CCT Cardiac Monitoring & Emergency Response 2 — Questions and Answers
Question 1: A patient's telemetry monitor shows a rhythm with no discernible P waves, an irregular RR interval, and a ventricular rate of 110 bpm. What is the most likely interpretation?
- Atrial flutter with variable block
- Atrial fibrillation with rapid ventricular response (Correct answer)
- Multifocal atrial tachycardia
- Junctional tachycardia
Correct answer: Atrial fibrillation with rapid ventricular response
Absent P waves with an irregularly irregular ventricular rhythm are the hallmark findings of atrial fibrillation.
Question 2: During continuous ECG monitoring, you observe a pause of 3.2 seconds with no P waves or QRS complexes. Which intervention is most immediately appropriate?
- Administer atropine IV
- Assess the patient and check lead connections (Correct answer)
- Begin chest compressions
- Prepare for synchronized cardioversion
Correct answer: Assess the patient and check lead connections
Before escalating treatment, the technician must first assess the patient's clinical status and verify that artifact or lead dislodgement is not causing the apparent pause.
Question 3: Which lead configuration provides the best view of inferior wall ischemia during continuous monitoring?
- Lead I
- Lead aVR
- Lead II (Correct answer)
- Lead V1
Correct answer: Lead II
Lead II best visualizes the inferior wall because it runs parallel to the inferiorly directed depolarization vector supplied by the right coronary artery.
Question 4: A monitored patient suddenly develops a wide-complex tachycardia at 180 bpm with AV dissociation. The most likely diagnosis is:
- Supraventricular tachycardia with aberrancy
- Ventricular tachycardia (Correct answer)
- Accelerated idioventricular rhythm
- Torsades de pointes
Correct answer: Ventricular tachycardia
AV dissociation is a strong criterion for ventricular tachycardia and differentiates it from most SVTs with aberrant conduction.
Question 5: What is the correct energy setting for the first synchronized cardioversion attempt in a hemodynamically stable patient with atrial flutter?
- 50–100 J biphasic (Correct answer)
- 200 J monophasic
- 360 J biphasic
- 120–200 J biphasic
Correct answer: 50–100 J biphasic
Atrial flutter is highly responsive to low-energy synchronized cardioversion, typically beginning at 50–100 J with a biphasic waveform.
Question 6: On a 12-lead ECG, which finding is most consistent with right ventricular infarction?
- ST elevation in leads V1–V4
- ST elevation in leads I and aVL
- ST elevation in lead V4R (Correct answer)
- ST depression in leads V5–V6
Correct answer: ST elevation in lead V4R
Right-sided lead V4R is the most sensitive single lead for diagnosing right ventricular infarction, showing ST elevation ≥1 mm.
Question 7: A patient on continuous telemetry is noted to have frequent PVCs in a pattern where every other beat is a PVC. This is called:
- Trigeminy
- Bigeminy (Correct answer)
- Couplet
- Quadrigeminy
Correct answer: Bigeminy
Bigeminy is defined as a pattern in which every sinus beat is followed by a premature ventricular contraction, creating a 1:1 alternating pattern.
CCT Cardiac Monitoring & Emergency Response 2
A patient's telemetry monitor shows a rhythm with no discernible P waves, an irregular RR interval, and a ventricular rate of 110 bpm.
What is the most likely interpretation?