NGN EKG for nurses Exam

Clinical Case: Mr. William Thompson, a 78-year-old male, arrives at the clinic for a follow-up visit. He has a history of chronic atrial fibrillation (AF) diagnosed 5 years ago with multiple hospitalizations, hypertension, and type 2 diabetes.  
His blood pressure is 140/85 mmHg, heart rate is 96 beats per minute, and his EKG shows atrial fibrillation with a ventricular rate of 95 beats per minute.

What is the most appropriate next step in managing Mr. Thompson’s chronic atrial fibrillation?

A 72-year-old patient presents to the emergency department with complaints of weakness and palpitations for the past 24 hours. 

Based on the patient’s presentation, which interventions should the nurse anticipate?  Select all that apply

A patient in the emergency department who is being monitored with a portable cardiac monitor/defibrillator develops this rhythm.


Which action will the nurse take first?

The nurse is diligently observing the cardiac monitors in the coronary care unit. Four patients present with varying cardiac rhythms, and the nurse is evaluating the urgency of each situation.

Based on the observed rhythms, which patient requires immediate nursing intervention?

A 67-year-old patient is admitted to the telemetry unit with recurrent episodes of palpitations and shortness of breath. The 12-lead ECG identifies a dysrhythmia. The physician prescribes amiodarone, and the nurse administers the first dose. One hour post-administration, the nurse reviews the telemetry to evaluate the medication’s effect.
Which finding from the telemetry indicates that the amiodarone administered to the patient is producing the desired therapeutic effect?

A 70-year-old patient is brought to the emergency department after experiencing bouts of dizziness. During the assessment, the nurse decides to evaluate the heart rate using the 6-second strip method. On the EKG strip, the nurse counts 4 R waves (QRS complexes) in a 6-second period.

Based on this method, what is the estimated heart rate of the patient?

A 60-year-old patient presents to the emergency department with complaints of severe, crushing chest pain radiating to the left arm, which started approximately 3 hours ago. The patient is sweaty and appears in distress.
A 12-lead ECG is immediately performed to evaluate the cardiac rhythm and potential ischemic changes.

What electrocardiographic changes might the nurse anticipate on this patient’s ECG? Select all that apply

The nurse is caring for the client admitted to the ED.

Patient Name: Mr. John Edwards

Age: 58 years

Gender: Male

Chief Complaint:
Mr. Edwards presents to the emergency department with a chief complaint of severe chest pain that began approximately 2 hours ago.

History of Present Illness:
Mr. Edwards reports that the chest pain started suddenly while he was watching television at home. He describes the pain as a heavy, crushing sensation located in the center of his chest, radiating to his left arm and jaw. He rates the pain as 9 out of 10 in intensity. The pain is continuous and is associated with diaphoresis (excessive sweating) and shortness of breath. Mr. Edwards states that he has never experienced anything like this before. He also feels nauseated and has had one episode of vomiting since the onset of the pain. Resting and taking deep breaths do not alleviate the pain.

Past Medical History:

• Hypertension (diagnosed 10 years ago; poorly controlled with occasional medication adherence)
• Hyperlipidemia (diagnosed 5 years ago; on simvastatin)
• Type 2 Diabetes Mellitus (diagnosed 8 years ago; on metformin)
• Former smoker (quit 5 years ago; 20-pack-year history)
• Family history of coronary artery disease (father died of a myocardial infarction at age 60)

Medications:

• Simvastatin 20 mg daily
• Metformin 500 mg BID
• Lisinopril 10 mg daily (reports missing doses occasionally)
• Aspirin 81 mg daily (reports not taking it consistently)

Allergies:

• No known drug allergies.

Social History:

• Mr. Edwards is a retired electrician. He lives with his wife and has two grown children. He admits to occasional alcohol consumption but denies drug use. He leads a sedentary lifestyle and has not been consistent with following dietary recommendations for his diabetes and hypertension.

A 58-year-old patient in the intensive care unit suddenly becomes unresponsive during a routine vital signs check.
The nurse immediately checks for a pulse but cannot palpate one.
Upon glancing at the telemetry monitor, the nurse observes a flat line without any electrical activity.

In this scenario, which interventions are most appropriate for the nurse to consider?

Mr. Carlos Rivera, a 45-year-old male, presents to the emergency department after experiencing a syncopal episode while playing basketball. He has no significant past medical history, but his brother died suddenly at age 40.
His EKG shows a right bundle branch block and ST-segment elevation in leads V1-V3.
The cardiologist diagnoses him with Brugada syndrome.
What is the most appropriate next step in managing Mr. Rivera’s condition?

Mrs. Sandra Miller, a 68-year-old female, was admitted to the hospital with complaints of dizziness, fatigue, and palpitations. She has a history of hypertension, hyperlipidemia, and a recent diagnosis of sick sinus syndrome.
Her blood pressure is 110/70 mmHg, and her heart rate is 45 beats per minute.
The EKG shows sinus bradycardia with occasional pauses. The cardiologist recommends the placement of a permanent pacemaker.
What is the most appropriate explanation for the patient regarding the purpose of the pacemaker?

A 72-year-old patient presents to the cardiology outpatient clinic for a routine follow-up. The nurse performs an initial assessment and notices a slow heart rate on the monitor. The patient is alert, and oriented, and reports feeling “just fine” with no noticeable symptoms. 

Given the patient’s presentation, which nursing interventions are most appropriate? Select all that apply

Ms. Emily Parker, a 29-year-old female, is brought to the emergency department by her roommate after being found unresponsive with an empty bottle of amitriptyline, a tricyclic antidepressant.
On arrival, she is lethargic but responsive to painful stimuli. Her EKG shows a widened QRS complex and a prolonged QT interval.
What is the most appropriate initial management for Ms. Parker?

A 68-year-old patient with a known history of chronic kidney disease presents to the emergency department after experiencing episodes of dizziness. On telemetry, the nurse observes a polymorphic ventricular tachycardia with a characteristic twisting pattern around the baseline. The rhythm is sporadic and self-terminating but recurs intermittently.
Based on the patient’s presentation, which interventions should the nurse anticipate?   Select all that apply

A 68-year-old male undergoing a routine health check-up is hooked up to an EKG monitor. The nurse observes a strange and inconsistent pattern on the EKG tracing. The patient is calm and denies any chest pain or discomfort.
What are the appropriate nursing interventions to identify the cause of this EKG tracing?Select all that apply

Mr. James Anderson, a 62-year-old male with a history of coronary artery disease and hypertension, is admitted for chest pain and shortness of breath. He is currently being monitored on telemetry, and the nurse observes this peculiar trace on his EKG.

EKG STRIP

Mr. Anderson denies any palpitations or dizziness.

Under which circumstances should the nurse report this condition to the physician? Select all that apply

A 58-year-old patient is admitted to the cardiac telemetry unit with complaints of palpitations and mild shortness of breath that started a few hours ago. Upon review of the telemetry strip, the nurse identified a sawtooth pattern in the atrial rhythm. 

Based on the patient’s presentation, which five medical interventions should the nurse anticipate for this patient?

A 58-year-old patient is rushed into the emergency department with complaints of chest pain, dizziness, and nausea that started several hours ago. 


Based on the observed cardiac rhythm, what is the nurse’s two priority action for this patient?

Patient B is a 45-year-old male who presents to the emergency department with sudden onset of chest pain, shortness of breath, and palpitations. He has a history of hypertension and alcohol abuse. The following strip is obtained.

Which of the following 3 factors determines whether defibrillation or cardioversion should be used in the management of this condition?