Acute Care Nurse Practitioner Cardiovascular Emergencies and Arrhythmia Management 2 — Questions and Answers
Question 1: Which ECG finding is characteristic of Wolff-Parkinson-White (WPW) syndrome?
- Prolonged PR interval with delta wave
- Short PR interval with delta wave and wide QRS (Correct answer)
- ST elevation with reciprocal changes
- Peaked P waves in lead II
Correct answer: Short PR interval with delta wave and wide QRS
WPW shows a short PR interval (<120 ms), delta wave (slurred QRS upstroke), and wide QRS from pre-excitation via the accessory pathway.
Question 2: A patient with WPW develops rapid atrial fibrillation. Which drug is CONTRAINDICATED?
- Procainamide
- Flecainide
- Adenosine (Correct answer)
- Ibutilide
Correct answer: Adenosine
Adenosine blocks the AV node in WPW-AF, preferentially routing conduction down the fast accessory pathway and potentially causing ventricular fibrillation.
Question 3: Which parameter is used to decide between synchronized cardioversion and defibrillation?
- Ventricular rate
- Presence of organized QRS complexes (Correct answer)
- Blood pressure
- Duration of arrhythmia
Correct answer: Presence of organized QRS complexes
Synchronized cardioversion is used when organized QRS complexes are present (AF, flutter, SVT, VT with pulse); defibrillation is for VF/pulseless VT.
Question 4: An ACNP manages a patient with new-onset rapid ventricular response atrial fibrillation and LVEF of 25%. Which rate control agent is preferred?
- Metoprolol IV
- Verapamil IV
- Diltiazem IV
- Digoxin IV (Correct answer)
Correct answer: Digoxin IV
Digoxin is preferred for rate control in AF with reduced EF (HFrEF) because beta-blockers and calcium channel blockers may further depress cardiac output.
Question 5: Which intervention is indicated for a patient in third-degree (complete) AV block with a ventricular rate of 28 bpm and hypotension?
- Administer atropine 0.5 mg IV and prepare for transvenous pacing (Correct answer)
- Start amiodarone infusion
- Give adenosine 6 mg IV
- Immediate synchronized cardioversion
Correct answer: Administer atropine 0.5 mg IV and prepare for transvenous pacing
Atropine is the first-line pharmacologic treatment for symptomatic bradycardia while arranging emergency transvenous pacing.
Question 6: Aortic dissection (Type A) presents with which classic clinical finding?
- Tearing chest pain radiating to the jaw
- Sudden severe tearing/ripping chest pain radiating to the back with unequal arm BPs (Correct answer)
- Pleuritic chest pain worse with inspiration
- Intermittent chest pressure with exertion
Correct answer: Sudden severe tearing/ripping chest pain radiating to the back with unequal arm BPs
Type A aortic dissection classically presents with sudden, severe tearing pain radiating to the back and pulse/BP discrepancy between arms.
Acute Care Nurse Practitioner Cardiovascular Emergencies and Arrhythmia Management 2
Which ECG finding is characteristic of Wolff-Parkinson-White (WPW) syndrome?