underlying heart and lung disease, congenital heart disease, and increased alcohol consumption.
A nurse is caring for a client who has severe septic shock and is receiving a pulmonary artery catheter. Which of the following complications should the nurse understand that this client is at risk for?
Select all that apply.
a Hyperkalemia
b Air embolism
c Thromboembolism
d Leukopenia
e Arrhythmias
Air embolism
c Thromboembolism
e Arrhythmias
Clients who have a pulmonary artery catheter are at risk for complications such as air embolism due to entrapment of air in the infusion ports, thromboembolism due to inflammation or infection of the catheter, and arrhythmias from cardiac wall irritation from the catheter. However, the pulmonary artery catheter itself does not cause any changes to lab values, such as leukopenia or hyperkalemia.
A nurse is assessing an electrocardiogram rhythm strip. The P waves and QRS complexes are regular. The PR interval is 0.16 second, and QRS complexes measure 0.06 second. The overall heart rate is 64 beats per minute. The nurse assesses the cardiac rhythm as:
A. Normal sinus rhythm
B. Sinus bradycardia
C. Sick sinus syndrome
D. First-degree heart block
Correct Answer: A. Normal sinus rhythm
Measurements are normal, measuring 0.12 to 0.20 second and 0.4 to 0.10 second, respectively. Sinus rhythms originate in the SA node. The SA node is located in the right atrium and is the heart’s natural pacemaker. The normal rate of the SA node is between 60 and 100. On ECG, sinus rhythm is represented by monomorphic P waves before each QRS complex and is regular.
A nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. There are no P waves, the QRS complexes are wide, and the ventricular rate is regular but over 100. The nurse determines that the client is experiencing:
A. Premature ventricular contractions
B. Ventricular tachycardia
C. Ventricular fibrillation
D. Sinus tachycardia
Correct Answer: B. Ventricular tachycardia
Ventricular tachycardia is characterized by the absence of P waves, wide QRS complexes (usually greater than 0.14 second), and a rate between 100 and 250 impulses per minute. The rhythm is usually regular. Ventricular tachycardia is characterized as a wide complex (QRS duration greater than 120 milliseconds) tachyarrhythmia at a heart rate greater than 100 beats per minute. It is classified by duration as non-sustained or sustained. Non-sustained ventricular tachycardia is defined as more than 3 beats of ventricular origin at a rate greater than 100 beats per minute that lasts less than 30 seconds in duration.
A nurse is viewing the cardiac monitor in a client’s room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following?
Correct Answer: C. Administer amiodarone (Cordarone) intravenously.
First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of antidysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Procainamide will terminate between 50% and 80% of ventricular tachycardias, and it will slow the conduction of those that it does not terminate. Amiodarone will convert about 30% of patients to sinus rhythm but is very effective in reducing the reversion rate of refractory SMVT.
A client is having frequent premature ventricular contractions. A nurse would place a priority on the assessment of which of the following items?
A. Blood pressure and peripheral perfusion.
B. Sensation of palpitations.
C. Causative factors such as caffeine.
D. Precipitating factors such as infection.
Correct Answer: A. Blood pressure and peripheral perfusion.
Premature ventricular contractions can cause hemodynamic compromise. The shortened ventricular filling time with the ectopic beats leads to decreased stroke volume and, if frequent enough, to decreased cardiac output. Physical examination findings would reveal an irregular heart rhythm upon auscultation if the patient is experiencing PVCs during the examination. In some patients, cannon A waves may cause chest or neck discomfort. Otherwise, there would not be any direct physical examination findings. A prolonged run of PVCs can result in hypotension.
A patient with cardiogenic shock has an IABP via femoral access. The nurse notices:
Cool, pale right foot
Weak pedal pulse
Complaints of numbness
Urine output decreasing
What is the nurse’s priority action?
A. Increase IV fluids
B. Notify the provider immediately
C. Reposition the leg
D. Administer dopamine
B — Correct ✅
Cool, numb foot + weak pulse + ↓ UO = impaired perfusion → notify provider immediately
A nurse notes that a client with sinus rhythm has a premature ventricular contraction that falls on the T wave of the preceding beat. The client’s rhythm suddenly changes to one with no P waves or definable QRS complexes. Instead, there are coarse wavy lines of varying amplitude. The nurse assesses this rhythm to be:
A. Ventricular tachycardia
Correct Answer: B. Ventricular fibrillation
Ventricular fibrillation is characterized by irregular, chaotic undulations of varying amplitudes. Ventricular fibrillation has no measurable rate and no visible P waves or QRS complexes and results from electrical chaos in the ventricles. VF is a WCT caused by irregular electrical activity and characterized by a ventricular rate of usually greater than 300 with discrete QRS complexes on the electrocardiogram (ECG). QRS morphology in VF varies in shape, amplitude, and duration with a prominent irregular rhythm.
A patient in the ICU has a pulmonary artery catheter. Readings show:
CVP: 2 mmHg
PA wedge pressure: Low
BP: 84/50
HR: 118
Urine output: 20 mL/hr
Which intervention should the nurse anticipate FIRST?
A. Administer IV fluids
B. Give IV furosemide
C. Start nitroglycerin infusion
D. Prepare for cardioversion
A — Correct ✅
Low CVP + low wedge + hypotension + low urine output = hypovolemia → give fluids first
After cardiac surgery, a client’s blood pressure measures 126/80. The nurse determines that the mean arterial pressure (MAP) is which of the following?
A. 46 mm Hg
MAP = (2 times the diastolic + systolic)/3 or (2d + s)/3 where d is diastolic and s is systolic
= 2 (80) + 126 / 3
= 160 + 126 / 3 = 286 / 3 = 95.33 or 95 mm HG
A woman with severe mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The physician orders pulmonary artery pressure monitoring, including pulmonary capillary wedge pressures. The purpose of this is to help assess the:
A. Degree of coronary artery stenosis.
Correct Answer: C. Pressure from fluid within the left ventricle.
The pulmonary artery pressures are used to assess the heart’s ability to receive and pump blood. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client. Pulmonary capillary wedge pressure (PCWP) is frequently used to assess left ventricular filling, represent left atrial pressure, and assess mitral valve function. It is measured by inserting a balloon-tipped, multi-lumen catheter (Swan-Ganz catheter) into a central vein, and advancing the catheter into a branch of the pulmonary artery.