Acute Care Nurse Practitioner Cardiovascular Emergencies and Arrhythmia Management 1 — Questions and Answers
Question 1: A patient presents with acute anterior STEMI. What is the preferred reperfusion strategy when PCI can be performed within 90 minutes?
- Fibrinolytic therapy
- Primary percutaneous coronary intervention (PCI) (Correct answer)
- Emergency CABG
- Conservative medical management
Correct answer: Primary percutaneous coronary intervention (PCI)
Primary PCI is the preferred reperfusion strategy for STEMI when achievable within 90 minutes of first medical contact.
Question 2: Which ECG finding is diagnostic of ST-elevation myocardial infarction (STEMI) in two contiguous leads?
- ST depression >1 mm
- New LBBB or ST elevation ≥1 mm (≥2 mm in V1-V3) (Correct answer)
- T-wave inversions >2 mm
- Prolonged QT interval >500 ms
Correct answer: New LBBB or ST elevation ≥1 mm (≥2 mm in V1-V3)
STEMI is diagnosed by ST elevation ≥1 mm in two contiguous leads (≥2 mm in V1-V3) or new LBBB with ischemic symptoms.
Question 3: A patient with acute decompensated heart failure (ADHF) has an SpOâ‚‚ of 85% on room air and BP 150/90. Which is the MOST appropriate initial intervention?
- Intubate immediately
- Administer IV furosemide and apply NIPPV (BiPAP) (Correct answer)
- Give normal saline bolus 500 mL
- Start norepinephrine
Correct answer: Administer IV furosemide and apply NIPPV (BiPAP)
ADHF with hypoxia but intact blood pressure is best managed with diuresis (furosemide) and NIPPV to offload preload and improve oxygenation.
Question 4: Which arrhythmia is the MOST common cause of sudden cardiac arrest in adults?
- Atrial fibrillation
- Ventricular fibrillation (Correct answer)
- Third-degree AV block
- Supraventricular tachycardia
Correct answer: Ventricular fibrillation
Ventricular fibrillation is the most common initial arrhythmia in sudden cardiac arrest, requiring immediate defibrillation.
Question 5: Which medication is indicated for rate control in atrial fibrillation with preserved ejection fraction and heart rate of 140 bpm?
- Adenosine
- Metoprolol IV (Correct answer)
- Amiodarone
- Digoxin
Correct answer: Metoprolol IV
IV metoprolol (beta-blocker) is a first-line rate control agent for AF with preserved EF due to its rapid onset and reliability.
Question 6: A patient develops torsades de pointes (TdP). Which intervention is MOST appropriate as immediate treatment?
- Amiodarone 300 mg IV
- Synchronized cardioversion
- IV magnesium sulfate 2 g (Correct answer)
- Procainamide infusion
Correct answer: IV magnesium sulfate 2 g
IV magnesium sulfate 2 g is the first-line treatment for torsades de pointes, even in patients with normal magnesium levels.
Acute Care Nurse Practitioner Cardiovascular Emergencies and Arrhythmia Management 1
A patient presents with acute anterior STEMI.
What is the preferred reperfusion strategy when PCI can be performed within 90 minutes?