NUR 436 Final Questions with Complete
Answers
Rule of Nines - Answer--Head: 9%
-Each arm: 9%
-Torso: 36%
-Inguinal: 1%
-Each leg: 18%
Normal Sinus Rhythm - Answer--Normal regularity
-Rate: 60-100 bpm
-1 P-wave: 1 QRS
-PRI: 0.12-0.20
-QRS: <0.12
Sinus bradycardia - Answer--Rate: <60 bpm
-Treatment: IV atropine, transcutaneous pacing, dopamine, epinephrine, permanent
pacemaker, hold/reduce bradycardia causing drugs
Sinus tachycardia - Answer--Rate: >100 bpm
-Treatment: treat the underlying cause, vagal maneuvers, betablockers (e.g.
metoprolol), adenosine, calcium channel blockers (diltiazem), synchronized
cardioversion
Premature Atrial Contractions - Answer--Rate: varies
-P wave: different shape, maybe hidden
-PRI: WNL
-QRS: normal
-Treatment: withdrawal stimulation (caffeine, SNS drugs), betablockers
Premature Ventricular Contraction - Answer--QRS: wide and distorted, early
Atrial Fibrillation - Answer--Rate: 350-600
-P-waves: chaotic, fibrillatory waves
-Irregular rhythm
-PRI: indiscernible
-Treatment: decrease ventricular response, prevent stroke, calcium channel blockers
(e.g. diltiazem), betablockers (e.g. metoprolol), dronedarone, digoxin, drug
(amiodarone) or electrical conversion, anticoagulant therapy
Atrial Flutter - Answer--Rate: 200-350 bpm
-PRI: indiscernible
-F-waves: sawtooth-shaped flutter waves
,-Treatment: digoxin, calcium channel blockers, betablockers, electrical cardioversion,
amiodarone, catheter ablation
Paroxysmal Supraventricular Tachycardia - Answer--HR: 150-220
-P-wave: hidden, abnormal
-PRI: shortened or normal
-Treatment: vagal maneuvers, coughing, adenosine, CCB. Betablockers, synchronized
cardioversion
Ventricular Tachycardia - Answer--Rate: 150-250
-Irregular or regular rhythm
-P-waves: independent, buried
-PRI: indiscernible
-QRS: distorted, wide
-Treatment: Pulseless (CPR, defibrillation/ACLS), unstable (synchronized
cardioversion), stable (amiodarone, treat cause - oxygen, replace electrolytes), long
term (internal implantable defibrillator)
Ventricular Fibrillation - Answer--HR not measurable
-Rhythm is chaotic
-P-wave, PRI, QRS: not measurable
-Treatment: CPR, ACLS, epinephrine, vasopressin
Asystole - Answer--Indiscernible EKG
-Treatment: CPR, ACLS, epinephrine, intubation
First-degree AV block - Answer-PRI: prolonged
Second-degree AB block Type 1 - Answer--Progressive lengthening of the PRI until
QRS is blocked
-Treatment: atropine, temporary pacemaker, transcutaneous pacing
Second-degree AB block Type 2 - Answer--Constant PRI and variable QRS complexes
-Treatment: transcutaneous pacing, temporary pacemaker
Third-degree AV block - Answer--No relationship between p-waves and QRS
complexes
-Treatment: transcutaneous pacemaker, transcutaneous pacemaker, dopamine,
epinephrine
Prioritization for care - Answer--know what your patient physically looks like (color,
temp, LOC, etc.)
-perform a head to toe assessment - best indicator of patient well-being
-use report to try and determine the order of patient assessment - most urgent to least
urgent
, -review the patient vitals from the previous hour: high blood pressure,
increase/decrease HR, increase temperature, decrease SpO2, increased oxygen
required, etc.
High alarms - Answer--Obstructions
-Decreased lung compliance
-Biting on oral ETT
-Copious thick secretions in airway
-Condensation in circuitry tubing
-Right mainstem bronchus intubation
-Coughing, gagging
-Bronchospasm
-Equipment failure
Low alarms - Answer--Connections
-Tube disconnected
-ETT displaced
-Low tracheal cuff pressure
-Ventilator malfunction
-Leak in circuitry
Tracheostomy complications - Answer-o Hemorrhage (large amount of blood
secretions)
o Edema
o Aspiration
o Accidental decannulation
o Tube obstruction
o Entrance of free air into the pleural cavity
Tracheostomy respiratory assessment - Answer-o Breath sounds
o WOB
o Vital signs
o Tightness of tracheostomy ties
o Type and amount of secretions
Tracheostomy interventions - Answer--Maintain a patient airway
-Facilitate the removal of pulmonary secretions
-Provide humidified air or oxygen
-Clean the stoma
-Monitor ability to swallow
-Teaching
-Raise the head of the bed
-Bedside equipment: suction catheters, suction source, gloves, sterile saline, sterile
gauze for wiping away secretions, scissors, extra tracheostomy tube of the same size
with ties already attached, another tracheostomy tube one size smaller, obturator
Answers
Rule of Nines - Answer--Head: 9%
-Each arm: 9%
-Torso: 36%
-Inguinal: 1%
-Each leg: 18%
Normal Sinus Rhythm - Answer--Normal regularity
-Rate: 60-100 bpm
-1 P-wave: 1 QRS
-PRI: 0.12-0.20
-QRS: <0.12
Sinus bradycardia - Answer--Rate: <60 bpm
-Treatment: IV atropine, transcutaneous pacing, dopamine, epinephrine, permanent
pacemaker, hold/reduce bradycardia causing drugs
Sinus tachycardia - Answer--Rate: >100 bpm
-Treatment: treat the underlying cause, vagal maneuvers, betablockers (e.g.
metoprolol), adenosine, calcium channel blockers (diltiazem), synchronized
cardioversion
Premature Atrial Contractions - Answer--Rate: varies
-P wave: different shape, maybe hidden
-PRI: WNL
-QRS: normal
-Treatment: withdrawal stimulation (caffeine, SNS drugs), betablockers
Premature Ventricular Contraction - Answer--QRS: wide and distorted, early
Atrial Fibrillation - Answer--Rate: 350-600
-P-waves: chaotic, fibrillatory waves
-Irregular rhythm
-PRI: indiscernible
-Treatment: decrease ventricular response, prevent stroke, calcium channel blockers
(e.g. diltiazem), betablockers (e.g. metoprolol), dronedarone, digoxin, drug
(amiodarone) or electrical conversion, anticoagulant therapy
Atrial Flutter - Answer--Rate: 200-350 bpm
-PRI: indiscernible
-F-waves: sawtooth-shaped flutter waves
,-Treatment: digoxin, calcium channel blockers, betablockers, electrical cardioversion,
amiodarone, catheter ablation
Paroxysmal Supraventricular Tachycardia - Answer--HR: 150-220
-P-wave: hidden, abnormal
-PRI: shortened or normal
-Treatment: vagal maneuvers, coughing, adenosine, CCB. Betablockers, synchronized
cardioversion
Ventricular Tachycardia - Answer--Rate: 150-250
-Irregular or regular rhythm
-P-waves: independent, buried
-PRI: indiscernible
-QRS: distorted, wide
-Treatment: Pulseless (CPR, defibrillation/ACLS), unstable (synchronized
cardioversion), stable (amiodarone, treat cause - oxygen, replace electrolytes), long
term (internal implantable defibrillator)
Ventricular Fibrillation - Answer--HR not measurable
-Rhythm is chaotic
-P-wave, PRI, QRS: not measurable
-Treatment: CPR, ACLS, epinephrine, vasopressin
Asystole - Answer--Indiscernible EKG
-Treatment: CPR, ACLS, epinephrine, intubation
First-degree AV block - Answer-PRI: prolonged
Second-degree AB block Type 1 - Answer--Progressive lengthening of the PRI until
QRS is blocked
-Treatment: atropine, temporary pacemaker, transcutaneous pacing
Second-degree AB block Type 2 - Answer--Constant PRI and variable QRS complexes
-Treatment: transcutaneous pacing, temporary pacemaker
Third-degree AV block - Answer--No relationship between p-waves and QRS
complexes
-Treatment: transcutaneous pacemaker, transcutaneous pacemaker, dopamine,
epinephrine
Prioritization for care - Answer--know what your patient physically looks like (color,
temp, LOC, etc.)
-perform a head to toe assessment - best indicator of patient well-being
-use report to try and determine the order of patient assessment - most urgent to least
urgent
, -review the patient vitals from the previous hour: high blood pressure,
increase/decrease HR, increase temperature, decrease SpO2, increased oxygen
required, etc.
High alarms - Answer--Obstructions
-Decreased lung compliance
-Biting on oral ETT
-Copious thick secretions in airway
-Condensation in circuitry tubing
-Right mainstem bronchus intubation
-Coughing, gagging
-Bronchospasm
-Equipment failure
Low alarms - Answer--Connections
-Tube disconnected
-ETT displaced
-Low tracheal cuff pressure
-Ventilator malfunction
-Leak in circuitry
Tracheostomy complications - Answer-o Hemorrhage (large amount of blood
secretions)
o Edema
o Aspiration
o Accidental decannulation
o Tube obstruction
o Entrance of free air into the pleural cavity
Tracheostomy respiratory assessment - Answer-o Breath sounds
o WOB
o Vital signs
o Tightness of tracheostomy ties
o Type and amount of secretions
Tracheostomy interventions - Answer--Maintain a patient airway
-Facilitate the removal of pulmonary secretions
-Provide humidified air or oxygen
-Clean the stoma
-Monitor ability to swallow
-Teaching
-Raise the head of the bed
-Bedside equipment: suction catheters, suction source, gloves, sterile saline, sterile
gauze for wiping away secretions, scissors, extra tracheostomy tube of the same size
with ties already attached, another tracheostomy tube one size smaller, obturator
