DC Dysrhythmia Patient Care & Safety Standards 2 — Questions and Answers
Question 1: A patient on continuous cardiac monitoring develops a sustained ventricular tachycardia at 160 bpm but remains awake and has a palpable pulse. What is the most appropriate initial intervention?
- Immediate unsynchronized defibrillation at 200J
- Administer amiodarone IV per protocol and notify physician (Correct answer)
- Perform immediate CPR
- Increase the monitoring electrode sensitivity
Correct answer: Administer amiodarone IV per protocol and notify physician
Stable VT with a pulse is treated with antiarrhythmic medications such as amiodarone while physician notification occurs, not immediate defibrillation.
Question 2: When applying monitoring electrodes, which skin preparation step is most critical to ensure accurate signal quality?
- Applying conductive gel after electrode placement
- Clipping or shaving excessive hair at electrode sites (Correct answer)
- Warming the electrode before application
- Using alcohol to moisturize the skin before application
Correct answer: Clipping or shaving excessive hair at electrode sites
Removing excessive hair at electrode sites reduces impedance and ensures proper electrode contact for accurate signal acquisition.
Question 3: A nurse notes a patient's rhythm strip shows a PR interval of 0.28 seconds with all P waves followed by QRS complexes. Which dysrhythmia does this represent?
- Second-degree AV block Type I (Wenckebach)
- First-degree AV block (Correct answer)
- Third-degree (complete) heart block
- Second-degree AV block Type II
Correct answer: First-degree AV block
A PR interval consistently greater than 0.20 seconds with each P wave followed by a QRS complex indicates first-degree AV block.
Question 4: A patient receiving digoxin develops frequent PVCs and complains of nausea. The nurse checks the serum digoxin level, which is 3.2 ng/mL. What is the priority nursing action?
- Administer the next scheduled digoxin dose with food
- Hold the digoxin dose and notify the provider immediately (Correct answer)
- Increase IV fluid rate to promote renal excretion
- Administer potassium supplementation per protocol
Correct answer: Hold the digoxin dose and notify the provider immediately
A digoxin level of 3.2 ng/mL is toxic (therapeutic range 0.5–2.0 ng/mL), and the drug must be withheld with immediate physician notification.
Question 5: Which patient condition most increases the risk of developing torsades de pointes?
- Hyperkalemia with a serum potassium of 6.2 mEq/L
- QTc interval prolongation greater than 500 ms (Correct answer)
- Sinus bradycardia with a rate of 48 bpm
- First-degree AV block with PR interval of 0.22 seconds
Correct answer: QTc interval prolongation greater than 500 ms
QTc prolongation beyond 500 ms significantly increases risk of torsades de pointes, a polymorphic ventricular tachycardia.
Question 6: When a patient's telemetry alarm activates, what is the correct sequence of actions for the monitoring nurse?
- Silence the alarm, identify the rhythm, then assess the patient
- Assess the patient at bedside, then interpret the rhythm strip
- Interpret the rhythm, assess the patient, then silence the alarm (Correct answer)
- Call the rapid response team before assessing the rhythm
Correct answer: Interpret the rhythm, assess the patient, then silence the alarm
Correct alarm response requires rhythm interpretation first, followed by patient assessment, then alarm management based on clinical findings.
Question 7: A patient in atrial fibrillation is prescribed rate control therapy. Which medication class is most commonly used for this purpose?
- Thrombolytics
- Beta-blockers or calcium channel blockers (Correct answer)
- Sodium channel blockers
- Vasopressors
Correct answer: Beta-blockers or calcium channel blockers
Beta-blockers (e.g., metoprolol) and non-dihydropyridine calcium channel blockers (e.g., diltiazem) are first-line agents for ventricular rate control in atrial fibrillation.
DC Dysrhythmia Patient Care & Safety Standards 2
A patient on continuous cardiac monitoring develops a sustained ventricular tachycardia at 160 bpm but remains awake and has a palpable pulse.
What is the most appropriate initial intervention?