FREE NURSING AND STUDY GAMES ABOUT ACLS

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FREE NURSING AND STUDY GAMES ABOUT ACLS

BRADYCARDIA EXAM QUESTIONS

Actual Qs and Ans Expert-Verified Explanation

This Exam contains:

-Guarantee passing score -42 Questions and Answers -format set of multiple-choice -Expert-Verified Explanation

Question 1: Describe standby pacing.

Answer:

Having electrodes placed in anticipation of clinical deterioration in patients with acute myocardial ischemia or infarction.Question 2: Which chronotropic drugs are recommend for symptomatic bradycardia other than Atropine? What are the recommended infusion rates?

Answer:

Epinephrine: initiate at 2-10mcg/min and titrate to patient response; Dopamine 2-10 mcg/Kg/minute and titrate to patient response

Question 3: What steps should follow the initiation of pacing?

Answer:

confirm electrical and mechanical capture, reassess for symptom improvement and hemodynamic stability, give analgesics and sedation for pain control, try to find and correct cause of bradycardia

Question 4: How does transcutaneous pacing work?

Answer:

by delivering an electrical stimulus through the skin via electrodes to the heart causing electrical depolarization and subsequent cardiac contraction Question 5: Why is it so important to be able to identify 3rd degree heart block?

Answer:

This the kind most likely to cause cardiovascular collapse and require immediate pacing

Question 6: What rhythms would cause you to initiate standby pacing?

Answer:

sinus node dysfunction resulting in severe and symptomatic bradycardia, Asymptomatic Mobitz type II second degree, Asymptomatic third degree, new BBB or bifasicular block

Question 7: Why might a patient need standby pacing?

Answer:

Several bradycardia rhythms are due to ischemic malfunction of conduction/pacing cells. These arrhythmias may decompensate into total block and cardiovascular collapse.Question 8: Why is caution advised for the use of atropine if the patient has acute coronary ischemia or MI?

Answer:

Atropine would increase the workload of the heart, the increased demand for oxygen could worsen ischemia or increase the size of the infarct

Question 9: Define third degree block.

Answer:

the p waves and QRS waves are firing independently of one another Question 10: How does pacing work to prevent bradycardia dependent escape rhythms?

Answer:

It takes the place of the pacemaker, superseding the unstable ventricular area.

Question 11: Under what circumstances would it be inappropriate to rely on atropine?

Answer:

Mobitz type II second or third degree AV block or in patients with third-degree AV block with new wide QRS complex.Question 12: Discuss the role of transcutaneous pacing if the heart is healthy but suffering from conduction problems related to electrolyte abnormalities or acidosis.

Answer:

After correction of the imbalance, rapid pacing can stimulate effective myocardial contractions until the conduction system recovers. (like using a generator till the electricity comes back on)

Question 13: What are the four steps to transcutaneous pacing?

Answer:

place electrodes on chest per directions, turn pacer on, set the demand rate to approximately 60/min (adjust to clinical condition once pacing is established), Set mA 2 above the dose at which consistent capture is observed.

Question 14: Define cardiovascular collapse.

Answer:

Sudden loss of effective blood flow to the heart and periphery Question 15: What is the course of action if the bradycardic patient is not adequately perfused?

Answer:

Give Atropine 0.5mg bolus and repeat q 3-5 minutes to a maximum of 3mg. If atropine is ineffective, transcutaneous pacing OR Dopamine IV infusion at 2-10mcg/kg per minute OR Epinephrine infusion at 2-10 mcg per minute Question 16: What are the criteria for identifying Mobitz type II second degree AV block on an ECG?

Answer:

rate: slow to normal, rhythm: irregular (QRS complexes are dropped), QRS's are usually wide, Pwaves are upright, more p waves than QRS's but PR interval is fixed and usually normal duration

Question 17: What are the precautions for transcutaneous pacing?

Answer:

contraindicated for severe hypothermia, not recommended for asystole, requires analgesia for conscious patients if patient condition allows, carotid pulse not good indication of capture because muscular jerking may be misinterpreted as pulse

Question 18: Define Second Degree AV block Type II (Mobitz II).

Answer:

The PR interval remains constant, but a beat is dropped Question 19: What is the general approach for the use of drugs for sedation/pain relief and TCP?

Answer:

parenteral benzodiazepine for anxiety and muscle contractions, parenteral narcotic for analgesia, chronotropic infusion once available, expert consultation

Question 20: Define First Degree AV block.

Answer:

Every P has a QRS but the PR interval is longer than 5 small boxes or > 0.2 seconds

Question 21: What do you do if TCP doesn't work?

Answer:

begin an infusion of dopamine or epinephrine and prepare for possible transvenous pacing by obtaining expert consultation.

Question 22: What is the third step in the bradycardia case?

Answer:

Decide if treatment is indicated. Is the bradycardia causing hypotension, altered mental status, signs of shock, ischemic chest pain, acute heart failure

Question 23: What are the indications for transcutaneous pacing?

Answer:

bradycardia resulting in unstable clinical condition: symptomatic sinus bradycardia, Mobitz type II second-degree AV block, Third degree AV block, New BBB or bifasicular block, bradycardia with symptomatic ventricular escape rhythms Question 24: Discuss the use of Transcutaneous pacing and accelerated idioventricular rhythm.

Answer:

AVIR may occur in the setting of inferior wall MI. The rhythm is usually stable and does not require pacing.