Download RELIAS DYSRHYTHMIA ADVANCED A EXAM SCRIPT 2026 COMPREHENSIVE QUESTIONS WITH ACCURATE SOLUT and more Exams Clinical chemistry in PDF only on Docsity!
RELIAS DYSRHYTHMIA ADVANCED A
EXAM SCRIPT 2026 COMPREHENSIVE
QUESTIONS WITH ACCURATE SOLUTIONS
GRADED A+
⩥ 2nd Degree AV Block Type I Mobitz, Wenckebach. Answer: IRREGULAR Rate: 60- 100 P wave: Present, upright PR Interval: Progressively longer until drop (PR interval longer and longer until drop) QRS: <0.12 sec Husband stays late till 9, then 11, then 1, then doesn't come home at all ⩥ 2nd Degree AV Block Type II. Answer: Irregular or regular Rate: < P wave: Present, upright PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop QRS: <0.12 sec
Husband stays late till 9 consistently, then wife goes out and doesn't come home ⩥ 3rd Degree AV Block. Answer: Atrials and ventricles don't communicate Rate: regular atrial P wave: Present, upright No relationship between P waves and QRS PR Interval: VARIABLE QRS: variable P-P ad R-R consistent but NO correlation Husband and wife live separate lives and don't communicate ⩥ SA Node. Answer: 1st 60 - 100 ⩥ AV Node. Answer: 2nd 40 - 60 ⩥ Bundle of His. Answer: 3rd
Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular) ⩥ Calculate Regular Rate. Answer: 1500/ # boxes R-R ⩥ Calculate Irregular Rate. Answer: # of Rs in 6 sec strip X 10 ⩥ Unifocal PVCs. Answer: Only 1 shape PVC ⩥ Bigeminy. Answer: PVC occurs every OTHER beat ⩥ Trigeminy. Answer: PVC occurs every THIRD beat ⩥ Couplet. Answer: 2 PVCs together ⩥ Triplet. Answer: 3 PVCs together ⩥ Multifocal. Answer: Multiple shapes
⩥ Monomorphic V Tach. Answer: Same Shapes V Tach ⩥ Polymorphic V Tach. Answer: Different Shapes V tach ⩥ Coarse V Fib. Answer: Chopy but not as high as polymorphic V tach ⩥ Fine V Fib. Answer: Fine and fibrillatory ⩥ Idioventricular Rhythms. Answer: Only purkinje fibers firing WIDE QRS always ⩥ Atrially Paced. Answer: Spike comes before P ⩥ Ventricularly Paced. Answer: Spike comes before QRS and QRS will be wide ⩥ AV Paced. Answer: Spike before P and before QR ⩥ Failure to Capture. Answer: Spikes with no QRS ⩥ Failure to Sense. Answer: Spikes happen regardless of QRS on their own
- Junctional tachycardia 100- 150 ⩥ Only Purkinje Fibers Firing Rhythms (Everything else has failed). Answer: Fires normally @ 20-50
- Idioventricular 20- 50
- Accelerated idioventricular 50- 100 ⩥ The conduction system or electrical system of the heart controls.... Answer: the sequence of muscle contractions so an optimal volume of blood is pumped from the heart with each beat ⩥ How are rate and rhythm of electrical activity and muscle contractions regulated in the heart normally? Answer: The pacemaker cells of the sinoatrial (SA) node ⩥ What causes a dysrhythmia? Answer: The firing of abnormal pacemaker cells or a blockage of the normal electrical pathway ⩥ What is the order of the electrical conduction system of the heart? Answer: SA node --> AV node ---> Bundle of His --> Purkinje's Fibers
⩥ What is the action of the SA node? Answer: Sends out, intermittently, an electrical shock that starts an electrical conduction that initiates contraction of the atria ⩥ What is the Atrioventricular (AV) node? Answer: Gate for conduction; it focuses and conducts the electrical current onward ⩥ Bundle of His is also called the ... Answer: electrical freeway ⩥ Electrical conduction reaching Purkinje's Fibers cause the .... Answer: ventricular contraction ⩥ Electrical impulses are conducted by which ions? Answer: - Sodium
- Calcium
- Potassium ⩥ What can cause irregular muscular contraction by triggering normally quiet pacemaker cells in areas of the heart other than the SA node to fire? Answer: - Stress
- Ischemia
- Heart failure
⩥ Dysrhythmias developing below the bundle of His are called _________. Answer: ventricular ⩥ Examples of Ventricular Dysrhythmias Answer: - Premature ventricular contractions (PVCs)
- Ventricular tachycardia (VT)
- Ventricular fibrillation VF) ⩥ Dysrhythmias that result from obstruction of conduction pathways are described by ____________. Answer: location (e.g. supraventricular or ventricular, left or right bundle branches). ⩥ Atrioventricular (AV) blocks Answer: Can be subclassified but degree of block ⩥ First degree AV block Answer: Partial block with delayed AV conduction ⩥ Second degree AV block Answer: Partial block; occasional blocked beats ⩥ Third degree AV block Answer: Complete block
⩥ Class I Answer: myocardial depressant inhibits sodium ion movement ⩥ Class Ia agents Answer: prolong duration of electrical stimulation ⩥ Class Ib agents Answer: shorten duration of electrical stimulation ⩥ Class Ic agents Answer: potent myocardial depressants, slow conduction rate ⩥ Class II agents Answer: beta-adrenergic blocking agents ⩥ Class III agents Answer: slow rate of electrical conduction ⩥ Class IV agents Answer: block calcium ion flow ⩥ Assessment of Patients with Dysrhythmias Answer: Initially monitor with ECG Past medication history Presence of six cardinal signs of cardiovascular disease (dyspnea, chest pain, fatigue, edema, syncope, palpitations) Basic mental status Baseline vital signs
- Constipation with distention and flatus ⩥ Class Ib Antidysrhythmic Agents: Drug Answer: lidocaine (Xylocaine) ⩥ Class Ib Antidysrhythmic Agents: Action Answer: shortens the duration of electrical stimulation ⩥ Class Ib Antidysrhythmic Agents: Uses Answer: - premature ventricular contractions
- ventricular tachycardia
- ventricular fibrillation ⩥ Class Ib Antidysrhythmic Agents: Common adverse effects Answer: Lightheadedness, muscle twitching, hallucinations, agitation, euphoria; respiratory depression ⩥ Class Ib Antidysrhythmic Agents: Serious adverse effects Answer: Dysrhythmias, neurotoxicity, seizures, confusion ⩥ Class Ib Antidysrhythmic Agent: Lidocaine Answer: - For IV use for dysrhythmias is different from lidocaine used as local anesthetic (has preservative in it)
- Should not be used for patients with complete heart block
- IM route available for emergency use until IV can be established ⩥ Class Ic Antidysrhythmic Agents: Actions Answer: Potent myocardial depressants, slow conduction rate ⩥ Class Ic Antidysrhythmic Agents: Uses Answer: treat ventricular tachycardias, supraventricular tachyarrhythmia, frequent premature ventricular contractions ⩥ Class Ic Antidysrhythmic Agents: Common adverse effects Answer: Dizziness, lightheadedness, faintness, unsteadiness, blurred vision, headaches, constipation, nausea ⩥ Class Ic Antidysrhythmic Agents: Serious adverse effects Answer: Visual disturbances, increasing dyspnea, exercise intolerance, edema, dysrhythmias ⩥ Class II Antidysrhythmic Agents (Beta Blockers): Drugs Answer: metoprolol (Lopressor, Toprol) ⩥ Class II Antidysrhythmic Agents (Beta Blockers): Actions Answer: Inhibit cardiac response to sympathetic nerve stimulation to reduce heart rate, systolic blood pressure, cardiac output (blocks beta receptors)
⩥ Which class of Antidysrhythmic Agents may cause exacerbation of preexisting dysrhythmia, and should not be given to patients who already have a severe sinus node dysfunction causing bradycardia? Answer: Class III Antidysrhythmic Agents ⩥ Class III Antidysrhythmic Agents: Serious adverse effects Answer: CNS: fatigue, tremors, involuntary movements, sleep disturbances, numbness and tingling, dizziness, ataxia, and confusion Respiratory: pulmonary interstitial pneumonitis, exertional dyspnea, cough GI: nausea/vomiting, constipation, abdominal pain, anorexia Thyroid disorders, hepatotoxicity, dysrhythmias Visual: pigmentations in the cornea, corneal microdeposits Integumentary: photosensitivity, blue-gray skin coloration Instruct patient that even when therapy is discontinued, it can take a few weeks for symptoms to go away completely. Instruct pt on how to deal with adverse effects when possible.
⩥ Class IV Antidysrhythmic Agents (Calcium Channel Blockers): Drugs Answer: Verapamil (Calan, Isoptin), diltiazem (Cardizem) Actions block calcium channels in SA and AV nodes: slow AV conduction, prolong refractoriness and decrease automaticity Uses Treat automatic and re-entrant tachycardias Do not give to patients with systolic heart failure See Chapter 23 for further discussion ⩥ Class IV Antidysrhythmic Agents (Calcium Channel Blockers): Actions Answer: Block calcium channels in SA and AV nodes: slow AV conduction, prolong refractoriness and decrease automaticity ⩥ Class IV Antidysrhythmic Agents (Calcium Channel Blockers): Uses Answer: - Treat automatic and re-entrant tachycardias
- Do not give to patients with systolic heart failure ⩥ Miscellaneous Antidysrhythmic Agents: Drugs Answer: adenosine (Adenocard) digoxin (Lanoxin) ⩥ Miscellaneous Antidysrhythmic Agents: adenosine (Adenocard) Actions Answer: Naturally occurring chemical in the body; strong depressant effects on the SA and AV nodes
⩥ The normal electrical conduction pathway in the heart starts with the firing of which component? a. Atrioventricular (AV) node b. Internodal pathway c. Sinoatrial (SA) node d. Atria Answer: c. Sinoatrial (SA) node Rationale: The firing of the SA node is the initiation of normal cardiac rhythm. The electrical impulse goes from the SA node through the internodal pathways, to the AV node, to the bundle of His, to the bundle branches, to the Purkinje fibers in the ventricles. Then the process is repeated. ⩥ What must the nurse do when obtaining lidocaine (Xylocaine), a Class Ib antidysrhythmic, to administer to a patient with a cardiac dysrhythmia? a. Protect the drug from exposure to sunlight. b. Administer the drug by IM injection. c. Ensure the dosage form to be administered is for dysrhythmias, not for local anesthesia. d. Ensure that the patient does not need cardiac monitoring. Answer: c. Ensure the dosage form to be administered is for dysrhythmias, not for local anesthesia.
The medication is available in 2 forms. One is for dysrhythmias and the other is for local anesthetics. The formulations are very different. The drug is not sensitive to sunlight. The patient DOES need monitoring for dysrhythmias. IM use is available, but the intravenous route is preferred. Either IM or IV require careful checking to ensure the correct formulation is administered. ⩥ Administering lidocaine (Xylocaine) at too high a dose can produce which effect? a. Seizures b. Increased respirations c. Tachycardia d. Hypertension Answer: a. Seizures Rationale: Lidocaine is used to prolong the refractory period and automaticity. If administered at too high a dose, the patient may notice numbness, tingling, and slurring of speech, and seizures may develop. It may cause a decrease in heart rate and respirations. It should not be given to patients who have heart block. The patient must be assessed initially and monitored carefully during administration. ⩥ For which cardiac rhythm is the use of amiodarone (Cordarone, Pacerone), a potassium channel blocking agent, contraindicated?
