Float Nurse

01. You respond to a Code Blue on the Telemetry floor.  When you arrive to the room CPR is in progress.  The patient already had a # 20 saline lock to the left AC.  When the patient is placed on the defibrillator monitor, the following rhythm is noted.  What is the next appropriate intervention? a. Administer a 1 mg epinephrine followed by a 10 cc saline flush b. Administer 300 mg of amiodarone c. Defibrillate at 200 joules d. Give Vasopressin 40 units IV 02. An 83 year old male who was admitted last night with a hip fracture is noted to be unresponsive.  No spontaneous respirations are noted.  A code is called and CPR is initiated with positive pressure ventilations. The ventilations are noted to adequate with good chest rise.  When you place the patient on the defibrillator monitor, the following rhythm is noted.  What is the next appropriate intervention? a. Give atropine 0.5 mg IV push b. Attempt transcutaneous paci...

01. You respond to a Code Blue on the medical floor. The 56 year old patient with pancreatitis was found to be pulseless and apneic. When you arrive to the room CPR is in progress and the patient is receiving positive pressure ventilations.  The ventilations are adequate with good chest rise. The patient already had a # 18 saline lock to the right AC.  When the patient is placed on the defibrillator monitor, the following rhythm is noted.  What is the next appropriate intervention. a. Administer a 1 mg epinephrine followed by a 10 cc saline flush b. Administer 300 mg of amiodarone followed by a 10 cc saline flush c. Begin transcutaneous pacing at 60 bpm d. Give atropine 0.5 mg IV followed by a 10 cc saline flush 02. A 75 year old is brought to the ER by his family with complaints of shortness of breath, chest pain, and nausea and vomiting.  The chest pain started two hours ago but seemed to go away when he rested.  But it has since returned. A ...

Answers 01.  100/min 02.  Asystole, PEA, pulseless VT, and pulseless VF 03. C- Check responsiveness and breathing.  Check for a carotid pulse.  Compressions A-Open airway and using head-tilt chin lift or jaw thrust maneuver. B-Give two rescue breaths observing for chest rise and fall then resume compressions 04. 120 – 200 J depending upon the manufactures suggested setting.  If unknown, then begin at 200 J. 05.  Anterior/posterior or Apex/right chest wall 06.    The provider delivering ventilations should give 1 breath every 6 to 8 seconds (8 to 10 breaths per minute) and should be careful to avoid hyperventilating the patient. 07. Vasopressin 40 u IV may be given as a onetime dose before epinephrine or as a second dose after the initial dose of epinephrine. 08.    Amiodarone 300 mg may be given IV/IO.   If Aminodarone is unavailable then Lidocaine 1 – 1.5 ...

Identify the following rhythms. 1. Lidocaine is a secondary antiarrhythmic that is used in the treatment of pulseless VF/VT. What is the recommended initial dose of Lidocaine that can be used to treat this rhythm? a. 1.0 - 1.5 mg/kg IV/IO b. 300 mg IV push c. 1 mg every 3 - 5 minutes d. 2 - 10 mcg/kg/min 2. a. NSR with trigeminal PACs b. NSR with trigeminal PVCs c. NSR with trigeminal PJCs d. NSR with a triplet of PVCs 3. a. Atrial fibrillation with some bigeminal PVCs b. Atrial fibrillation with multifocal PVCs c. Atrial fibrillation with trigeminal PJCs d. Atrial fibrillation with bigeminal PACs 4. What is the initial joule setting when defibrillating a patient with this rhythm using a monophasic defibrillator?  a. 100 J  b. 200 J  c. 300 J  d. 360 J 5. a. Sinus bradycardia with sinus arrhythmia b. Sinus bradycardia with sinus arrest c. Complete heart block d. ...

Identify the following rhythms. 1. Lidocaine is a secondary antiarrhythmic that is used in the treatment of pulseless VF/VT. What is the recommended initial dose of Lidocaine that can be used to treat this rhythm? a. 1.0 - 1.5 mg/kg IV/IO b. 300 mg IV push c. 1 mg every 3 - 5 minutes d. 2 - 10 mcg/kg/min 2. a. NSR with trigeminal PACs b. NSR with trigeminal PVCs c. NSR with trigeminal PJCs d. NSR with a triplet of PVCs 3. What is the initial joule setting when defibrillating a patient with this rhythm using a monophasic defibrillator? a. 100 J b. 200 J c. 300 J d. 360 J 4. a. Sinus rhythm with unifocal PVCs b. Atrial fibrillation with trigeminal PVCs c. Atrial flutter with multifocal PVCs d. First degree block with bigeminal PVCs 5. a. Sinus bradycardia with sinus arrhythmia b. Sinus bradycardia with sinus arrest c. Complete heart block d. Sinus rhythm with PACs Answers 1. a. 1.0...

Identify the following rhythms. 1. A 34 year old female is brought by her husband to the ER with complaints of weakness, palpitations, chest pain, shortness of breath, and nausea VS 98.4-188-30. BP 90/56. Sat 92%. She is placed on the monitor and the following rhythm is noted. An IV is started and oxygen administered at 2L/min. A trial dose of adenosine 6 mg is given while setting up for cardioversion. There was is no change in the rhythm. What is the recommended initial joule setting for cardioversion of SVT? a. 50 J b. 150 J c. 200 J d. 250 J 2. During a code in the ER of a 56 year old with a history of cocaine use, you pause for a rhythm check and note the following rhythm. What is the rhythm? a. Ventricular tachycardia changing to torsades de pointes b. Ventricular tachycardia changing to ventricular fibrillation c. Ventricular tachycardia changing to atrial fibrillation d. Ventricular tachycardia changing to polymorphic VT 3...

Identify the following rhythms. 1. a. Idioventricular rhythm b. Complete heart block c. Sinus bradycardia with a wide QRS complex d. Atrial flutter with slow ventricular response 2. a. Sinus arrhythmia b. Sinus rhythm with PACs c. Atrial fibrillation d. Wandering atrial pacemaker 3. A 70 year old with a history of persistent atrial fibrillation undergoes elective cardioversion. She receives Versed 3 mg prior to the cardioversion. Oxygen is at 2 L/min via nasal cannula. An initial attempt at 150 J shows the following rhythm changes. What is the next appropriate intervention for this patient? a. Place the defibrillator in the synch mode and cardiovert at 200 J b. Increase the joule setting to 200 J and shock again c. Check for a pulse and monitor the rhythm d. Give adenosine 6 mg IV and re-cardiovert at the same or a higher joule setting. 4. A 79 year old who lives alone is brought to the ER by her family becaus...

Identify the following rhythms. 1. a. Idioventricular rhythm b. Demand ventricular rhythm c. Junctional rhythm d. Atrial paced 2. After experiencing several episodes of this rhythm, the MD orders an Amiodarone drip beginning with a bolus dose. What is the usual loading dose for an Amiodarone infusion? a. 150 mg IV over 10 minutes b. 200 mg IV over 10 minutes c. 250 mg IV over 10 minutes d. 300 mg IV over 10 minutes 3. A 75 year old arrives to the ER in cardiac arrest. CPR is in progress. He has received two shocks at 200 J and 300 J as well as two doses of epinephrine 1 mg in route. As he is transferred to the stretcher and placed on the monitor, the following rhythm is observed. What medication is indicated in the treatment of this dysrhythmia? a. Vasopressin 40 units IV b. Procainamide 20 mg/min c. Magnesium 1 -2 gm IV d. Amiodarone 150 mg IV 4. a. Sinus bradycardia b. Junctional rhythm c. Atrial fibrilla...

Answer the following questions. 1. All of the following medications are indicated in the treatment of this rhythm EXCEPT: a. Epinephrine 1mg (1:10,000) IV q3 - 5 minutes b. Magnesium 1 - 2 gms IV c. Lidocaine 1 - 1.5 mg/kg IV bolus d. Amiodarone 300 mg IV push 2. What antiarrhythmic medication can be given to a patient who has symptomatic VT? a. Lidocaine 3.0 mg/kg IV push b. Procainamide 20 mcg/kg/min until arrhythmia suppressed c. Amiodarone 150 mg IV over 30 minutes d. Cardizem 5 - 10 mg/hr, watch for hypotension 3. In the absence of vascular access, what antiarrhythmic can be given via the ET tube? a. Amiodarone b. Lidocaine c. Magnesium d. Epinephrine 4. Atrial fibrillation with a slow rate may also lead to a drop in cardiac output leading to signs and symptoms of shock. While immediate transcutaneous pacing is recommended, beta adrenergic medication may serve as a “bridge: to transcutaneous pacing. Of the followi...