CET Emergency Cardiac Monitoring 2 — Questions and Answers
Question 1: During a cardiac emergency, a patient's monitor suddenly shows a flat line with no discernible waveforms. The FIRST step is to:
- Call a code immediately
- Check lead connections and patient (Correct answer)
- Increase monitor gain/sensitivity
- Begin CPR
Correct answer: Check lead connections and patient
A flat line (asystole) must first be confirmed by checking lead connections and the patient, since a loose lead is a common cause of a false flat-line display.
Question 2: Which ECG finding is MOST associated with hyperkalemia in an emergency setting?
- Prolonged QT interval
- Tall, peaked T waves (Correct answer)
- ST-segment depression
- Shortened PR interval
Correct answer: Tall, peaked T waves
Tall, peaked (tented) T waves are the earliest and most characteristic ECG sign of hyperkalemia.
Question 3: A patient in the ED develops sudden onset wide-complex tachycardia at 180 bpm with hemodynamic instability. The appropriate intervention is:
- Adenosine 6 mg IV push
- Synchronized cardioversion (Correct answer)
- Amiodarone 150 mg IV over 10 min
- Vagal maneuvers
Correct answer: Synchronized cardioversion
Hemodynamically unstable wide-complex tachycardia requires immediate synchronized cardioversion regardless of the specific rhythm.
Question 4: ST elevation in leads II, III, and aVF with reciprocal changes in leads I and aVL indicates an infarction of the:
- Anterior wall
- Lateral wall
- Inferior wall (Correct answer)
- Posterior wall
Correct answer: Inferior wall
Leads II, III, and aVF are the inferior leads; ST elevation in these leads with reciprocal changes laterally localizes the STEMI to the inferior wall.
Question 5: In pediatric emergency cardiac monitoring, the normal heart rate range for a 2-year-old child at rest is approximately:
- 60–100 bpm
- 80–130 bpm (Correct answer)
- 100–160 bpm
- 140–200 bpm
Correct answer: 80–130 bpm
Resting heart rate for a 2-year-old is normally 80–130 bpm; rates outside this range may warrant investigation.
Question 6: Which arrhythmia is characterized on the ECG by an irregularly irregular rhythm with no discernible P waves and a fibrillatory baseline?
- Atrial flutter
- Atrial fibrillation (Correct answer)
- Multifocal atrial tachycardia
- Junctional tachycardia
Correct answer: Atrial fibrillation
Atrial fibrillation produces an irregularly irregular ventricular response with chaotic atrial activity replacing organized P waves.
Question 7: During continuous monitoring, the ECG technician notices artifact that mimics ventricular fibrillation but the patient is conscious and talking. The MOST likely cause is:
- True VF with intact consciousness
- 60-Hz electrical interference
- Patient movement or muscle artifact (Correct answer)
- Wandering baseline from respirations
Correct answer: Patient movement or muscle artifact
A conscious, talking patient cannot be in true VF; coarse, irregular artifact in a conscious patient is most often caused by movement or muscle tremor.
CET Emergency Cardiac Monitoring 2
During a cardiac emergency, a patient's monitor suddenly shows a flat line with no discernible waveforms.
The FIRST step is to: