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Bradycardia Practice Test

A symptomatic bradycardia exists when what 3 criteria are present? 1. The heart rate is slow. 2. The patient has symptoms. 3. The symptoms are due to the slow heart rate. 1. The heart rate is fast. 2. The patient has symptoms. 3. The symptoms are due to the fast heart rate. 1. The heart rate is slow. 2. The patient has no symptoms. 3. The lack of symptoms are due to the slow heart rate. None of the above A symptomatic bradycardia exists clinically when 3 criteria are present:
  1. The heart rate is slow
  2. The patient has symptoms
  3. The symptoms are due to the slow heart rate
AHA Advanced Cardiovascular Life Support Provider Manual, p. 122
What is the main decision point in the Adult Bradycardia with a Pulse Algorithm? If the heart rate is below 50/min Identify and treat underlying cause Identify if the patient has adequate or poor perfusion Administer atropine The decision point is deciding if the patient has adequate or poor perfusion.
  • If the patient has adequate perfusion, observe and monitor.
  • If the patient has poor perfusion, proceed to treatment.
AHA Advanced Cardiovascular Life Support Provider Manual, p. 124
What is the correct dosing regimen of atropine to treat symptomatic bradycardia? 2 to 10 mcg/min and titrate to patient response 2 to 20 mcg/kg per minute and titrate to patient response 0.5 mg IV. Repeat every 2 to 3 minutes to a maximum of 3 mg 0.5 mg IV. Repeat every 3 to 5 minutes to a maximum of 3 mg The correct dose of atropine in bradycardia is 0.5 mg given every 3 to 5 minutes to a maximum dose of 3 mg. Atropine should be used cautiously in the presence of cardiac ischemia or MI as it may worsen ischemia and increase infarct size. Doses lower than 0.5 mg may result in a paradoxical slowing of the heart. AHA Advanced Cardiovascular Life Support Provider Manual, p. 125 What is not a precaution for TCP? TCP is contraindicated in severe hypothermia and is not recommended for asystole. Conscious patients require analgesia for discomfort unless delay for sedation will cause/contribute to deterioration. Avoid AV nodal blocking agents Do not assess the carotid pulse to confirm mechanical capture; electrical stimulation causes muscular jerking that may mimic the carotid pulse. Precautions for TCP are as follows:
  • TCP is contraindicated in severe hypothermia and is not recommended for asystole.
  • Conscious patients require analgesia for discomfort unless delay for sedation will cause/contribute to deterioration.
  • Do not assess the carotid pulse to confirm mechanical capture; electrical stimulation causes muscular jerking that may mimic the carotid pulse.
AHA Advanced Cardiovascular Life Support Provider Manual, p. 127
What is the correct step order when performing TCP?
  1. Turn the pacer on.
  2. Place pacing electrodes on the chest according to package instructions.
  3. Set the demand rate to approximately 60/min.
  4. Set the current milliamperes output 2 mA above the dose at which consistent capture is observed.
  1. Place pacing electrodes on the chest according to package instructions.
  2. Turn the pacer on.
  3. Set the current milliamperes output 2 mA above the dose at which consistent capture is observed.
  4. Set the demand rate to approximately 60/min.
  1. Turn the pacer on.
  2. Place pacing electrodes on the chest according to package instructions.
  3. Set the demand rate to approximately 60/min.
  4. Set the current milliamperes output 2 mA above the dose at which consistent capture is observed.
  1. Place pacing electrodes on the chest according to package instructions.
  2. Turn the pacer on.
  3. Set the demand rate to approximately 60/min. This rate can be adjusted up or down once pacing is established.
  4. Set the current milliamperes output 2 mA above the dose at which consistent capture is observed.
Perform TCP by following these steps:
  1. Place pacing electrodes on the chest according to package instructions.
  2. Turn the pacer on.
  3. Set the demand rate to approximately 60/min. This rate can be adjusted up or down once pacing is established.
  4. Set the current milliamperes output 2 mA above the dose at which consistent capture is observed.
AHA Advanced Cardiovascular Life Support Provider Manual, p. 127
What drugs are appropriate forms of treatment according to the Adult Bradycardia with a Pulse Algorithm? Atropine Dopamine Epinephrine All of the above If the patient has poor perfusion, you administer atropine. If atropine is ineffective, prepare for TCP or consider dopamine or epinephrine infusion. AHA Advanced Cardiovascular Life Support Provider Manual, p. 123 The initial treatment for bradycardia is: Dopamine Atropine TCP Epinephrine If the patient has poor perfusion, you administer atropine. If atropine is ineffective, prepare for TCP or consider dopamine or epinephrine infusion. AHA Advanced Cardiovascular Life Support Provider Manual, p. 123 Which is not a cornerstone of managing bradycardia? Differentiate between signs and symptoms that are caused by the slow rate versus those that are unrelated Optimize the patient's hemodynamic and ventilation status Correctly diagnose the presence and type of AV block Use atropine as the drug intervention of first choice The cornerstones of managing bradycardia are to:
  • Differentiate between signs and symptoms that are caused by the slow rate versus those that are unrelated.
  • Correctly diagnose the presence and type of AV block
  • Use atropine as the drug intervention of first choice.
  • Decide when to initiate TCP
  • Decide when to start epinephrine or dopamine to maintain heart rate and blood pressure
  • Know when to call for expert consultation about complicated rhythm interpretation, drugs, or management decisions
AHA Advanced Cardiovascular Life Support Provider Manual, p. 120
Which rhythm is associated with the bradycardia case? Third-degree AV block Atrial flutter Ventricular fibrillation Unstable SVT The bradycardia case involves these ECG rhythms
  • Sinus bradycardia
  • First-degree AV block
  • Second-degree AV block (Type I & Type II)
  • Third-degree AV block (Complete)
AHA Advanced Cardiovascular Life Support Provider Manual, p. 120
The type of AV block most likely to cause cardiovascular collapse is: Sinus bradycardia First-degree AV block Second-degree AV block Third-degree AV block Complete, or third-degree AV block is the degree of block most likely to cause cardiovascular collapse and require immediate pacing. AHA Advanced Cardiovascular Life Support Provider Manual, p. 120