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Chapter 25: Bradycardia and Tachycardia
from TEST BANK; Buttaro: Primary Care Interprofessional Collaborative Practice 6TH EDITION. All Chapters
by StudyGuide
Buttaro: Primary Care: A Collaborative Practice, 6th Edition
Multiple Choice
1. A patient prescribed a beta blocker medication is in the emergency department with reports of syncope, shortness of breath, and hypotension. A cardiac monitor reveals a heart rate of 35 beats per minute. Which medication may be used to stabilize this patient?
a. Adenosine b. Amiodarone c. Atropine d. Epinephrine
ANS: D a. Administer atenolol intravenously. b. Admit to the hospital for urgent cardioversion. c. Refer the patient to a cardiologist.
Epinephrine is indicated if unstable bradycardia is caused by beta blockers. This patient is symptomatic and unstable and should be treated. Adenosine and amiodarone are used to treat tachycardia. Atropine is used for some types of bradycardia, but not when induced by beta blockers.
2. A patient reports heart palpitation but no other symptoms and has no prior history of cardiovascular disease. The clinic provider performs an electrocardiogram and notes atrial fibrillation and a heart rate of 120 beats per minute. Which is the initial course of action in treating this patient?
NURSINGTB.COM d. Initiate steps to begin anticoagulant therapy.
ANS: C a. Atrial fibrillation b. Atrial flutter c. Monomorphic ventricular tachycardia d. Polymorphic ventricular tachycardia
This patient has no history of serious heart disease and does not have symptoms of chest pressure, acute MI, or congestive heart failure and may be referred to a cardiologist for evaluation and treatment but anticoagulant therapy to minimize the risk of clot formation should be started initially. The 2014 AHA Guidelines for Atrial Fibrillation recommend shared decision-making in regard to anticoagulation based on relative risk of the patient for thromboembolic event. Atenolol is given IV for patients who are unstable; the advanced life support treatment guidelines do not recommend treatment of tachycardia if the patient is stable. Urgent cardioversion is rarely needed if the heart rate is less than 150 beats per minute unless there are underlying heart conditions.
3. Which cardiac arrhythmia in an unstable patient requires unsynchronized shocks, or defibrillation?
ANS: D
Polymorphic ventricular tachycardia should be treated as ventricular fibrillation with unsynchronized shocks. The other arrhythmias are treated with synchronized cardioversion.
