CMT Patient Safety and Monitoring 2 — Questions and Answers
Question 1: When monitoring a patient on telemetry, which ECG rhythm requires immediate intervention?
- Normal sinus rhythm
- Sinus bradycardia at 55 bpm in a sleeping patient
- Ventricular fibrillation (Correct answer)
- Sinus arrhythmia
Correct answer: Ventricular fibrillation
Ventricular fibrillation is a lethal rhythm with no organized cardiac activity, requiring immediate defibrillation.
Ventricular fibrillation (VF) is a disorganized electrical activity where the ventricles quiver instead of contracting, producing zero cardiac output. Without immediate intervention, death occurs within minutes. Treatment follows ACLS protocol: immediate high-quality CPR, defibrillation as soon as possible (200J biphasic), epinephrine every 3-5 minutes, and amiodarone for refractory VF. On the ECG, VF appears as chaotic, irregular waveforms with no identifiable P waves, QRS complexes, or T waves. Medical technicians monitoring telemetry must recognize lethal rhythms and activate the emergency response system immediately.
Question 2: The normal adult blood pressure range is:
- Less than 100/60 mmHg
- Less than 120/80 mmHg (Correct answer)
- 140/90-160/100 mmHg
- 160/100-180/110 mmHg
Correct answer: Less than 120/80 mmHg
Normal adult blood pressure is less than 120/80 mmHg according to the American Heart Association guidelines.
AHA blood pressure categories: Normal (<120/<80), Elevated (120-129/<80), Stage 1 Hypertension (130-139 or 80-89), Stage 2 Hypertension (≥140 or ≥90), and Hypertensive Crisis (>180 and/or >120—requires immediate medical attention). Proper measurement technique includes: seated patient with feet flat and back supported, arm at heart level, correct cuff size (bladder covers 80% of arm circumference), no caffeine/smoking for 30 minutes prior, 5 minutes of quiet rest before measurement, and averaging two readings taken 1-2 minutes apart.
Question 3: A patient's oxygen saturation (SpO2) drops to 88%. The medical technician should first:
- Document the finding and continue monitoring
- Reposition the patient and verify the reading, then notify the nurse or provider (Correct answer)
- Wait 30 minutes and recheck
- Administer oxygen without an order
Correct answer: Reposition the patient and verify the reading, then notify the nurse or provider
First verify the reading by repositioning the probe and checking for signal quality, then promptly notify the nurse or provider for clinical assessment.
An SpO2 of 88% is below the normal range (95-100%) and warrants prompt action. The systematic approach is: (1) Check the pulse oximeter signal quality (waveform, signal strength indicator), (2) Reposition the probe or try a different finger, (3) Assess the patient clinically (respiratory rate, effort, color, level of consciousness), (4) Ensure the patient is in an upright or semi-Fowler's position, (5) Notify the nurse/provider immediately with assessment findings, (6) Administer supplemental oxygen only if there is a standing order or protocol. A medical technician should not independently initiate oxygen without an order unless there is an approved emergency protocol. Causes of low SpO2 include respiratory disease, heart failure, atelectasis, and PE.
Question 4: Which vital sign change would indicate a patient is developing sepsis?
- Blood pressure 118/76 mmHg
- Temperature 101.5°F with heart rate 110 bpm and respiratory rate 24 (Correct answer)
- Heart rate 72 bpm at rest
- Respiratory rate 16 breaths per minute
Correct answer: Temperature 101.5°F with heart rate 110 bpm and respiratory rate 24
The combination of fever, tachycardia, and tachypnea meets criteria for systemic inflammatory response syndrome (SIRS), which may indicate sepsis.
Sepsis screening criteria (qSOFA and SIRS) include combinations of: temperature >100.4°F (38°C) or <96.8°F (36°C), heart rate >90 bpm, respiratory rate >20 breaths/min, WBC >12,000 or <4,000, altered mental status, and systolic BP ≤100 mmHg. Early recognition is critical because sepsis progresses rapidly to septic shock (sepsis + persistent hypotension despite fluid resuscitation + lactate >2 mmol/L). Every hour delay in antibiotic administration increases mortality by approximately 8%. Medical technicians play a vital role in early detection through frequent vital sign monitoring and immediate reporting of concerning trends.
Question 5: Capillary refill time is assessed by pressing on a nail bed and should return to normal color within:
- Less than 2 seconds (Correct answer)
- 3-5 seconds
- 5-10 seconds
- 10-15 seconds
Correct answer: Less than 2 seconds
Normal capillary refill time is less than 2 seconds, indicating adequate peripheral perfusion.
Capillary refill time (CRT) is a simple, non-invasive assessment of peripheral perfusion. Technique: firmly press the patient's nail bed for 5 seconds until it blanches (turns white), release, and count the seconds until color returns. Normal is less than 2 seconds. Prolonged CRT (>2 seconds) may indicate dehydration, shock, peripheral vascular disease, hypothermia, or heart failure. Factors affecting CRT include ambient temperature (cold environments prolong it), age (slower in elderly), nail polish, and lighting conditions. While CRT alone is not diagnostic, combined with other findings (tachycardia, hypotension, altered mental status), it helps identify patients with compromised perfusion.
Question 6: Continuous cardiac monitoring is most important for patients receiving which type of medication?
- Oral antibiotics
- Topical antifungal cream
- Intravenous potassium (Correct answer)
- Oral acetaminophen
Correct answer: Intravenous potassium
IV potassium administration requires continuous cardiac monitoring because rapid infusion or high concentrations can cause fatal cardiac arrhythmias.
Intravenous potassium is a high-alert medication because hyperkalemia can cause fatal cardiac arrhythmias including ventricular fibrillation and asystole. ECG changes with hyperkalemia progress from peaked T waves, to prolonged PR interval, widened QRS, sine wave pattern, and finally cardiac arrest. Safety requirements for IV potassium: maximum concentration of 40 mEq/L in peripheral IV (higher concentrations require central line), maximum infusion rate of 10-20 mEq/hour, continuous cardiac monitoring during infusion, IV pump required (never gravity infusion), and serum potassium level checked before and after administration. Other medications requiring cardiac monitoring include digoxin, antiarrhythmics, and certain chemotherapy agents.
CMT Patient Safety and Monitoring 2
When monitoring a patient on telemetry, which ECG rhythm requires immediate intervention?