BCEN Cardiac Emergencies 5

Question 1

A patient on digoxin presents with nausea, vomiting, and a heart rate of 42 bpm with a junctional escape rhythm. Serum digoxin level is 3.8 ng/mL. What is the most appropriate treatment?

Accepted Answer

Administer digoxin-specific antibody fragments (Digibind)

Answer

Digoxin toxicity with hemodynamic compromise or life-threatening arrhythmias is treated with digoxin-specific Fab antibody fragments (Digibind/DigiFab).

Question 2

A patient presents with polymorphic ventricular tachycardia and a prolonged QTc interval of 560 ms. What is the first-line treatment?

Accepted Answer

Magnesium sulfate 1-2 g IV over 15 minutes

Answer

Magnesium sulfate is first-line treatment for Torsades de pointes associated with prolonged QT interval, even if serum magnesium is normal.

Question 3

Which of the following is the most important reason to avoid applying carotid massage bilaterally for SVT conversion?

Accepted Answer

It may dislodge atherosclerotic plaque and cause stroke

Answer

Bilateral carotid massage is contraindicated because it can dislodge atherosclerotic plaque from the carotid arteries, causing stroke; it must also be performed one side at a time.

Question 4

A patient has a first-degree AV block with a PR interval of 0.26 seconds. Which statement is most accurate about this finding?

Accepted Answer

All impulses are conducted with a fixed prolonged delay and usually requires no treatment

Answer

First-degree AV block is characterized by a PR interval >0.20 seconds with all impulses conducted; it is typically benign and rarely requires treatment.

Question 5

Which of the following signs best differentiates type I (Wenckebach) second-degree AV block from type II second-degree AV block?

Accepted Answer

Progressive PR interval lengthening before a dropped beat in Wenckebach

Answer

Mobitz type I (Wenckebach) is distinguished by progressively lengthening PR intervals until a QRS is dropped, whereas Mobitz type II has a constant PR interval with sudden non-conducted beats.

(BCEN) Board of Certification of Emergency Nursing Practice Test

(BCEN) Board of Certification of Emergency Nursing Practice Test

BCEN Cardiac Emergencies 5