Chapter 15

c. Pathologic arrhythmia

A heart rate greater than 130 is usually due to which of the following conditions? a. Stress b. Fever c. Pathologic arrhythmia d. Hypoxemia

b. I and III

A patient is brought to the emergency room in full cardiac arrest. The paramedics have not been able to establish intravenous access for administration of resuscitation drugs. Which of the following should be considered? I. Administering drugs via the endotracheal tube II. Having the nurse insert a gastric tube III. Using an intraosseous route a. I and II b. I and III c. II and III d. I, II, and III

algorithm

A/an _______________ is a systematic approach to help practitioners treat cardiac emergencies.

b. Increased conduction through the AV node and increased heart rate.

Administration of positive inotropic drugs causes all of the following except: a. An increased force of contraction of the heart. b. Increased conduction through the AV node and increased heart rate. c. Increased cardiac output. d. Increased tissue perfusion.

c. Enhanced oxygen release at the tissues.

Administration of sodium bicarbonate causes all of the following effects except: a. Metabolic alkalosis. b. Increased serum sodium. c. Enhanced oxygen release at the tissues. d. Hyperosmolality.

b. Inamrinone

All except which of the following are antiarrhythmic drugs? a. Lidocaine b. Inamrinone c. Amiodarone d. Procainamide

b. AV heart block

All except which of the following are indications for beta blockers? a. Suspected myocardial infarction b. AV heart block c. Supraventricular tachyarrhythmia d.Unstable angina

a. Decreased parasympathetic tone

All except which of the following can be the cause of bradycardia? a. Decreased parasympathetic tone b. Profound hypoxia c. Heart block d. Damage to the conduction system

d. Sodium bicarbonate

All except which of the following drugs can be safely administered via the endotracheal tube during a resuscitation? a. Atropine b. Epinephrine c. Oxygen d. Sodium bicarbonate

d. It increases the oxygen consumption of the heart.

Benefits of epinephrine include all except which of the following? a. It increases the rate and force of myocardial contraction. b. It improves cerebral blood flow. c. It makes the heart more susceptible to direct countershock. d. It increases the oxygen consumption of the heart.

b. Patients receiving digitalis

Epinephrine should be used with caution in which of the following situations? a. Profound symptomatic bradycardia b. Patients receiving digitalis c. Severe allergic reactions d. Pulseless ventricular tachycardia

2 to 2.5

If drugs are administered via an endotracheal tube during a resuscitation, the dosage should be increased to ________________ times the IV dose.

a. Atrial fibrillation

In which of the following situations would digoxin be administered? a. Atrial fibrillation b. Symptomatic bradycardia c. Ventricular fibrillation d.Pulseless arrest

oxygen

Irritability of myocardial cells can occur due to a lack of ________________ to the myocardium.

pharmacology category I

Medications that are used in advanced cardiac life support are referred to as _______________drugs

a. Vasopressin

Of the following medications, which drug causes peripheral vasoconstriction? a. Vasopressin b. Inamrinone c. Nitroglycerin d. Sodium nitroprusside

lidocaine

Premature ventricular contractions and wide complex PSVT can be treated with ________________.

c. Atrial fibrillation

Pulseless cardiac arrest is produced by all except which of the following arrhythmias? a. Asystole b. PEA c. Atrial fibrillation d. Ventricular fibrillation

epinephrine or vasopressin

Pulseless electrical activity is treated pharmacologically with _______________ or _______________.

It is acceptable to use procainamide in this situation if lidocaine has failed.

Should procainamide be administered instead of lidocaine for ventricular fibrillation?

supraventricular tachycardia

Tachycardia that originates in the atria or AV node is called a/an ________________.

a. 40 units IV or IO given once.

The acceptable dosage for vasopressin during resuscitation is: a. 40 units IV or IO given once. b. 20 units IV given every 10 minutes. c. 40 units IV or IO given alternately with epinephrine. d. 20 units IV or IO given alternately with epinephrine.

c. Cardiac arrest due to metabolic acidosis

The administration of sodium bicarbonate is indicated in which of the following situations? a. Cardiac arrest due to respiratory failure b. During CPR, prior to intubation c. Cardiac arrest due to metabolic acidosis d. Hypokalemia

hypotension

The most common problem with procainamide, if it is given too rapidly, is ________________.

relative bradycardia

The term that describes a heart rate in the normal range when tachycardia would be expected is _______________.

pulseless arrest

To treat a patient who is in ventricular fibrillation, a health care team should follow the ________________ algorithm.

d. Cardioversion

Treatment for ventricular fibrillation includes all except which of the following? a. Defibrillation b. Compressions c. Ventilations d. Cardioversion

False

True or False? A patient with a ventricular or supraventricular rhythm that is stable must be treated with cardioversion.

True

True or False? Dopamine can be used with hypovolemia after volume replacement.

False

True or False? Epinephrine increases the rate and force of myocardial contraction through alpha-adrenergic effects.

True

True or False? Lidocaine is no longer the first-line antiarrhythmic drug used to treat ventricular tachycardia and ventricular fibrillation.

True

True or False? Norepinephrine is used for severe hypotension and low total peripheral vascular resistance refractory to other sympathomimetics.

False

True or False? Patients should be placed in the Trendelenburg position prior to administration of adenosine.

False

True or False? Patients with severe left ventricular dysfunction receiving verapamil may experience an increase in blood pressure.

True

True or False? The pause in the electrical impulse at the AV node allows time for the atria to contract and blood from the atria to flow into the ventricles.

True

True or False? The treatment for ventricular tachycardia and ventricular fibrillation is the same.

True

True or False? When a patient experiences a myocardial infarction, irreversible death of myocardial cells has occurred.

d. I, II, and III

Vasopressin can be administered for which of the following reasons during resuscitation? I. For hemodynamic support in vasodilatory shock II. As an alternative to the second dose of epinephrine in pulseless arrest III. To treat prolonged cardiac arrest after administration of epinephrine a. I and II b. II and III c. I and III d. I, II, and III

Verapamil is a negative chronotropic and negative inotropic drug, which results in a decreased heart rate and force of contraction as well as a reduction in systemic vascular resistance. This, however, can cause hypotension. Diltiazem has negative chronotropic effects with only mild negative inotropic action, which results in a slower rate and force of contraction without the hypotension, as seen with verapamil.

What advantage does diltiazem have compared to verapamil?

Lidocaine decreases automaticity, increases the fibrillation threshold, and decreases the defibrillation threshold. This makes the heart more resistant to fibrillation and more responsive to defibrillation so that a lower shock joule or fewer shocks are required.

What are the benefits of administering lidocaine during ventricular fibrillation?

ibutilide

When calcium-channel blockers or beta blockers are ineffective in controlling heart rate in atrial fibrillation, ________________ should be administered.

c. Torsade de pointes

Which of the following arrhythmias should not be treated with amiodarone? a. Supraventricular tachycardia b. Ventricular fibrillation c. Torsade de pointes d. Pulseless ventricular tachycardia

a. Adenosine

Which of the following calcium-channel blocking agents should not be used to treat atrial fibrillation? a. Adenosine b. Cardizem c. Isoptin d. Verapamil

b. Dopamine

Which of the following cardiac agents is also administered for allergic anaphylactic reactions? a. Atropine b. Dopamine c. Epinephrine d. Metoprolol

d.Propranolol

Which of the following drugs would not be considered for an asthmatic patient who requires treatment for atrial fibrillation? a. Atenolol b. Esmolol c. Metoprolol d.Propranolol

d. Lidocaine

Which of the following drugs would not be used in the treatment of asystole? a. Epinephrine b. Vasopressin c. Atropine d. Lidocaine

a. Symptomatic bradycardia

Which of the following is an indication for the administration of atropine? a. Symptomatic bradycardia b. Intranodal AV block c. Third-degree block with wide QRS complex d. Hypothermic bradycardia

d. Heart failure without signs of shock

Which of the following is an indication for the administration of dobutamine? a. Clinical signs of shock b. A known drug-induced shock c. Increased renal vasoconstriction d. Heart failure without signs of shock

d. Adenosine

Which of the following is the drug of choice for treating narrow-complex paroxysmal supraventricular tachycardia? a. Dopamine b. Diltiazem c. Amiodarone d. Adenosine

When sodium bicarbonate is administered, it combines with acid to neutralize it and in the process produces carbon dioxide and water. This increases the amount of carbon dioxide in the blood. In order to remove this additional carbon dioxide from the body, ventilation must be adequate because carbon dioxide is excreted through the lungs during exhalation.

Why is it important for a respiratory therapist to know whether sodium bicarbonate is being administered during resuscitation?

Ventricular fibrillation causes the ventricles to quiver rather than contract. Without contraction, there is not any cardiac output, and therefore there is no palpable pulse.

Why is ventricular fibrillation life threatening, and how is it treated?

Inamrinone

_______________ is administered for heart failure that is refractory to diuretics, vasodilators, and conventional inotropic agents.

Magnesium

________________ is administered for refractory VF after lidocaine is given.

Epinephrine

________________ is the first drug administered for all causes of cardiac arrest.

Vasopressin

________________ may be considered as an alternative to the first or second dose of epinephrine in the treatment of pulseless arrest.