ACLS review: Bradycardia Review Questions Part 3

21. Second degree AV blocks are classified as Mobitz I and Mobitz II. Which statement most correctly describes Mobitz I
a. Regular rhythm with PR interval greater than >.20
b. Irregular rhythm with P waves unrelated to QRS complexes and regular R-R interval
c. Irregular rhythm with progressive prolongation of the PR interval over successive beats
d. Irregular rhythm with normal PR interval on conducted beats and non-conducted P waves that are not followed by QRS complexes

22. AV blocks are classified as 1st , 2nd, and 3rd degree. Which statement most correctly describes third degree heart block?

a. Regular rhythm with PR interval greater than >.20
b. Regular rhythm with P waves unrelated to QRS complexes and regular R-R interval
c. Regular rhythm with progressive prolongation of the PR interval over successive beats
d. Irregular rhythm with normal PR interval on conducted beats and non-conducted P waves that are not followed by QRS complexes

23. A 47 year old patient comes to the emergency room with complaints of syncope and shortness of breath. The patient is placed on the monitor and started on oxygen at 2L/min via nasal cannula. IV access is obtained with #18 in the right AC. After placing the patient on the cardiac monitor the following rhythm is observed:

However, the patient’s skin remains cool and clammy and he appears anxious and of shortness of breath. What would be your next intervention for this patient?
a. Vagal maneuvers
b. Atropine 1.0 mg IV/IO given slowly
c. Transcutaneous pacing
d. Epinephrine 1.0mg IV/IO push q3-5 minutes
24. Atropine sulfate reverses cholinergic-mediated decreases in heart rate. All of the following are true regarding the effects of atropine EXCEPT:
a. In the presence of an MI, it may worsen ischemia or increase the zone of infarction
b. It will likely be ineffective in patients with a heart transplanted.
c. The recommended atropine dose for bradycardia is 0.5 mg IV every 3 to 5 minutes
d. It is the first line treatment in patients with bradycardia with symptoms of poor perfusion

25. The patient is prepared for immediate transcutaneous pacing. What steps should be taken to prepare the patient for external pacing

a. Remove any medication patches that might come in contact with the pacing pads
b. Ensure the skin is clean and dry.
c. Shave chest hair
d. All the above.
26. The pacing pads are placed in what position on the body?
a. On both shoulders
b. One on the left shoulder and the other under the right breast
c. One over the left shoulder blade and the other under the left breast
d. One over each ear.

27. The physician orders that the patient be receive transcutaneous pacing in the synchronous or demand mode with a rate of 60. What statement most correctly defines what is meant by the asynchronous or fixed rate mode.

a. It provided continuous pacing regardless of the patient’s intrinsic rate
b. The pacemaker senses the patient’s heart rate and only paces when the patient’s heart rate falls below a certain rate
28. After setting the rate on the transcutaneous pacemaker, the miliampheres are increased until electrical capture is observed. What statement best defines what is meant by electrical capture?
a. Electrical capture occurs when there are pacemaker spikes observed on the ECG monitor
b. Electrical capture occurs when muscle contraction is observed on the chest wall
c. Electrical capture is observed when a pacemaker spike precedes each QRS complex.
d. Electrical capture is observed when a QRS complex immediately follows the pacer spike.

29.  After initiating transcutaneous pacing, the following rhythm is observed on the monitor.

What would be the next appropriate intervention?
a. Give atropine 0.5mg IV push
b. Assess the patient’s pulse and BP
c. Continue to increase the milliamps
d. Start Dopamine at 2mcg/kg/min.
30 After the above intervention, the following rhythm is observed.

What would be the most appropriate intervention?
a. Repeat atropine at 1mg IV push
b. Assess the patient’s pulse and BP
c. Set pacer in fixed rate mode
d. Increase Dopamine to 5mcg/kg/min.

31. Epinephrine infusion may be used for patients with symptomatic bradycardia or hypotension after atropine or pacing fails. What is the correct dose of epinephrine for a patient with unstable bradycardia?

a. 1mg (1:1000 solution) IV push q3-5 minutes
b. 1mg (1:10,000 solution) IV push q3-5 minutes’
c. Begin infusion at 2-10mcg/min
d. Begin infusion at 2-10mcg/kg/min

Answers

21. c. Irregular rhythm with progressive prolongation of the PR interval over successive beats
22. b. Regular rhythm with P waves unrelated to QRS complexes and regular R-R interval
23. c. Transcutaneous pacing
24. d. It is the first line treatment in patients with bradycardia with symptoms of poor perfusion
25. d. All the above.
26. c. One over the left shoulder blade and the other under the left breast
27. a. It provided continuous pacing regardless of the patient’s intrinsic rate
28. d. Electrical capture is observed when a QRS complex immediately follows the pacer spike.
29. c. Continue to increase the milliamp
30. b. Assess the patient’s pulse and BP

31. c. Begin infusion at 2-10mcg/min


Reviewed 3/1/16