TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
Chapter 100: Cardiac Arrhythmias Buttaro: Primary Care: A Collaborative Practice, 6th Edition MULTIPLE CHOICE 1. A patient reports sustained, irregular heart palpitations. What is the most likely cause of these symptoms? a. Anemia b. Atrial fibrillation c. Extrasystole d. Paroxysmal attacks ANS: B Atrial fibrillation causes palpitations that are irregular and tend to be sustained. Anemia will cause rapid palpitations that are regular. Extrasystole causes palpitations or an awareness of isolated extra beats with a pause. Paroxysmal attacks start and terminate abruptly and are usually rapid and regular. 2. An adult patient reports frequent episodes of syncope and lightheadedness. The provider notes a heart rate of 70 beats per minutes. What action will the provider take next? a. Evaluation of the patient’s orthostatic vital signs b. Monitoring the patient’s heart rate while the patient is bearing down c. Prescribing an electrocardiogram (ECG) and exercise stress test (ETT) d. Reassuring the patient that the symptoms are non-cardiac in origin ANS: A NURSINGTB.COM Orthostatic vital signs are helpful to exclude orthostatic hypotension as a cause of syncope and are easily performed in the clinic. Assessment for vagal bradycardia may be performed next. ECG and ETT are not recommended as an initial evaluation in a healthy patient, unless other causes are not determined. Without assessment of the cause of the syncope, cardiac causes cannot be excluded. 3. A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac monitor shows a heart rate of 225 beats per minute. The provider notifies transport to take the child to the emergency department. What initial intervention may be attempted in the clinic? a. Intravenous adenosine b. Administration of a beta blocker c. A loading dose of digoxin d. A carotid massage ANS: D This child has paroxysmal supraventricular tachycardia (PSVT). Vagal maneuvers or carotid massage may be attempted to slow the ventricular rate. Adenosine is contraindicated in patients with asthma. Medications such as beta blockers and digoxin are not used in emergency treatment of PSVT.
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