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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
The primary decision point in the ACLS Bradycardia Algorithm is: The patient's heart rate The patient's blood pressure The determination of adequate perfusion The presence of chest pain 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
Identify the correct dosing regimen of atropine to treat symptomatic bradycardia: Atropine 0.5 mg IV every 2 minutes to a maximum of 2 mg Atropine 1 mg IV every 3-5 minutes to a maximum of 3 mg Atropine 1 mg every 5 minutes to a maximum of 3 mg Atropine 0.5 mg IV every 3-5 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
Identify the correct sequence of steps to performs TCP (transcutaneous pacing):
  1. Turn the pacer on.
  2. Place pacing electrodes on the chest.
  3. Set the demand rate to 50 beats/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.
  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 50 beats/min.
  1. Turn the pacer on.
  2. Place pacing electrodes on the chest.
  3. Set the demand rate to 50 beats/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.
  2. Turn the pacer on.
  3. Set the demand rate to 60 beats/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 60 beats/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, 125 A patient has a third degree heart block. He is complaining of chest pain and he is hypotensive and diaphoretic. He also has pulmonary congestion. He has a large-bore intravenous in his left antecubital fossa. He has been given atropine 0.5 mg intravenously x3 with only a transient increase in heart rate and no improvement of symptoms. The next intervention should be: Start a dopamine infusion at 2-10 mcg/kg/minute Start an epinephrine infusion at 2-10 mcg/minute Attempt TCP (transcutaneous pacing) Any of these are acceptable interventions when atropine is ineffective 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, 125-126 Signs and symptoms of bradycardia may include: Syncope or near syncope Decreased level of consciousness Hypotension All of these Signs and symptoms of bradycardia include (but not all inclusively): chest pain, shortness of breath, dizziness, syncope, decreased level of consciousness, and hypotension. AHA Advanced Cardiovascular Life Support Provider Manual, p. 122, 124 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. 128